36 
confinement in the institution for two years. He was a markedly 
demented case and was confined in a ward with about thirty others. 
His isolation was the more complete in that he had had no visitors 
from the outside, nor had he, so far as knovm, eaten any food except 
that supplied by the institution. 
He used the same water, milk, and general food supplies that were 
used by the other inmates and the attendants at the institution, yet 
his was the only case which occurred. 
It is difficult to explain how infection could have reached tiffs one 
man without also reaching others living in the somewhat isolated 
institution. Several possible ways, however, suggest themselves. 
Flies had rather free access to the ward, and they may have deposited 
infection on some piece of food which this individual ate. There 
were in the three or four weeks prior to the onset of illness of this 
man two cases of typhoid fever in a house about one-half mile from 
the institution. The excreta from these cases were handled very 
carelessly, and flies were abundant. 
The man was allowed to walk about the grounds of the institu- 
tion, but always under guard. He had a habit of seizing upon vari- 
ous things, such as cigar butts, banana peels, etc., and putting 
them into his mouth. In this way he might have picked up some- 
thing infected which had been throvTi over the fence into the insti- 
tution grounds from grounds adjoining, and wlffch were frequented 
by picnicking parties. The possibility of there being a bacillus 
carrier in the ward to account for the infection occurred to us, but 
examinations of specimens of stools and urine of the eleven inmates 
who had been admitted to the ward vdthin the year previous were 
all negative for the typhoid bacillus. 
Xo history could be obtained of any cases or suspected cases of 
typhoid fever in the households of the ward attendants who went to 
their own homes at night. Still it is possible that the infection was 
brought in on the hands or clothing of the hospital attendants. 
The mystery of this one case stands out remarkably. He was the 
only one of about 3,000 persons, living under practically the same 
conditions, to develop typhoid fever. 
This case was the only one to occur among the inmates of the 
institution during a period of five years. Xo other cases developed 
in the institution vdthin the eight months follovfing the onset of 
this case. 
In view of the facts, it seems that water and milk as possible fac- 
tors can be excluded. Such vegetables as are eaten uncooked were 
supphed the institution from the market, and the man had eaten 
uncooked tomatoes and blackberries during the month previous to 
his iUness. The chances of infection having been conveyed to this 
