The disease is caused by a specific germ known as the typhoid bacillus. These germs are found in the excreta (stools and urine) of persons ill with typhoid fever.
Failure to properly disinfect these excreta and carelessness in the care of persons ill with typhoid fever lead to the transmission of the disease from the sick to the well by the infection of water, milk or food with the typhoid bacillus or by direct contact.
The disease is contracted by taking into the mouth in some form the discharges from some previous case. There is no other way. It is, therefore, a disease of filth and someone is at fault somewhere for every case of typhoid fever that occurs.
Bad sanitary conditions, such as lack of drainage, open cess-pools, sewer gas, decaying vegetable matter, etc., may favor the contraction of the disease, but cannot cause it unless the specific germ, the typhoid bacillus, is present.
The water supply of a community becomes infected by the entrance into it of the excreta (stools and urine) of persons suffering from typhoid fever.
Milk (in which typhoid bacilli grow and multiply very rapidly) usually becomes infected by washing out milk cans with water in which these bacilli are present, or from the presence of the bacilli on the hands or persons of those handling milk. Oysters spread the disease when they have been "freshed" in water rich in sewage and containing the typhoid bacillus. Flies, whose bodies have become foul with typhoid excreta, may infect food, milk, etc. Those who take care of typhoid patients may contract the disease if they do not at once disinfect their hands after handling the patient, or clothing or bedding which has become soiled with the discharges.
How to Keep From Getting Typhoid Fever.—If the chance of infection is to be reduced to a minimum, all drinking water, concerning the character of which there may be the slightest doubt, should be boiled, and all milk, the handling and care of which is not absolutely beyond suspicion, should be pasteurized or boiled. All food supplies (meat, milk, vegetables, etc.), should be carefully protected against flies, and flies should not be permitted access to the sick-room, the kitchen nor to the room in which the meals are eaten. Bathing at all beaches which have sewers emptying in their immediate vicinity should be strictly avoided. In the majority of cases it is probable that the system must be slightly below par in order that the disease may be contracted; therefore, all indigestible food, green fruit, etc., which may set up indigestion or diarrhea, and so render the system more susceptible to infection, should be avoided. In addition, the elementary rules of cleanliness and hygiene, both as to the house and person, should be most strictly observed. No member of a household in which a case of typhoid fever occurs should take food in any form without previously washing the hands.
Typhoid bacilli enter the body only through the mouth. If sufficient care be taken to prevent their entrance, the contraction of the disease can be absolutely prevented.
How to Keep From Spreading the Disease.—In order to protect themselves and others in the household, persons caring for or in any way coming into contact with a case of typhoid fever must constantly bear in mind that the secretions and excretions (urine, stools, etc.), of the patient contain typhoid bacilli and are capable of transmitting the disease to others. The person who nurses the patient should not do the cooking for the family. The bedding used by the patient should be washed separately from that used by others. Special dishes, plates, knives, forks, etc., should be kept for the use of the patient alone, and should be washed separately and thoroughly. Particular attention should be paid to immediate disinfection of the stools and urine of the patients until the restoration of health is complete.
The urine is especially dangerous. It may look entirely normal and yet contain typhoid bacilli for some time after recovery is apparently complete. In a few instances the typhoid bacilli may persist in the stools for weeks or months after recovery. Such persons are called "typhoid carriers," and constitute a grave menace to the health of the community. The best disinfectants are carbolic acid and freshly slacked lime; both are effectual, cheap and easily obtained. Urine or stools to which has been added one-third of their volume of a solution of one part of carbolic acid to twenty parts of water are, as a rule, sufficiently disinfected in half an hour, provided the mass of the stool is broken up and thoroughly mixed with the solutions. The best method is to keep the urinal of bed-pan partly filled with the disinfecting solution at all times. In this way any germs present in the urine or stools are almost instantly destroyed. Stools and urine should never be thrown out on the ground. If no system of drainage is at hand, they should be very thoroughly disinfected and emptied into a hole in the ground and covered with earth. All persons nursing or handling the patient in any way should be careful to wash their hands very thoroughly with soap and water before leaving the sick-room. They should never, while in the sick-room, touch any article of food or put their hands to their mouths. Careful observation of the above suggestions and precautions will almost certainly prevent contraction of typhoid fever or the spread of the disease.