BACILLI OF THE COLON-TYPHOID-DYSENTERY GROUP 075 



found no increase in complement fixation. In general, we would not 

 hope for very much light from serological investigations upon the ques- 

 tion of whether or not an individual was a carrier, but would imme- 

 diately proceed to bacteriological examination, either by feces, urine, or 

 duodenal examination. , 



THE TREATMENT AND CURE OF TYPHOID CARRIERS. The great 

 importance of the typhoid carrier from the epidemiological point of view 

 has led to innumerable medical and surgical attempts at cure. That 

 there can be no doubt about the possibility of cure in most cases, by 

 surgical gall-bladder extirpation, is, of course, certain. It will be neces- 

 sary in the future, however, especially on the basis of the recent work of 

 Nichols, Garbat and some German observers, to precede such operations 

 by fecal and duodenal examinations, and it must be remembered that 

 there will always be a certain percentage of cases which are liver-duct 

 carriers, in contrast to gall-bladder foci, which will not clear up. Also, 

 the operation is not without danger, with a certain amount of mor- 

 tality, and, of course, cannot be applied generally upon the enormous 

 numbers of carriers that exist. 



According to Garbat and others, attempts to cure by other means 

 necessarily depend to a veiy large extent upon early diagnosis of the 

 carriers before the condition has become stubbornly chronic. But in all 

 cases, cure by other than surgical means has been discouraging. Many 

 different methods have been attempted. Vaccination with the ordi- 

 nary typhoid vaccines has given discouraging results in the hands of 

 Park and many others, although much was hoped from it at first. 

 Irwin and Houston 98 claimed to have cured a urinary carrier by vacci- 

 nation, but Houston and Thomas " failed in other cases. Petruski 10 

 in 1902 claimed that vaccination during the course of the disease might 

 prevent the development of the carrier state. But, on the whole, 

 vaccination has not brought the results that have been hoped for it, 

 and we are rather reluctant to believe that on a theoretical basis it is 

 encouraging, since the organisms in the chronic carrier are physiologically 

 outside the body, and not in contact with antibodies or leucocytes. 



Medicinal treatment has been tried with many agents, but without 

 much success. Discouraging results have been obtained with urotropin, 

 methylene blue, saliciyates, iodin and arsenic preparations. Conradi 101 

 in 1910 tried chloroform with apparently successful results in rabbits 



98 Inrit/ and Ifonxton, Lancet, 1, 1909, 154. 



99 HouKlon and Tlunmi*, Cent. f. Bakt. Rcf., 45, 1910, 390. 



100 Petmski, cited r rom Kiister, loc. cit. 



101 Conradi, Centralb. f. Immimit., 7, 1910, 158. 



