BACILLUS TYPHOSUS 213 



" In 1907 she entered a family in New York City and two months 

 after her arrival two cases developed, one of which proved fatal. 



" The cook was removed to the hospital March 19, 1907. Cul- 

 tures taken every few days showed bacilli off and on for three 

 years. Sometimes the stools contained enormous numbers of 

 bacilli and again for days none would be found. She was released 

 on parole in 1910, promising to report to the Health Department 

 and not to engage in cooking. She broke her parole and disap- 

 peared. In 1915 in an epidemic of typhoid at a maternity hos- 

 pital a total of twenty-five cases developed. Investigation showed 

 that the food was the cause and the cook was identified as ' Ty- 

 phoid Mary.' During the period of disappearance she infected 

 a friend and was the cause of several cases in a small private sani- 

 torium. She is known to have been the cause of at least fifty 

 cases of typhoid fever." 



The tracing of typhoid carriers is an important and at the same 

 time difficult problem. A Widal reaction cannot be depended 

 upon since the agglutinins in the serum vary in amount from time 

 to time. The actual proof that a person is a carrier lies in the 

 isolation of the typhoid bacillus from the feces or urine, and as the 

 organism may not always be present, several examinations must 

 be made if negative results are at first obtained in suspected cases. 



Modes of Communication. The typhoid bacillus probably 

 always enters the body by way of the mouth, fingers or food being 

 responsible for its conveyance. Water-borne epidemics still 

 occur, though with much less frequency. Fortunately typhoid 

 bacilli do not multiply in water; they usually die within seven 

 days except in winter, when a covering of ice or snow affords 

 them some protection. Water-borne epidemics of typhoid almost 

 always occur in the spring, fall, or winter, since most fecal material 

 eventually finds its way to water, and as watercourses draining 

 inhabited regions are likely to be contaminated with human feces, 

 there is always the possibility of surface water containing typhoid 

 bacilli. The first big epidemic in America definitely traced to 

 the water supply occurred in 1885 at Plymouth, a small mining 

 town near Philadelphia. Of the 8000 inhabitants 1000 contracted 



