THE PREVENTION OF TYPHOID FEYER. 
Sometimes called “Enteric Fever,” “Gastric Fever,” “ Pytliog enic 
Fever,” “ Typlio-malarial Fever,” and by tlie Germans 
“Abdominal Typhus.” 
Document Issued by the Michigan State Board of Health. 
Fourteenth Edition, 10,000, March, 1899. 
Typhoid fever is a common and protracted disease, terminating fatally in 
about one case out of eight or ten. 
The number of deaths returned as having occurred in Michigan from 
typhoid fever averages about six hundred per year; but not all of the deaths 
are reported; the number of deaths which actually occur in Michigan from 
typhoid fever is probably more than eight hundred per year; and the number 
of persons in Michigan sick with typhoid fever is probably about six or eight 
thousand each year. A large proportion of that sickness and mortality can 
be and ought to be prevented. 
The greatest number of deaths from this disease is of persons in the prime 
of life, and this should prompt to greater efforts for the prevention of the 
disease. Persons of all ages have the disease, and even though some have it 
in a mild form, yet they may be the medium of communication of the 
disease in a fatal form to others, for although it is not one of the most conta- 
gious diseases, Typhoid fever is a communicable disease. 
Typhoid fever is believed to be caused by a special contagium; and the 
specific cause of the disease may be conveyed to persons by contact, through 
the air, by flies, and by drinking water contaminated by discharges from a person 
affected with the disease, or by leachings from the bodies of those who have 
died of typhoid fever. The germs permeate the entire body, and are some- 
itmes found a considerable time after apparent recovery. 
Mode of spreading or of communication.—Drinking-water contam- 
inated with urinary or fecal discharges is believed to be the most common 
source or vehicle of typhoid fever. The frequent outbreaks of this disease 
traceable directly and unmistakably to a water-supply thus contaminated, 
point to this as the chief source of danger. It seems to prevail most in times 
of drought, in the fall of the year, especially after a period of high tempera- 
ture, and when the water in wells is low, and its contaminations most concen- 
trated. The disease has also been traced to milk diluted with infected water, 
and in some cases to emanations from the walls of sewers, drains and cess- 
pools.* The typhoid bacillus is not destroyed by ordinary drying, therefore 
typhoid fever may be spread through the air, by the dust of dried urine or other 
excreta settling on bread or other foods. The bacillus is not destroyed by 
once freezing, but is destroyed by repeated freezing and thawing. 
Filth and bad sanitary condition of premises generally, increase the danger 
of spreading typhoid fever. Good water-supplies, water-closets and sewers,, 
generally restrict typhoid fever. 
Protect the water-supply.—The most scrupulous care should be taken 
to keep the present sources of drinking-water pure, and to procure future sup- 
plies only from clean sources. The general water-supply of cities and villages 
is a matter of the greatest concern; it should be procured from places where 
there can be no probability of immediate or remote contamination. The 
well-known outbreak of typhoid fever at Plymouth, Pa.,where over a thousand 
cases and 114 deaths occurred, is apparently an illustration of how great a 
calamity may follow the fouling of a general water-supply by the discharges 
of a person sick with typhoid fever. When there is no general water-supply, 
nor good sewers, much may be done to protect the wells by the abolition of 
cess-pits and privy-vaults, by the use of dry earth in privies, and by the fre- 
quent removal therefrom of all their contents. 
♦Page 1029, Vol. IX, Reference Handbook, Buck, Win., Wood & Co., N. Y. 2 
THE PREVENTION OF TYPHOID FEVER. 
Great care should be taken to prevent the contamination of the water- 
supply by discharges from the bowels of a person sick with typhoid fever, 
as by drainage into wells, .springs, or other water-supply, from a privy-vault, 
sewer, drain or cemetery. Privies often drain into wells, unsuspected by 
those who use the water. Should typhoid discharges pass into such a privy, 
an outbreak of typhoid fever among those using the water from a neighbor- 
ing well would be likely to occur. If such a well were the source of the 
general water-supply of a city, typhoid fever might soon be epidemic there. 
Extraordinary care should be taken to prevent typhoid-infected discharges 
from entering any general water-supply from a well or small stream. The 
use of water from a source likely to be infected with excreta from a typhoid 
fever patient should be promptly stopped. Great care should be given to the 
milk supply. 
There is good reason to suspect the water of a well whenever a vault is 
situated within one hundred feet of it, particularly if the soil be porous. In 
numerous instances fluids from excreta have leached into wells from much 
greater distances; and it has been proved that a well thirty rods from a cem- 
etery received water which had filtered through the soil of the cemetery.* 
Dangerously contaminated water may be, and often is found to be, clear and 
colorless, and to have no bad taste. 
Period of incubation.—The time between receiving the cause of typhoid 
fever into the system and becoming sick therefrom, is not uniform; but it is 
very often about eleven days, sometimes as long as twenty-one days. 
