TYPHOID BACILLI IN EXCRETA 307 



ance. Most observers state that they disappear totally at the 

 commencement of convalescence, but certain authorities state that 

 they have found the bacilli in the stools nine days and fifteen days 

 after the temperature had become normal (Stepolansky and 

 Stroganoff). The reason for this divergence of view is the great 

 difficulty of detection of the bacilli in the faeces by our present 

 methods. Hence it is not possible to lay down any hard and fast 

 limitations. It may, however, be said that the faeces are highly 

 infectious soon after the commencement of the disease, and that 

 later they become less dangerous. During the infectious period 

 it is certain that the stools are enormously charged with typhoid 

 bacilli. 



While referring to this matter of elimination of the bacillus in 

 the intestinal excreta it should be remarked, that there is con- 

 siderable evidence to show that an individual may become the 

 bearer and distributor of the infecting agent of typhoid fever, 

 without developing the disease himself It would appear that 

 just as typhoid fever may develop and death result without in- 

 testinal ulceration, so also the bacillus may gain access to, and 

 develop in, the intestine, and yet be voided without having produced 

 the disease. It has been suggested that such an occurrence may 

 be due to the presence in the intestine of irritative saprophytic 

 germs, causing a profuse diarrhoea capable of sweeping out of the 

 alimentary canal any typhoid bacilli. Much the same series of 

 events would occur in cases, if such are possible, of immunity of 

 certain individuals. It is within the range of possibility that the 

 specific germ of typhoid may be transported from place to place, 

 and from person to person, and eventually to a milk supply by an 

 immune man. This, or something akin to it, may be the explana- 

 tion of certain epidemics which have appeared to originate de 

 novo. 



The urine is the other chief excretion by which the bacilli of 

 typhoid fever are voided from the body. Horton-Smith has 

 demonstrated that the urine of typhoid patients contains the 

 bacilli of the disease in the proportion of i in every 4 cases. 

 He has also shown that as a rule it is towards the end of the 

 disease, or during convalescence, that this condition occurs. 

 Further, whilst it is always difficult to find the bacilli in the stools, 

 in the urine it is always easy, for when they are present they are 

 nearly always in pure culture, and not uncommonly they are 

 present in such extraordinary numbers that one cubic centimetre 

 may contain many thousands of micro-organisms (Horton-Smith). 



