3o6 PATHOGENIC BACTERIA IN MILK 



in nearly all cases there is a definite local and primary disease 

 whence the secondary dissemination of the micro-organism takes 

 place." ^ 



The Vehicle of Infection 



From these facts it follows not only that typhoid fever is a 

 general disease, but that the alvine discharges are not alone the 

 vehicle for the elimination of the specific agent causing the disease. 

 Indeed, there are four excretions which have been described as 

 infectious, with more or less frequency, in typhoid fever^ — the 

 sweat, the expectoration, the faeces, and the urine. The first two 

 need not be discussed in connection with the subject under con- 

 sideration. The latter two demand somewhat careful attention. 



The fcBces, or alvine discharges, have long been known to 

 harbour large numbers of the bacilli, and for the reasons already 

 stated. But in recent years our knowledge has become more 

 precise and delimited, with the result that it is now held that only 

 in certain stages of the disease are the excreta heavily charged 

 with bacilli. They are not likely to be largely present, for example, 

 in the very early stages of the disease. 



Reed, Vaughan, and Shakespeare in their Report on the Origin 

 and Spread of Typhoid Fever in the United States army military 

 camps during the Spanish War of 1898, state that the elimination 

 of the typhoid bacillus in the stools probably begins soon after its 

 introduction through the mouth. "Typhoid bacilli are most 

 abundant," they add, " in the stools of patients suffering from this 

 disease where there is sloughing of the intestinal ulceration. 

 However, it should be borne in mind that typhoid stools are 

 infectious often before the individual shows any evidence of the 

 disease. In other words, the stools of a man in the incubation 

 period of typhoid fever may be laden with the bacilli of this disease. 

 On the other hand, the stools may continue to be infectious long 

 after convalescence has set in." ^ 



Typhoid bacilli can, however, be demonstrated in the stools — 

 though only with great difficulty owing to extraneous organisms — 

 at the end of the first and during the second weeks, and at the 

 beginning of the third week. If there be a relapse, the bacilli can 

 be found in the stools during the early part of the relapse. 

 Karlinski names the ninth day as the time of their earliest appear- 



^ Lectures on Typhoid Fever. (Goulstonian Lectures.) P. Horton-Smith, 

 M.D., F.R.C.P. (J. & A. Churchill, 1900.) 



* American War Department : Official Report^ 1900, p. 203. 



