17,1 Brillantes: Disease-carrier Problem 111 
cases or carriers, and more often cases than carriers since, in 
spite of the extensive examinations made to detect the latter, 
very few have been found. 
Experience with one case in Bilibid Prison, in 1917, would 
appear to indicate that the patient had been a carrier for more 
than four months before coming down with the disease. 
The Philippine Health Service stated, in 1917, that antityphoid 
vaccination will not rid carriers of the bacilli. In connection 
with carriers, the Service made the following statements. 
1. A positive Widal may indicate that a person has suffered 
a previous severe or mild form of typhoid; that he has received 
antityphoid vaccination; or that he is a “carrier” (commonly 
believed to have suffered from an unrecognized attack). 
2. A positive Widal cannot be pronounced a “carrier” unless 
actual discharge of bacilli, by fzeces or urine, is shown. 
3. A typhoid carrier is not a danger to himself, but is such 
to unaffected people; therefore he should be debarred from 
places where food and drink are dispensed. For urinary carriers 
urotropin should be administered. 
So far no work has been done on treatment of intestinal 
carriers. 
In a survey (1917) of cases and contacts the following re- 
sults were obtained: In the group of cases, recognized or sus- 
pected clinically, 62.98 per cent gave a positive Widal test, while 
for the contacts the percentage was only 9.21. Of great im- 
portance is the fact that out of the twenty-five fecal specimens 
from convalescents and other presumptive carriers, in only one 
was Bacillus typhosus demonstrated. One explanation offered 
for this encouragingly negative result was that possibly the vi- 
tality of the tropical strain of bacillus is shorter than has been 
' observed in cold climates. 
These findings therefore tend to show that there is hope 
of reducing the incidence of typhoid, and even of completely 
eradicating the disease. 
DIPHTHERIA CARRIERS 
In 1900 sporadic cases of diphtheria began to be reported 
in Manila. From one case reported in 1900 there was a gradual 
increase to eight in 1906, the mortality having always been 100 
per cent. From fifteen cases in 1907 there was an increase 
to forty-nine in 1912, the mortality having relatively decreased. 
Cases, few in number, began to be reported from the provinces. 