Householders and Physicians must immediately give notice to the local 
health officer, of the first case, and of every case of a “disease dangerous to 
the public health,” and typhoid fever is such, declared so by the State Board 
of Health. This is required by sections 1675 and 1676, Howell’s Statutes, as 
amended by Act No. 158, Laws of 1895. If the fine is not paid, a house- 
holder may be imprisoned for disobedience of this law.f 
Every case of so-called “typho-malarial fever/’ and every case of 
fever of doubtful origin continuing more than seven days, should be 
reported to the local health officer, and the same precautions taken as in 
other cases of typhoid fever. 
Upon receipt of such notice, the local board of health has duties 
to perform which it is a great violation of public trust for the board to neg- 
lect or postpone. The law is very plain as to the nature and the importance 
of these duties. One section of the law is §1673 Howell’s Statutes. 
Duties of the local board of health, and of the health officer.—In 
order that no time may be lost, it is the duty of every board of health to make 
provision for prompt action by its health officer, authorizing and directing 
him to be prepared at all times, as executive officer of the board, to act with- 
out waiting for a meeting of the board, whenever a case of typhoid fever 
occurs within its jurisdiction. Some of these duties of the health officer may 
be briefly suggested as follows: He should— 
1. Give public notice of every infected place, so that no person may un- 
guardedly drink water or take food from a source likely to be contaminated, 
or in any other manner contract the disease. 
2. Investigate the probable source, and manner in whfch the disease orig- 
inated. If probably from a contaminated well or general water-supply, see 
that measures are taken, by boiling the water, or stopping its use, to prevent 
further cases being caused in the same manner. 
3. Order and enforce the disinfection of all urine and discharges from the 
* Page 66. Ypsilanti Sanitary Convention, Supplement to the Annual Report of the Michigan State 
Board of Health, 1885. 
+!Supervi»ors must prosecute for all forfeitures under this law; township officers must give notice to 
supervisors; prosecuting attorney to conduct suit if requested; see sections 8439, 8440 and 8442, 
Howell’s Statutes. Health officers of villages and cities must notify prosecuting attorney of all 
violations of this section—see Act No. 157, Laws of 1879, §1684, Howell’s Statutes; the prosecuting 
attorney must prosecute for all such forfeitures incurred within his county.—See section 8442, 
Howell’s Statutes. — . THE PREVENTION OF TYPHOID FEVER. 
3 
bowels of patients sick with typhoid fever. It is safest to disinfect the dis- 
charges of all persons who have diarrhoea.* 
4. Disinfect the contents of the privy on the premises, or any other that 
has been used by the patient, f 
5. Order and secure the disinfection of all articles of clothing or bedding 
that have been soiled by discharges from the patient. 
6. Secure the cooperation of the people in the prevention of this disease, by 
teaching them its mode of spread, the best methods for its prevention, and 
the greater importance of efforts for its prevention in times of drought and 
low water in wells. \ 
7. Act 137, Laws of 1883 (amended by Act No. 34, Laws of 1889), speci- 
fies other duties which the health officer should perform, among which may 
be mentioned the disinfection of the room, and all articles likely to be infect- 
ed, before allowing their use by other persons; and prompt, regular and full 
reports to the Secretary of the State Board of Health, as well as to the presi- 
dent of the local board of health. 
The local board of health and the physician in charge of a case 
of this disease should cooperate for its restriction. The local board of health 
should especially guard against its spread by cases not attended by a physician. 
The local board is required to make and publish regulations, and should 
thus publicly require that every case of typhoid fever shall be reported to the 
health officer, who shall act for the restriction of the disease.!- 
Personal precaution.—Do not drink water which has a bad taste or 
odor, or which comes from a source that renders it likely to be impure, es- 
pecially if there is reason to believe that it may contain anything derived from 
a person sick with typhoid fever. 
Disinfect the bowel discharges of the sick.—This is a measure of 
prime importance. The bowel discharges should, in all cases, be received 
upon papers or old cloths and promptly burned, or be received in vessels and 
at once thoroughly disinfected by thick “milk of lime,” or as follows: Disin- 
fect each discharge from the bowels by thoroughly mixing with it at least one 
ounce of chlorinated lime in powder, or one quart of “Standard Solution No. 
1,” recommended by the American Public Health Association’s committee.! 
In country districts, villages and small cities, where the privy is not far distant 
from a well, discharges should not be thrown into a privy-vault, but, after being 
disinfected, they should be carried a greater distance from any source of 
drinking-water and then covered with earth. 
Rags, closet-paper, or other similar material used about the patient, should 
be immediately burned. 
Disinfect the urine.—The urine of typhoid patients has been found to 
contain large numbers of the germs of the disease. Not only the urine should 
be disinfected, but any shirt, garment or cloth upon which even small quan- 
tities of urine have come, should be carefully disinfected, and preferably 
before it has been permitted to dry so that the germs might float off as atmos- 
pheric dust. 
