110 THE ACUTE SELF-LIMITED INFECTIONS 



typhoid germ growth, but does not kill many. The bacilli 

 do not come from the cow, but are introduced somewhere in 

 the route from her to the consumer. Vegetables grown in 

 ground upon which infected manure or water has been spread 

 may carry the disease; such as, for instance, water-cress, 

 lettuce, tomatoes, or others that are eaten raw. Oysters 

 fattened in water contaminated by sewage are said to trans- 

 mit the disease. 



House-flies may settle upon human excreta in out-houses 

 or toilets or in sick-rooms, and by walking on articles intended 

 for food, leave behind some of the germs. 



The personal contact of nurse, physician, or a member 

 of the family must never be underestimated as a means of 

 direct transmission. Indeed, it is looked upon by some 

 authorities as the most important and fruitful method. Upon 

 bed-pans, glasses, eating utensils, bed linen, or clothes there 

 may be a few bacilli lurking, which can easily be conveyed 

 to the mouth by persons handling these objects. 



The typhoid bacilli may lurk in the body, probably in the 

 bile passages, for a long time after the attack. For this 

 reason disinfection of stools and urine should be continued 

 for at least two months after the patient is well or until the 

 patient has been declared free of typhoid organisms by the 

 laboratory. Such people as may spread the disease' by this 

 means are called "carriers." There are also cases on record 

 in which persons who never suffered with typhoid fever have 

 excreted the bacilli in their stools. It is probable that these 

 persons have had sufficient resistance to overcome intestinal 

 disease, but the germs have infested the bile passages and 

 passed down them to be mixed with the excreta. Two such 

 cases are known to the writer, one of which had a history of 

 having nursed her husband in a fatal attack of typhoid, but 

 whose personal history is free of any illness suggesting this 

 disease. 



Measures for preventing infection should be directed 

 toward killing all the typhoid bacilli, not such a difficult 



