74 TYPHOID FEVER 



the expedition for the relief of Chitral in 1895 typhoid infection was 

 carried by the soldiers, and when they encamped at Kahr an epi- 

 demic developed. In the invasion of Egypt infected regiments were 

 drawn from Mediterranean stations. On the disembarkment at 

 Ismalia occasional cases began to appear and continued to do so until 

 a serious epidemic manifested itself in the permanent camp at Cairo. 

 In the South African war the English failed to profit by the lesson 

 for which all nations had paid so dearly. The restriction of typhoid 

 in armies was first successfully practiced in the Russo-Japanese war 

 by both parties and this was the first great war in which the victims 

 of typhoid did not greatly add to the death lists. Now, with our 

 knowledge of sanitation, aided by the protection afforded by vaccina- 

 tion, typhoid in both military and civil life should recede rapidly and 

 soon be known only in the records of the past. 



The typhoid bacillus is eliminated from the infected person chiefly 

 in the stools and urine. Vomited matter, the saliva and the discharges 

 from posttyphoidal abscesses may contain the virus, but compared with 

 the stools and the urine these are of minor importance. The stools 

 of every person infected with this disease contain the bacilli, but in 

 widely varying amounts, from a few, difficult of recognition on account 

 of the great numbers and rapid growth of other bacteria, up to a pure 

 culture. As a rule, typhoid bacilli are most numerous in the stools 

 during the third week of the disease, at a time when the intestinal 

 ulcers are sloughing. The stools of all suffering from this disease 

 should be thoroughly disinfected. However, the bacilli may be present 

 in the stools both before the disease is recognized clinically, and long 

 after clinical recovery. In many instances the stools continue to be 

 infected for from six to eight weeks after the subsidence of the fever. 

 In a few instances the individual becomes a constant and chronic car- 

 rier of the infection and may remain so for years. Moreover, every- 

 one who harbors this organism does not develop the disease. Any one 

 of these classes, the convalescent, the carrier and the apparently well 

 man, may infect wide areas and diverse places. The only hope of 

 complete protection lies in provision for the disposal of the excreta 

 of all men in such manner that they cannot find their way, directly or 

 indirectly, by short or long circuit, into the alimentary canal of others. 



