680 PATHOGENIC MICROORGANISMS 



contact infection may take place from fomites fingers food to mouth, 

 that is, towels, bed clothing, underclothing, etc., and emphasizes the 

 importance of sanitary paper towels, etc., in toilets. 



Since in contact infection the case is of relatively little danger, 

 largely because of the fact that danger of a case is so well recognized 

 and precautions against transmission from such a source are easily 

 taken, and have become matters of routine in well-regulated sick-rooms 

 and hospitals, the interest in these infections centers upon the typhoid 

 carrier. 



The Prevention of Typhoid Fever. 114 The measures which are 

 necessary for the prevention of typhoid fever can be easily deduced 

 from a consideration of the material in the foregoing paragraphs. 



Of great importance is recognition of cases, hospitalization and isola- 

 tion. During such hospitalization there should be careful attention to 

 disinfection of discharges, sterilization of bedding, bed-pans, eating 

 utensils, etc., etc. Patients should never be discharged from hospitals 

 until the urine and feces have been found free from typhoid bacilli, 

 and several examinations at intervals of two or three days should 

 be negative before this is considered to be the case. . . 



Attention to sewage disposal, water supplies, filtration and chlorina- 

 tion of water with constant supervision of such plants from both a bac- 

 teriological, chemical and engineering point of view. 



Similar supervision of milk supply, with especial attention to the 

 carrier state of the personnel of dairies and milk handlers. 



Public health arrangements for the immediate epidemiological study 

 of cases which occur and laboratory facilities for the tracing of carriers 

 indicated by such epidemiological studies. 



Eventual examination for the carrier state of food handlers, pro- 

 fessional cooks, and exclusion from such professions of people found to be 

 carriers. 



Community measures for the suppression of fly-breeding places and 

 flies, screening of kitchens, and the absolute elimination of open latrines 

 of any kind. 



The prevention of oyster culture near sewage outlets. 



Finally, more and more attention must be given to generalized 

 vaccination. 



Vaccination and Specific Therapy in Typhoid Fever. The failure 

 to produce a soluble toxin from typhoid cultures has naturally so far 



114 See Rosenau's Hygiene Also Zinsser Prevention of Com. Dis. in Nelson's 

 System, 1921. 



