Prophylaxis 641 



Typhoid Carrier s.r— The. persistence of typhoid bacilli in the gall- 

 bladder for years after an attack of typhoid fever is commonly at- 

 tended with the regular or occasional appearance of the bacilli in 

 the intestinal contents of the individuals concerned, who then be- 

 come "carriers," and as such are a menace to the health of those 

 about them. In miUtary cantonments, in institutions, and in as 

 many other places when people are congregated together as prac- 

 ticable, examinations should be made, from time to time, of all those 

 whose occupation brings them into contact with food subsequently 

 eaten by the rest, to see that there are no "carriers" among them. 



The method is comparatively simple. The suspect is furnished with a small 

 bottle containing about s cc. of sterUized ox-bile, and instructed to introduce a 

 fragment of his feces about the size of a soup bean, and bring it to the laboratory 

 the next day. 



The bottle is then thoroughly shaken so as to mix the bile and feces thoroughly 

 together and distribute the contained bacteria with fair uniformity, after which 

 a platinum loopful is stroked upon Conradi-Drigalski plates, or mixed with 

 melted Endo's medium and poured into Petri dishes. Bluish white, thin, leaf- 

 like colonies, should be picked and tested for fermentation and milk coagulation 

 and in the absence of either, if composed of motile, gram-negative, non-sporulating 

 bacilli, further tested by means of an agglutinating serum. 



Prophylactic Vaccination. — Following the principle of Hafikine's 

 anticholera inoculations Pfeiffer, and Kolle,* Wright, f and SempleJ 

 have used subcutaneous injections of sterilized cultures as a prophy- 

 lactic measure. One cubic centimeter of a bouillon culture steriUzed 

 by heat was used. 



The "Indian Medical Gazette" gives the following important 

 figures showing what was accomplished in 1899: Among the British 

 troops in India there were 13 12 cases of typhoid fever, with 348 

 deaths (25 per cent.). The ratio Of admissions to the total strength 

 was 20.6 per 1000. There were 4502 inoculations, and among them 

 there were only 9 deaths from typhoid fever — 0.2 per cent, of the 

 strength. There were 44 admissions, giving 0.98 per cent, of the 

 strength. Among the non-inoculated men of the same corps and at 

 the same stations, of 25,851 men there were 675 cases and 146 deaths, 

 giving the relative percentages of admissions and deaths as 2,54 and 

 o.s6.§ 



In a later contribution, Wright|| showed that the' prophylactic 

 va,ccination against typhoid fever reduced the number of cases and 

 diminished the death-rate among the inoculated, and also called 

 attention to the slight risk the inoculated run of being injured in 

 case their vital resistance is below normal, or they are already in the 

 fiarly stages of the disease, or where the dose administered is too 

 large, or the second vaccination given too soon after the first. 



* "Deutsche med. Wochenschrift," 1896, xxn; 1898, xxiv. 

 t "Lancet," Sept., 1896. 

 t "Brit. Med. Jour.," 1897, i, p. 256. 

 § "Phila. Med. Jour.," Oct. 13, 1900, p. 688. 

 II "The Lancet," Sept. 6, 1902. 

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