56 



UEVIEW — TKOriCAL MEDICINE, ETC. 



Enteric 

 Fever — 



continued 



that in South Africa tlio KafBrs suffer from it much more frequently than is supposed and 

 tend to scatter infection broadcast. 



Considerable importance now attaches to the question of typhoid carriers, i.e. persons 

 who have recovered from the disease but harbour the specific germ in their bodies and are 

 in a condition to infect those with whom they or their excreta come in contact. 



Levy and Kayser''' record the results of the bacteriological examination of the body of 

 a person who was known to have been a typhoid fever " carrier" during life. The patient, 

 who was in an asylum, must have harboured bacilli for several years and had re-infected 

 herself from the gall bladder or bile ducts. She died of typhoid sepsis, but during life the 

 bacilli were present in her stools and she had undoubtedly been the cause of several small 

 epidemics. 



Kayser had previously recorded two cases in 1906, one in the person of a female baker 

 who infected every new employee at the bakery which she owned, and the other in a female 

 engaged in the milk trade, who was apparently responsible for the outbreak of an epidemic 

 due to infected milk in which 17 cases were involved with two fatalities. 



These and other instances are referred to by A. Ledingham and T. C. S. Ledingham- in 

 a paper dealing with cases of enteric fever which kept cropping up in a Scottish lunatic 

 asylum and which were traced to the pi-esence of three typical typhoid carriers. They state 

 that the bacilli probably vegetate in the gall bladder, from which they are intermittently- 

 ejected into the intestine, and make it clear that anyone found to be a typhoid carrier 

 should be kept constantly under bacteriological supervision. They also suggest that 

 possibly many typhoid epidemics would be avoided if the excreta of recovered typhoid cases 

 (especially female cases) were examined systematically (say once a month) up to six months 

 after recovery. A point they mention which is worth noting is that typhoid stools 

 submitted for bacteriological examination should on no account be mixed with urine, as the 

 latter markedly inhibits the growth of intestinal organisms on the plate. They also give a 

 useful bibliographical table. 



In the Lancet for January 23rd, 1908, allusion is made to an outbreak in a Home for 

 Inebriates, which was also traced to a typhoid carrier, and mention is made of Dudgeon and 

 Gray's work, which resulted in the finding of typhoid bacilli in bone lesions 3J years after 

 an outbreak of enteric fever. 



Dean^ has drawn attention to the case of a typhoid carrier of twenty-nine years' 

 standing, and details the bacteriolgical method he employed in recovering B. typhosus from 

 the stools. A general review of the subject will be found in the copy of the journal in 

 which Dean's paper occurs. 



Forster,''* impressed by these discoveries, has put forward a new theory as regards the 

 pathogenesis of typhoid. Because the bacillus is regularly found in the gall bladder during, 

 and often for a long time after, the disease, because it is usually not found in the faeces in 

 the early stages, while Conradi has found it in the blood during the incubation period, and 

 because if one injects typhoid bacilli into the circulation of animals they are excreted into 

 the bile, Forster concludes that the bacilli taken into the stomach and intestines with food 

 and drink do not multiply there but pass into the circulation from which they are excreted 

 into the liver and bile. He believes the bacilli which appear in the stools after the end of 

 the first week of the fever are derived from this source and from the intestinal ulcers. 



The same is more or less true of paratyphoid infections. The occurrence of " carriers " 

 is explained by the fact that bile plus proteid matter (say inflammatory products) constitutes 

 a good medium for the B. tijphosns. Most enteric patients cease to be carriers after two to 

 six weeks, but about 2 per cent, go on excreting bacilli for several or even many (20 or 

 more) years. The majority of these are women, females being more liable to diseases of 

 the gall bladder than men. 



As showing the great hygienic importance of these carriers, Forster presents some very 

 interesting statistics. Of 386 cases investigated, 77 (20 per cent.) were due to infection 



1 Levy, E., and Kayser, H. (December 11th, 1906). Miiiich Med. Ifoch. 



» Ledingham, A., and Ledingham, T. C. S. (January 4th, 1908), " Typhoid Carriers." Brituih Medical 

 Journal, p. 15. 



= Dean, Q. (March 7th, 1908), " A Typhoid Carrier of Twenty-nine Years' Standing." Lancd, Vol. 1. 



* Forster, J. MUnch. Med. Woch., 1908, No. 1, p. 1. 



• Article not consulted in the original. 



