In the earlier period of Typhoid fever the temperature takes a tolerably uniform upward course; increasing from morning till evening, and decreasing from evening till morning, with a daily rise on the whole, up to the evening of the fourth day, when it reaches 104 or 104 1/2. Any marked deviation from this course may be taken as a proof that the case in question is not a case of Typhoid fever. During the second half of the first week, and the first half of the second week the range of temperature is nearly uniform: its maximum, 104 1/2, 105 or more being reached on the fourth or fifth day, but sometimes later. At that maximum it generally remains for one day only, sometimes for two days, rarely for three.

In the vast majority of instances, the disease, even when its progress is mild and favourable, does not manifest much abatement before the twenty-first day. When the higher temperatures are protracted longer than this, the case is a severe one. It becomes dangerous, or at best has a tedious recovery, if the temperature attain 106. Complete recovery can never be announced till the evening temperature shows perfect freedom from fever.

"In Typhoid fever the contagious power belongs chiefly and especially to the discharges from the bowels, to that thinnish, yellow fluid, unmixed with mucus, and having an alkaline reaction which is peculiar to that disease. This peculiar flux comes from the ulcerated glands in the intestines, and conveys the poison of Typhoid just as surely as the pustules on the skin in Small Pox are pregnant with the specific contagion of that disease. In the country according to Dr. Budd, the poison of this disease, and of some others, infects the ground. "The alvine discharges accumulate day by day on the open soil which surrounds the patient's dwelling, until they envelop the whole household, and often the neighbours also, in a fever-miasm, which is incomparably more virulent than the atmosphere of the sick chamber itself." "Among the poor, when this fever breaks out in a family, the discharges from the bowels are thrown either into the common privy, or, as I have seen a hundred times in rural districts, are cast upon the dung-heap or into the open gutter. From this point, following the line of water-shed, this pestilent stuff often makes its way to considerable distances where, appearing now under the guise of endemic miasm it may carry disease and death into many an unsuspecting household.

"On the other hand, in country mansions, in cities, and in large towns, the alvine excretions, the principal vehicles of the poison, are for the most part discharged through water-closets into the drains and common sewers, and so cease to be dangerous to the houses in which they are thrown off from the body of the sick person. The danger thus carried from the houses of the sick is transferred to other houses more or less distant. During the prevalence of Typhoid fever in a large town, a vast quantity of the dejections peculiar to that disease must be daily and hourly poured into and through the drains and sewers, impregnating the sewer gases with the specific poison. These gases, so infected, enter many a house the inmates of which are unsuspicious of such a source of fearful peril. Mr. Rawlinson, the well known engineer, has stated in print that, in the year 1859, disinfectants were freely used in some of the London main sewers, and the smell of the disinfectants was found to pervade all the houses in the district connected by drains with sewers; showing that such houses must at all other times be pervaded with diluted sewer gases. The drainage containing this poison frequently soaks through the soil, and makes its way into* wells."

To show that Typhoid fever may be communicated by drinking-water containing the specific poison, Dr. Budd relates the following case:

Richmond Terrace, Clifton, is built in the form of a horseshoe, and contains thirty-four good houses. Of these 13 were supplied with drinking-water from a pump at one end of the terrace. In the latter end of September the state and smell of this water suggested that it was tainted with sewage; and subsequently an examination of the well revealed the actual leakage. Early in October intestinal fever broke out, nearly all at once, in all the 13 houses in which the tainted water had been drunk. In almost every house of the 13, two or three persons were laid up, and in some a much larger number.

These houses were many of them far apart from each other in the length of the terrace; and their immates, for the most part, were not in the habit of personal intercourse. Meanwhile, the other families on the terrace, living side by side with these, but not drinking water from the tainted well, remained perfectly free from fever.

The following report of an outbreak of Typhoid Fever in Islington, England, by Dr. Edward Ballard, Medical Officer of health for Islington, although rather long, is well worth the space it occupies, and is well worth perusal, as a guide and a caution. The disease is an important one, it spares neither rich nor poor, the cottage of the labourer or the palace of the prince. His Royal Highness Prince Albert died of it, and the Prince of Wales had a narrow escape from sharing the same fate.

This outbreak of fever occurred in July and August, 1870. Various suggestions were made as to its cause. Some thought it was owing to a new railway cutting opening the mouths of a number of old drains and sewers, but the cutting extended in both directions, far beyond the boundary of the invaded district, and yet no Typhoid developed except in that district. Others thought it might be a dung-shoot in a yard, but this is overhung on three sides by dwellings occupied by labourers, yet in these not a single case of fever occurred.

Another suggestion made to me proceeded primarily from a lady, secondarily from her medical attendant, to whom she expressed her idea. Fever occurred in this lady's family, and in four families of her acquaintance about the same time. She then called to mind that some little time previously she had changed her milkman, and, as ladies will do, had induced those friends of hers to adopt the same tradesman. Ergo, it was the milk. It happened that her medical attendant, during the months of July and August, had several families of his clientele down with Typhoid, and, among the rest, the family of the very milkman whose wares were suspected. He wisely made some cautious inquiries, and found that out of eleven such families, there were ten who were supplied from this source; the exceptional family resided a mile and a half off. Comparing notes with other private practitioners, the reality of a serious outbreak became obvious. Till then, I had only heard of fatal cases, but now these other gentlemen began to make a similar inquiry, and there was such uniformity in the result, that one after another communicated with me on the subject. Altogether, private lists of cases were furnished me by nine private practitioners in the neighbourhood, marking the families supplied by this milkman; some spontaneously, others immediately on my request. At first, I confess, I was sceptical; I thought I could satisfactorily account for the cases, without having recourse to what appeared a farfetched theory; albeit, it became the favorite one with my medical friends, each, of course, guided by his individual experience. I thought, considering the limitation of the outbreak, and the probability that a milkman in the neighbourhood would supply a great part of it, that, after all, the association observed might be nothing more than a coincidence, strange and curious indeed, but of no scientific worth, and I did not hesitate to check gossip by saying so. When I add that now I not only believe that the distribution of milk from the dairy I have mentioned was the means of sowing Typhoid in the district, but regard it as proved, it may be readily conceived that the evidence I have gathered is tolerably convincing. The general result of an inquiry into the milk supply of the families within the quarter mile radius into which I ascertained that Typhoid fever had entered, was this, viz:-