of weeks of fever and from the effects of the poison germ.  Typhoid fever is also characterized by its slow (insidious), slyly, creeping onset, peculiar temperature, bloating of the abdomen, diarrhea, swelling of the spleen, rose-colored spots and a liability to complications, such as bleeding from the bowels, peritonitis, bronchitis and pneumonia.  Its average duration is three to four weeks, often longer.  In order to take this disease there must first be the poison germ and then this enters into the system, generally through water that contains the germ, milk, oysters and other foods, etc.

Cause.—­The typhoid bacillus (typhoid).  This enters into the alimentary canal usually through contaminated water or with milk directly infected by the milk or by water used in washing cans.  Also through food to which the germs are carried from the excreta (discharges) by flies, occasionally through oysters by freshening.

Filth, improper drainage and poor ventilation favor the preservation of the bacillus germ and lower the power of resistance in those exposed.

[196 Mothers’ remedies]

Time.—­It occurs most frequently between August and November and in those of from fifteen to twenty years of age.  The Peyer’s patches and solitary glands of the bowel enlarge, become reddish and are somewhat raised.  These go on and ulcerate until the blood vessels may be eaten into and bleeding sometimes results, it eats through the bowel, then there is perforation and peritonitis.  The spleen is enlarged, the liver shows changes, the kidney functions are also deranged.

Symptoms.—­The symptoms are variable.  The following gives the symptoms in a typical case: 

Incubation.—­The period of incubation lasts from eight to fourteen and sometimes to twenty-three days.  During the period the patient feels weak, is almost unable to work, has chilly feelings, headache and tiring dreams, does not know what is the matter with him, constipation or diarrhea, has no appetite, may have some pain in the abdomen which is occasionally localized in the right lower side.  Soreness on deep pressure is often found there.  In some cases there is nosebleed.

First Week.—­After the patient is obliged to take to his bed:  During the first week there is in some cases a steady rise in the fever each evening showing a degree or degree and one-half higher than the preceding evening, reaching 103 to 104, and each morning showing higher fever than the preceding morning.  The pulse is characteristically low in proportion to the temperature, being about 100 to 110, full of low tension, often having double beat.  The tongue is coated; there is constipation or diarrhea; the abdomen is somewhat distended and a little tender to the touch in the lower right portion.  There may be some mental confusion at night.  Bronchitis is often present.  The spleen becomes enlarged between the seventh and tenth day and the eruption usually appears during this period on the stomach and abdomen.