1 Since Olivia first had symptoms of typhoid fever on 1 or 2 February, she was now in the third week of her infection. Typhoid was understood to be linked somehow to “insanitary conditions in house drainage, water supply, &c.” and, more specifically, to be transmitted by contaminated drinking water or milk. Symptoms typically lasted for a month, although sometimes as long as three months, often with prolonged relapses. First symptoms were known to begin “somewhat insidiously. Indeed, it is no uncommon thing for patients with this fever to go about for a considerable time after its action has begun. The most marked of the early symptoms are headache, lassitude, and discomfort, together with sleeplessness and feverishness, particularly at night.” By the second week, patients had high fever, spots, diarrhea, vomiting, severe abdominal pains, intestinal hemorrhages, and enlarged spleen and liver. By the third week, “nervous disturbance is exhibited in delirium, in tremors and jerkings of the muscles.” The diet recommended was milk, barley water, and broths, and during convalescence

When drugs failed to lower temperature, cold baths and massage were sometimes recommended. By the early 1880s, a bacterium, Salmonella typhi, was identified as the cause of the disease (Ziporyn, 72–73). By 1890, the death rate from typhoid fever was estimated at about twelve percent of cases.

2 The Rochester physician has not been identified. Samuel E. Moffett’s infirmity probably was related to a nervous disorder that he evidently suffered at least through late 1872 (11 June 71 to JLC; 21 June 71 to OC and MEC; 26 Nov 72 to JLC and PAM, NPV). Clemens later recalled:

3 Cincinnatus A. Taft (1822–84), Hartford’s leading doctor, was an 1846 graduate of the College of Physicians and Surgeons of New York. He practiced homeopathy, “although he exercised a certain eclectic independence, which looked rather to cure than to creed, and was not entirely within the limitations of any one ‘school’” (“The Death of Dr. Taft,” Hartford Courant, 27 June 84, 1). He became the Clemens family physician after they moved to Hartford (4 Dec 71 to OLC).

4 Clemens had sent a draft for $300 directly to the Fredonia bank in June 1870. Presumably he had met Clement in Fredonia in early October 1870 (25 June 70 to JLC and PAM; 4 Oct 70 to Redpath, n. 1).