TYPHOID FEVER 75 



The urine in about 30 per cent, of cases of typhoid is infected with the 

 bacillus and carriers may distribute the infection through this excretion. 



Contact infection is the most common mode in the distribution of 

 typhoid. Different students of epidemiology in widely distant lands 

 agree in this and even go so far as to place practically the same esti- 

 mate on the number of cases originating in this manner. About 60 

 per cent, of all cases of typhoid are believed to be due to contact 

 infection. The board of medical officers in 1898 placed the percentage 

 of contact cases at 62.80, while Drigalski gives it for Germany as 

 64.7. These conclusions seem to have been reached quite indepen- 

 dently, inasmuch as the German makes no mention of the American 

 studies which were conducted nine years before his. Formerly, it 

 was supposed that typhoid is mostly water-borne and the board of 

 officers began their investigations possessed fully of this view, but their 

 studies convinced them that this is an error and first furnished indis- 

 putable evidence that contact is the most important factor in the dis- 

 tribution of typhoid. Contact is both direct and indirect. The board 

 divided the cases between the two as follows : Direct, 35.01 ; indirect, 

 27.79 per cent. In more than 90 per cent, of the cases due to direct 

 contact the hands bear the infection directly to the mouth. Klinger 

 found this to be true in 1,315 out of 1,397 cases. This certainly should 

 emphasize the importance of personal cleanliness. 



In indirect contact infection, clothing, bedding, drinking cups, 

 dishes, foods, etc., may serve in the transport of the infection from 

 one person to another. Soiled clothing may retain virulent bacilli. 

 Soiled blankets shipped from South Africa in the Boer war carried 

 the infection to those who used them in England. In the Spanish war 

 our camps were not rid of infection until the clothing of the soldiers, 

 their beddings and the tents were disinfected. Infected fecal matter 

 deposited on oyster beds render this article of food dangerous. 

 Infected employees in dairies spread the infection through milk and 

 its products. Not infrequently cases are so distributed as to show the 

 route of the milk man. Greens and salads, fruits and berries may 

 become bearers of typhoid infection. 



Water epidemics are explosive in outburst and are characterized 

 by the simultaneous infection of a large number of those who con- 

 sume the water. In flowing water the typhoid bacillus dies out in from 



