TYPHOID BACILLUS 343 



by some observers that the agglutination seen in icteric patients 

 is due to bile in the blood stream. This, however, has not been 

 proven. A negative agglutination, when the clinical symptoms suggest 

 typhoid fever, should suggest the possibility of a paratyphoid infection. 



Ophthalmo Reaction. Chantemesse 1 has found that an ophthalmo 

 reaction may be elicited in typhoid patients similar to that produced 

 by the introduction of tuberculin in the eye of the tuberculous patient. 

 Broth cultures of typhoid bacilli are precipitated with alcohol; the 

 precipitate is dried and pulverized; ^ milligram of the powder is 

 dissolved in a few drops of sterile saline solution and introduced into 

 the eye. A transient redness with a flow of tears occurs in normal 

 individuals; a severe reaction (even accompanied by a serofibrinous 

 exudate in unusual cases), which reaches its maximum intensity 

 within twelve hours, is elicited in typhoid patients, and, occasionally, 

 in individuals who have recovered from the disease. The diagnostic 

 value of the reaction is as yet undetermined. 



Dissemination and Prophylaxis. The disease typhoid fever occurs 

 only by transmission of typhoid bacilli directly or indirectly from 

 preexisting cases. The disease is acquired only by the ingestion of 

 the specific organisms, and infection by any other channel than the 

 alimentary canal has not so far been satisfactorily demonstrated. 



Prophylactic measures, therefore, should begin with the isolation 

 of the patient and disinfection of all excreta and all utensils which 

 have been in contact with the patient. The organism may occur in 

 the fecal discharges of patients before clinical symptoms develop, in 

 patients recently recovered from the disease, in carriers (which number 

 about 2 per cent, of all cases diagnosed), and probably in a relatively 

 few individuals in whom the organism may gain a temporary foothold 

 without producing symptoms. The bacilli may be transmitted to 

 others by the hands of those who care for the patients, and the hands 

 of carriers. Fecal matter containing typhoid bacilli may be trans- 

 ferred by flies, by water, through milk, and perhaps by vegetables 

 which are eaten uncooked. The water in which typhoid patients have 

 bathed is frequently grossly contaminated with the organisms. Rarely, 

 wells and water supplies are contaminated by urinary typhoid car- 

 riers, in which event the colon bacillus, which is ordinarily relied upon 

 for evidence of contamination, may be absent. A thorough disin- 

 fection of excreta including urine will prevent spread of the disease 

 from known cases. 



1 IV. International Cong, of Demog. and Hyg., Berlin, September 26, 1907. 