*Even cases so lightly sick as to be able to walk about and work are very dangerous; as in the 
well-known case at Caterham, England, where, in 1879, 352 cases of fever were caused, it is believed, 
by the diarrhoeal discharges from one such workman getting into the general water-supply of the 
towns of Caterham and Red Hill. 
tHow isolated privies may become infected is illustrated by the case of a peddler sick with 
typhoid fever admitted into Bellevue Hospital, New York City, who is reported to have said that 
while suffering from the diarrhoea in the early stages of this disease, he had visited between forty 
and fifty different privies. 
tPamphlets containing such information, issued by this State Board of Health, for distribution to 
neighbors of families in which there is typhoid fever, or to other persons likely to read them, may be 
had on application to tne Secretary of the State Board of Health, at Lansing. 
1 Sections 1630 and 1639, Howell’s Statutes 
H “Standard Solution No. 1,” is made by adding to each gallon of soft water, four ouncesof chloride 
cf lime of the best quality, which should contain at least 25 per cent of available chlorine. “Use 
one quart of this solution for the disinfection of each discharge in cholera, typhoid fever, etc. Mix 
well and leave in vessel for at least one hour before throwing into privy-vault or water-closet.’’ 4 
THE PREVENTION OF TYPHOID FEVER. 
Soiled clothing, towels, bed-linen, etc., on removal from the patients 
should be placed in a pail or tub of zinc solution, made in proportions 
as follows : Water, one gallon; sulphate of zinc, four ounces; common salt, 
two ounces. Soiled clothing should, in all cases, be disinfected before send- 
ing away to a laundry, either by boiling for at least half an hour (it may be 
boiled in the zinc solution), or by soaking in a strong solution of chlorinated 
soda. 
Bodies of those dead from typhoid fever should be wrapped in a cloth 
wet with a strong solution of chlorinated soda, or with “Standard Solution 
No. 1,” or with zinc solution. The zinc solution should be made in propor- 
tions of one-half pound of chloride of zinc to one gallon of water; or, 
water, one gallon; sulphate of zinc, eight ounces; common salt, four ounces. 
No public funeral should be held in a house where there is or has recently 
been a case of typhoid fever. 
After a death or recovery from typhoid fever the room in which 
there has been a case of typhoid fever, whether fatal or not, may well, with 
all its contents, be thoroughly disinfected. Room disinfection by formaldehyde 
is fully explained in our “Teachers* Sanitary Bulletin” No. 9.—Dec., 1898. 
Rooms to be disinfected must be vacated. For a room ten feet square 
at least three pounds of sulphur or eight ounces of formaldehyde should bn 
used; for larger rooms proportionately increased quantities, at the rate of 
three pounds of sulphur or eight ounces of formaldehyde for each one thou- 
sand cubic feet of air space. 
Hang up and spread out as much as possible all blankets and other articles 
to be disinfected; turn pockets in clothing inside out, and otherwise facilitate 
the access of the sulphurous or formaldehyde gas to all infected places. 
Close the room tight, place the sulphur in iron pots or pans which will not 
leak, supported upon bricks over a sheet of zinc or in a tub containing water, 
so that in case melted sulphur should leak out of the pot the floor may not be 
burned; set the sulphur on fire by hot coals or with the aid of a spoonful of 
alcohol lighted by a match; be careful not to breathe the fumes of the burn- 
ing sulphur, and when certain the sulphur is burning well leave the room, 
close the door, and allow the room to be closed for twenty-four hours. 
Disinfect tlie privy.—It is especially important that the contents of the 
privy be disinfected. For this purpose use four ounces of the best quality of 
“chloride of lime” to each gallon of material in the vault. 
Boil the drinking water.—Immediately on the appearance of typhoid 
fever a careful examination should be made of the surroundings of the house, 
and particularly of the source of the water used, to determine, if possible, 
whether it has been contaminated by leachings from a privy, or other source 
of filth. If the sick person has been at home, and not away where the disease 
might be contracted, it will be safest that water from the same source aa that 
used by the sick person immediately before having been taken sick should not 
be used for drinking or culinary purposes unless it is boiled. Thorough 
boiling will destroy the germs of the disease. Ordinary filtering will not 
do so. 
Isolation of the sick.—This is not always necessary if extreme care is 
taken, but as typhoid fever is sometimes transmitted through the air, also 
directly from one person to another, and indirectly by means of flies, it is wise 
for all who can properly do so, to keep away from the premises. 
Perfect cleanliness of nurses and attendants should be enjoined and 
secured. As the hands of nurses may become contaminated by the poison of 
the disease, a good supply of towels and basins, one containing a solution of 
chlorinated soda,* chlorinated lime or the zinc solution, and another for 
plain soap and water, should always be at hand and freely used. 
♦To one part of Labarraque’s Solution (liquor sodas chlorinatse) add five parts of soft water.