230 THE CARRIAGE OF TYPHOID FEVER BY FLIES 



A new danger is also added by the discovery of typhoid 

 "carriers." Although cases of walking typhoid or ambulatory 

 enteric fever have been known for a number of years and the 

 occurrence of chronic carriers was recognised in Germany, it is 

 only wathin the last few years that the attention of medical men 

 generally, in Europe and America, has been draw-n to this im- 

 portant fact. The occurrence of these chronic carriers, w^ho are 

 not ill but continue to give out the typhoid bacillus in their 

 excreta and urine, is discussed at some length by Howard (1911). 

 He quotes from an important article in the Boston Medical 

 and Surgical Journal and gives the following quotations and 

 cases : 



" It is asserted by Kutscher that, in south-western Germany, 

 direct contact is a more important factor in the spread of typhoid 

 fever than polluted water, and that about f<>ur per cent, of typhoid 

 patients become chronic carriers of the specific bacilli which they 

 excrete in both urine and faeces, sometimes for long periods. 

 Doerr, for example, cites cases reported by Drober and Hunner, in 

 which the bacilli were isolated from the gall-bladder seventeen 

 and twenty years after recovery, and Lentz asserts that if after 

 ten weeks convalescence the excretion of the bacilli has not ceased, 

 it will most likely continue permanently and uninterruptedly, in 

 spite of medication. He cites a number of cases in which, after 

 ten, thirty and even forty years after recovery, the excretion 

 continued. Levy and Kayser report that in the autumn of 1905 

 a number of cases of typhoid fever occurred in an insane asylum, 

 in which two years previously an inmate had had the disease and 

 had recovered. On the appearance of these later cases this person 

 was examined and was found to be excreting the bacilli in her 

 faeces. Further examinations were made at intervals of several 

 weeks and the bacilli Avere found ten times. In October 190(5, 

 she died of a typhoid bacillery septicemia due to auto-infection 

 from the gall-bladder, and on autopsy the bacilli were isolated 

 from the spleen, liver, bile, w^all of the gall-bladder and from the 

 interior of a large gall stone." 



Nieter and Liefmann repoi't a similar case occurring in an 

 insane asylum containing 250 inmates among which seven chronic 

 carriers were found. 



