Typhoid fever is clearly a preventable disease, which may also be said of all other infectious and contagious diseases. Since its communicability has been established beyond question, it is of the greatest importance that proper measures should be taken to prevent the contraction of the disease by others, as well as for the relief and recovery of the persons suffering. The proper preventive measures to be adopted are careful examination of drinking water, and all other possible sources of contamination, thorough ventilation of the sickroom of patients suffering with the disease, destruction of the germs in the discharges of the patient by disinfection and burying at a safe distance from any well, cistern, or other sources of water supply.

The general management of the disease should be precisely as has been described for fever. In many cases, by the adoption of vigorous measures, especially by the employment of the wet-sheet pack, hot-air bath, Turkish bath, and other means for exciting vigorous perspiration at the outset of the disease, its career can be cut short. We have succeeded in a number of instances in breaking up the disease when it had advanced sufficiently far to leave little doubt as to its real character. The fever should be controlled by means of sponge baths, cold compresses to the bowels, ice packs, and cold enemas. The delirium and sleeplessness are best relieved by ice compresses, or the ice pack applied to the head. When discomfort is occasioned by pain or gas in the bowels, fomentations should be applied once or twice a day, or every three or four hours, according to the requirements of the case. The use of stimulants is seldom called for. We occasionally employ them, when the patient seems to be sinking with exhaustion from the long continuance of the disease, but do not feel at all certain that we have ever obtained any marked benefit from their use.

In the treatment of a large number of cases of this disease, we have had no occasion for the employment of such large doses of quinine as have lately been recommended by some eminent German physicians. In a few cases in which we have given this remedy a trial, the benefits derived from its use, as shown by the decrease in bodily temperature, were so insignificant when compared with the effects which could be obtained by the employment of other measures already described under the treatment of fever, that we had no desire whatever to resort to it again. The cold enema produces far more decided and permanent results than the largest doses of quinine which can be safely given, and is quite free from the unpleasant after effects of this drug. If the patient is very greatly troubled with inability to sleep, mild doses of gelsemium may be employed when other means fail; but if the head is kept cool by cold compresses changed every few minutes, or the ice pack or cold-water bag, very little difficulty will generally be experienced.

It is frequently the case that the patient is not out of danger when convalescence begins, as hemorrhage from the bowels may occur even after the disappearance of most of the other symptoms of the disease. The only typhoid fever patient we ever lost, was one in whom hemorrhage from the bowels occurred after convalescence seemed to be fully established. The patient gave marked symptoms of tuberculosis when attacked by the fever, and although the disease ran a very mild course, seeming to be very easily controlled by treatment, the patient finally died in consequence of the unfortunate accident referred to, which was probably due to the relaxed condition of the blood-vessels, and the generally debilitated condition of the system.

Perforation of the intestines by ulceration may also occur at a very late period, giving rise to inflammation of the peritoneum, and thus occasioning death. The patient should be very careful not to take solid food of any kind, especially meat, for some little time after convalescence is fully established, as the stomach becomes very greatly weakened in this as in most other febrile diseases, the secretion of gastric juice being almost suspended, and not being fully established for some time after recovery begins, making the digestion of meat more difficult that that of other foods. The directions given under treatment for fevers, respecting diet, ventilation, nursing, etc., should be carefully followed.

The proportion of deaths in typhoid fever under ordinary methods of treatment are stated by Dr. Flint to be about eighteen to twenty-five in a hundred. Very often the fatality has reached a much higher per cent than this. According to M. France Glenard, between six and eight thousand cases of typhoid fever have been treated by a method essentially the same as we have described, with an average mortality of only about six per cent. Stieler treated a large number of cases at Munich, losing less than six per cent. JŘrgenson reports a mortality of only three and one-tenth per cent. Brandt claims to have lost only two and one-tenth per cent. GlÚnard treated fifty-two cases at Lyons without a single death. We might mention many others who have been equally successful, but will only add our own experience in the treatment of sixty cases, by the aid of an assistant physician and a medical student, without losing a single, patient, although in many cases the disease appeared in its worst form. When the plan of treatment pointed out can be pursued thoroughly and systematically from the outset, death will result in only a very small proportion of cases.