This disease, latterly called Intestinal Fever, or Enteric Fever, resembles, in many respects, Tyhus Fever. But while the latter fever is usually propagated by contagion, Typhoid Fever is generally considered a cess-pool fever.

It is very rarely (if ever) found to pass from one person to another in the wards of a well-conducted Hospital, or in a private dwelling-house. Dr. Murchison tells us that, during his own experience, in the London Fever Hospital, of 1048 cases of Typhoid Fever, there were but two which appeared to have originated in the Hospital: whereas the number of Typhus patients being 2581, thirty-six of the attendants and patients contracted the disease.

Typhoid Fever commences more gradually than Typhus, and with premonitory symptoms. It is often difficult to specify the exact day on which the illness began. The patient is later in taking to his bed.

The countenance of the patient in Typhoid fever, though heavy and oppressed, differs remarkably from that of the sufferer under Typhus: its flush is less dusky, its expression less dull and stupid, more anxious, less apathetic; and sometimes, on the occurrence of delirium, it is even vivacious. The delirium comes on later, and is decidedly more active; and the patients are more disposed to try to get out of bed. Sometimes, however, there is no delirium from first to last.

In Typhoid Fever, pain in the head is almost always one of the earliest symptoms; not acute pain, but dull, lasting several days, and ceasing, if delirium or stupor ensue. Unless questioned about it, patients seldom complain of this pain.

A striking characteristic of Typhoid Fever is the prevalence of diarrhoea. Often this is an early symptom; sometimes it is postponed to the latter part of the beginning of the second week. It is either spontaneous, or it continues after a dose of purgative medicine. Pain in the abdomen frequently precedes and accompanies it. Whenever it occurs, the stools are for the most part loose, frequent, and fetid; and either dark in colour, or of a yellow-ochre appearance, or somewhat like pea-soup. They are alkaline also, whereas in health the faeces are always acid. If you make pressure upon the abdomen, you will find it unnaturally hard and resisting, as though its walls were made of pasteboard, often very much distended; but whether large or not Sir William Jenner states that its shape is invariably the same, and somewhat peculiar. The patient is never pot-bellied, but tub-shaped. Frequently uneasiness is manifested when pressure is made on the belly; and another symptom, not commonly met with in other diseases, is usually noticeable in the first stage of this; namely, a slight gurgling movement, evidently from the mixture of liquid and gas within the bowel, which movement becomes audible, or palpable to the hand on pressing the same region. This symptom is still more common in the more advanced stages of the disorder. It is of rare occurrence in Typhus Fever.

As the disease proceeds, so does the diarrhoea; from three to six stools, or even more, occurring daily. When they take place involuntarily, when they are passed into the bed without notice on the part of the patient, they add materially to his danger by the irritation and the sores which are apt to result from their contact with the skin. There is seldom much pain now complained of by the patient; but, if you make pressure on the belly you may often remark that he winces, or that a transient expression of suffering passes across his features. The character of the evacuations remains the same, and is in itself distinctive of the disease; thin, yellowish, ochrey, like pea soup. When, in fever, such stools persist day after day, and several of them every day, you may safely infer that there is ulceration of the bowels, although there should be no pain complained of even when the abdomen is pressed. And the same conclusion will become still more certain when bleeding from the bowels occurs, as it is apt to do, in this stage of the fever. It often takes place unexpectedly, sometimes in considerable quantity, and rapidly exhausts the patient; or it recurs at intervals to a smaller amount, wasting his strength as surely, though more slowly.

Another distinctive mark between Typhoid and Typhus fevers is the difference between the eruptions of the two fevers. The Typhoid eruption is papular or pimply. It consists of little circular or lenticular spots of a bright rose-colour, which fades insensibly into the hue of the neighbouring skin. They are slightly elevated, with round heads, which seldom or never become vesicular. From first to last these spots disappear completely under pressure, and re-appear when the pressure is taken away. Each spot lasts about three days. Others follow. Ordinarily the number present at one time is from six to twenty. Occasionally there is only one. Sometimes there are more than one hundred. They occur on the breast and belly, rarely on the limbs or face.

These spots begin to show themselves, generally, during the second week of the disease; and fresh spots come out every day or two till the third week, in the course of which they cease to appear, except in cases of relapse, when they also may return with the other symptoms.

The spots peculiar to Typhoid fever do not remain visible on the dead body.

It is necessary to be careful not to mistake flea-bite for Typhoid spots.

The tongue in Typhoid fever has a different appearance to the tongue of Typhus. It is oftener moist throughout the disease in Typhoid than in Typhus, and when dry, more frequently red, and, as it were, glazed. Generally, if brown at all, it is of a yellowish instead of a blackish-brown.

In Typhoid Fever there is frequently ulceration of the bowels, perhaps most frequently, and these ulcerations are the cause of the bleeding; and the existence of these ulcers is likely to prolong the illness of the patient after the fever itself is ended; to protract his convalescence, to hinder his recovery, and even to endanger his life, though he may seem to be getting well, by causing bleeding or perforation of the bowel.