BACILLI OF THE COLON-TYPHOID-DYSENTERY GROUP 673 



Yet, when they occur, they are of much greater danger to others because 

 of the more indiscriminate distribution of urine. According to Gar- 

 bat 89 about 6.8 per cent of all typhoid cases show typhoid bacilluria 

 for one or two months after the fever has disappeared. In such cases 

 often the organisms are discharged intermittently, and for this reason 

 repeated examination is necessary. Chronic urinary carriers have been 

 reported by Prigge, 90 Houston, 91 and others, and are usually associated 

 with some pathological lesion of the genito-urinary tract. In a case 

 reported by Mayer and Ahreiner 92 there was a pyonephrosis, and in 

 other cases, cystitis, or other inflammations of the bladder, ureter, and 

 kidney have been found. 



By so-called healthy carriers are meant individuals who harbor 

 typhoid bacilli in the stools and in .whom no history of typhoid infection 

 at any time in their lives can be obtained. We know more about typhoid 

 fever than we did formerly, and we think that it is quite clear to most 

 students of the disease that a negative history of this kind, especially if 

 obtained from people who have lived vigorous, active, physical lives, 

 must be very unreliable. Extremely mild cases of typhoid fever, while 

 not common, do occur, and it is not impossible that an individual with 

 an unusual resistance may have been ill for a few weeks, perhaps with a 

 little fever at sometime without going to a doctor. On the other 

 hand, Scheller 93 in examining a group of people, in connection with the 

 investigations made of a mild epidemic, found a considerable number of 

 temporary carriers who did not develop the disease. These people had 

 taken milk infected from a carrier, 18 of a total of 44 acquiring the 

 organisms without getting sick, while 32 of the same group actually got 

 sick. It is not impossible, therefore, that individuals associated with 

 typhoid cases and during epidemics may become temporary carriers. 



Carriers may increase enormously in the course of epidemics espe- 

 cially if these epidemics take place among the large groups of vaccinated 

 people. Such conditions prevailed among the Allied and probably 

 among the German Armies during the war, when the enormously in- 

 creased opportunities for fecal transmission produced incident to active 

 warfare, with open latrines, unprotected kitchens, unlimited fly breeding, 

 and defective scattered small water supplies, made sanitary control 

 impossible. Hundreds of thousands of men suffered from diarrheas and 



89 Garbat, Jour. A. M. A., Nov., 1916, 1493. 



90 Prigge, Klin. Jahr., 22, 1909-1910, 245. 



91 Houston, with Irwin, Lancet, 1, 1909, 311. 



92 Mayer and Ahreiner, cited from Gay, loc. cit. 



93 Scheller, Cent, f . Bakt., Erste Abt., Orig., 45, 1908, 385. 



