drainage. (1) Typhoid fever appears to attack one sex as readily as the other; (2) the disease is chiefly met with in youth and adolescence; (3) typhoid fever is always endemic amongst us, and the cases treated in the London hospitals do not vary greatly from year to year; (4) it is most common in the autumn and winter; (5) it is most common after a dry and hot summer, and unusually scarce in summers that are cold and wet; (6) it does not appear that intemperance, fatigue or mental emotions predispose to this disease; (7) some people, owing to what is called a peculiar idiosyncrasy, are more liable to it than others; (8) all classes are alike subject to it when exposed to the exciting cause; (9) fresh comers in an affected locality take the fever more readily than the ordinary residents of the place; (10) there is no clear evidence that occupation has much influence. Numbers of cases go to prove that those nursing the sick from this disease very frequently catch it, but this is probably due to neglect of proper precautions in the sanitary management of patients.
It is not often transmitted to the nurses who take care to wash and disinfect their hands after all attentions to the patients, and carefully avoid breathing when stooping over vessels containing discharges. Whenever any drainage soaks from the surface into a well used for drinking purposes, or when sewer gases escape into a house by a leaky pipe, or when the traps are out of order, or when one drinks foul or stagnant water into which drainage has entered, then arise the conditions which excite the disease. Very many old houses are improperly drained, and whenever a storm occurs and the sewers are suddenly flushed, the gases escape upwards into the waste-pipes of the houses along the route, and overcome the resistance of the traps. It is therefore of the greatest importance that the drains of all old houses should be thoroughly tested by a competent surveyor, and, if possible, an approved modern scheme of pans, traps and ventilating shafts substituted. In any case it is essential that the house drain shall never enter the main sewer without first a communication with the open air, preferably by a shaft carried above the level of the house; that a small air-pipe be carried from beneath the pan or trap of an indoor water-closet to the house-top; that a cistern with a continuous supply of water should be applied close to and above each water-closet, and that the cistern for the drinking water should be quite distinct from the other cisterns. In modern houses the sanitary arrangements are usually much better, but to insure health all drains should be thoroughly flushed with a couple of pails of water every other day in winter and every day in summer, and the pans kept thoroughly clean. In small places the dry earth system should be adopted, and lime mixed with the excreta when removed, as otherwise the typhoid bacillus will not be destroyed and will remain active for years. Care must be taken that no leakage from an old cesspool can escape into the well.
Symptoms.—The onset of typhoid fever is always very gradual and
