6oo Typhoid Fever 



In every case the greatest care should be taken for their proper 

 disinfection, a rigid attention paid to all the details of cleanliness in 

 the sick-room, and the careful sterilization of all articles which are 

 soiled by the patient. If country practitioners wereas carefulin this 

 particular as they should be, the disease would be much less frequent 

 in regions remote from the filth and squalor of large cities with their 

 unmanageable slums, and the distribution of the bacilli to villages 

 and towns, by milk, and by watercourses polluted in their infancy, 

 might be checked. 



In large cities where typhoid fever has been endemic the incidence 

 of the disease has been enormously reduced by purification of the 

 water-supply. Where this measure is not possible, the safety of the 

 individual citizens can be promoted by using bottled pure waters 

 for drinking purposes or by boiling the water for domestic con- 

 sumption. 



In military camps, etc., the fly as a carrier of the infection must 

 first be excluded from the latrines and then as well from the kitchens 

 and mess tents. When epidemics are in progress, green vegetables 

 and oysters that may be polluted by infected water must be guarded 

 against. 



Prophylactic Vaccination. — FoUowing the principle of Hafikine's 

 anticholera inoculations, Pfeiffer and Kolle,* Wright,t and Wright 

 and Semplef have used subcutaneous injections of sterilized cultures 

 as a prophylactic measure. One cubic centimeter of a bouillon culture 

 sterilized by heat was used. 



The "Indian Medical Gazette" gives the following important 

 figures showing what was accomplished in 1899: Among the British 

 troops in India there were 13 12 cases of typhoid fever, with 348 

 deaths (25 per cent.). The ratio of admissions to the total strength 

 was 20.6 per 1000. There were 4502 inoculations, and among them 

 there were only 9 deaths from typhoid fever — 0.2 per cent, of the 

 strength. There were 44 admissions, giving 0.98 per cent, of the 

 strength. Among the non-inoculated men of the same corps and at . 

 the same stations, of 25,851 men there were 675 cases and 146 

 deaths, giving the relative percentages of admissions and deaths as 

 2.54 and o.56.§ 



In a later contribution, Wright || showed that the prophylactic 

 vaccination against typhoid fever reduced the number of cases and 

 diminished the death-rate among the inoculated, and also called 

 attention to the slight risk the inoculated run of being injured in 

 case their vital resistance is below normal, or they are already in the 

 early stages of the disease, or where the dose administered is too 

 large, or the second vaccination given too soon after the first. 



* "Deutsche med. Wochenschrift," 1896, xxii; 1808, xxiv. 

 t "Lancet," Sept., 1896. 

 j "Brit. Med. Jour.," 1897, i, p. 256. 

 ' "Phila. Med. Jour.," Oct. 13, 1900, p. 688. 

 "The Lancet," Sept. 6, 1902. 



