The introduction of typhoid germs by oysters would seem to be easily prevented by interdicting or regulating the fatten ing process for which the oysters are placed in fresh water, when the latter is often impure. Oysters obtained from their beds in the deep sea are not con taminated.
4. Good drainage is an important fac tor in the prevention of typhoid in cities and towns. There is a direct relationship between the amount of impurity of the soil and the number of cases of typhoid fever. In the cities of Munich and Vienna, when the soil had been saturated with sewage for years, the introduction of pure water from without reduced the mortality to a considerable extent, but it was not until thorough drainage was made that the greatest reduction in the numbers of typhoid cases took place. When the streets and lanes are kept free from garbage, manure, and other impuri ties the liability to typhoid is lessened. This can be better understood when we -know, from the investigations of Martin and others, that the bacilli grow much more rapidly in soil saturated with sew age and that the hot weather of summer is favorable to their growth.
For years typhoid has been looked upon as a filth disease, and it is still equally true that cleanliness is one of the best measures of prevention. It was at one time thought that this disease was caused by defective plumbing. Dried germs may possibly be introduced into a dwelling in this way. It is, however, probable that a condition of the system may thus be brought about which becomes easily affected. Vaccination against typhoid fever has received much attention from pathologists recently, but clinical application of this measure has been too limited to warrant more than a passing notice.
General Management of Cases.—Care ful nursing at the commencement and throughout the disease is one of the prin cipal factors. The importance of early treatment is shown by Osier's statistics of the deaths in 229 cases: 9.5 per cent. of the patients died who had been admitted during the first week, 6.2 per cent. of those in the second week, 12 per cent. of those in the third week, and 25 per cent.
of those in the fourth week. The danger of moving patients after the first week is recognized by all physicians. Patients are often conveyed with comparative safety a long distance in railway carriages especially fitted up for the purpose.
It has also been clearly established that rest in the recumbent posture is of the greatest importance. A single bed (for convenience in nursing) with a hair mattress on springs should be selected. A rubber cloth should be placed under the sheet and the covering should be light. Two beds may be used in some cases, so that, if necessary, the patient can be moved from one to the other.
If at home, a room should be chosen which is most separated from the re mainder of the house and at the same time convenient for the nurse. In cities a back room is to be preferred on account of the street-noises. The patient ought to remain in the recumbent posture all the time. A bed-pan and urinal should he used. The body should be sponged night and morning, the night-dress and sheets changed each day, and soiled cloth ing removed at once and placed in a dis infectant solution. The excreta should be carefully disinfected.
In hospitals typhoid-fever patients are frequently placed alongside of those suf fering from other diseases. There is no special danger in this so long as the great est care is taken in the disinfection of the excreta. The fact, however, that nurses often take the disease after at tendance upon fever patients, and, fur ther, that it is frequently difficult to in duce the ward-tenders, who are not so well educated as the nurses, to be thor ough in disinfection would lead one to believe that it is desirable to isolate ty phoid patients in hospitals.
The patient should be kept as quiet as possible and his wants attended to with regularity and care. Friends, even those of the family, should not, as a general rule, be allowed to remain any length of time in the room. lie should never be left alone even when there is no delirium. He may try to rise, and, if delirium is present, there is much danger. Patients have been known to destroy themselves by jumping, from the window.