558 THE TREATMENT OF DISEASES. 



the list. It is most commonly known as " spotted fever," " epidemic," or " con- 

 tagious fever," and " camp fever," or " gaol fever." The terms " malignant fever " 

 or " putrid fever " have been sometimes applied to severe cases. 



Typhus attacks people of all ages and both sexes indiscriminately. If we were 

 to rely solely on evidence obtained from death registers and hospital statistics we 

 might imagine that it was very uncommon in children, but this is readily explained 

 if we remember that typhus seldom proves fatal to children, and that in many of 

 our large hospitals people under fifteen are not admitted. 



Depressing mental emotions, over- work, and anxiety, by undermining the general 

 health, render the system more susceptible to attacks of the disease. It is supposed 

 by many that during the prevalence of an epidemic the fear of catching the fever, 

 and the consequent depression which it produces, may act as a powerful predisposing 

 cause. 



Persons who are under-fed, or who live upon food of an inferior quality, are 

 especially liable to suffer from typhus. Typhus is by no means an aristocratic disease. 

 It seldom attacks the rich and well-to-do, but prefers to associate with paupers and 

 those but little removed from the level of pauperism. It delights in dirt and 

 squalor, and is never so happy as when it can obtain admission to a gaol or work- 

 house. It often breaks out, and always attains it greatest severity, when people are 

 worse off and more badly fed than usual. It is almost always an accompaniment of 

 war and commercial distress, and often follows in the wake of strikes. In Ireland, 

 during the potato famines of 1818 and 1847, typhus raged with the greatest severity, 

 and it is estimated that on each of those occasions more than one-eighth of the 

 entire population was attacked. 



Over-crowding is a very favourable condition both for the production and propa- 

 gation of typhus. Some of our most fatal epidemics have occurred in Liverpool, 

 where in many parts the houses are built back to back in narrow unventilated courts. 

 In Glasgow the mortality from typhus fever in different parts of the town corresponds 

 so exactly with the degree of density of the population that there can be very little 

 doubt that they stand in the relation of cause and effect. 



Typhus is essentially a disease of cold and temperate climates, and there is no 

 sufficient evidence to show that it ever occurs within the tropics. Great Britain and 

 Ireland are, and ever have been, the chief seats of the disease. It is most common 

 during the last two months of the year, probably because at that time the poorer 

 classes suffer more from want of food, and display a greater aversion than usual to 

 proper ventilation. 



Typhus fever is a distinctly contagious disease, but at the same time tolerably 

 close communication with the sufferer is necessary for its transmission from person 

 to person. For instance, the extension of typhus fever from a hospital to the 

 adjacent houses seldom or never occurs, and in this respect it differs from small-pox 

 and many other diseases of this class. Casual visitors to fever wards are rarely 

 attacked, but nurses, who in the discharge of their duties are brought in very much 

 closer contact with the patients, seldom escape. Doctors in charge of fever patients 

 nearly always catch typhus sooner or later, though, as a rule, much less quickly than 

 nurses. It would appear that dilution with air in a great measure destroys the 



