BACILLI OF THE COLON-TYPHOID-DYSENTERY GROUP 671 



carriers have been subdivided by a number of writers into intestinal 

 carriers, gall-bladder carriers, and liver or bile duct carriers. We will 

 see how the newer methods of duodenal tube examination have made 

 these distinctions between carriers possible. 



PERCENTAGES OF CHRONIC TYPHOID CARRIERS FOUND BY 

 VARIOUS INVESTIGATORS IN A STUDY OF CONVALESCENT 



CASES * 



* Table taken from Gay, F. P., Typhoid Fever, MacMillan & Co., New York, 

 1918. 



By far the most common localization of typhoid bacilli in the body 

 of the carrier is the gall bladder. In speaking of the sequela? of typhoid 

 fever we have seen that cholecystitis is almost always related to a pre- 

 ceding attack of typhoid fever. As a matter of fact in the course of 

 typhoid fever the organisms are always present in the gall bladder. 

 This was noted by Chiari 82 as early as 1894, by Pratt, 83 and by many 

 others. Longcope is quoted by Gay to have taken bile cultures as a 

 routine in suspected typhoid deaths at the Pennsylvania Hospital, and 

 found typhoid bacilli in all positive cases. In the gall bladder appar- 

 ently the organisms find a protected nidus where they can persist 

 for years. If gall stones are formed later, typhoid bacilli can often 

 be isolated from them. We ourselves have reported a case in which we 

 isolated the organisms from gall stones seventeen years after the attack 

 of typhoid. 



That liver-duct carriers, however, may exist independently of gall- 

 bladder infection has been shown by such cases as the one cited by 

 Garbat in the essay mentioned above. He speaks of two patients 



82 Chiari, Cent, f . Bakt., Orig., 15, 1894. 



83 Pratt, Amer. Jour. Med. Sciences, 1901. 



