152 
TWO OR MORE CASES IN SAME HOUSE. 
There were 35 instances in winch two or more cases developed in 
the same house and in these 35 houses there were 81 cases all told. 
The largest number of cases occurring in one house was 4, and there 
were 2 such instances. 
Of these 81 cases, 39 were secondary to previous cases in the same 
households and were attributed to infection by direct contact, 17 
were attributed to milk infection, and 25 to undetermined factors. 
AVENUES OF INFECTION BY PERSONAL CONTACT. 
Of the cases investigated in 1908 there were 17 which developed 
among persons living in buildings in wliich grocery stores were located, 
1 in a building in which there was a bakery, and 1 in a building in 
which there was a saloon. The patients were cared for at these 
dwellings during a whole or a part of their illness, and in some in- 
stances a member of the family or other person who attended the 
patient was closely associated vdth the business. Furthermore, in 
some instances the precautions taken in the disposal of the stools, 
urine, etc., of the patient were decidedly inefficient. 
The extent and freedom of association between persons of all walks 
of life in a large urban community makes it easy to understand how 
the infection from a given case of typhoid fever may be conveyed 
by devious and multiple ways to a number of persons widely sepa- 
rated socially and geographically. Many cases are no doubt due to 
direct or indirect personal contact wliich can not be traced. 
Our studies of typhoid fever in TTashington in 1908 have sub- 
stantiated the view we held in 1907 that typhoid fever here is in 
large part a contact disease and that it should be treated as a quaran- 
tinable disease. It is irffinitely easier to destroy the infection in the 
excreta of the patient than in the various foods and beverages, on the 
hands of persons, bodies of insects, etc., by which it may be dissemi- 
nated after it leaves the bedside. 
PROPHYLAXIS. 
Of the total 665 cases investigated, 324, or 48.7 per cent, were 
treated at hospitals. One case a few days after onset of illness was 
taken for treatment to a place outside of the District of Columbia. 
The time of admission to hospital of the cases considered as having 
contracted the infection in the District of Coliunbia was as follows : 
Vases. 
Within 5 days after onset of illness 143 
Within 10 days after onset of illness 74 
Within 15 days after onset of illness. 18 
Within 20 days after onset of illness 3 
Within 25 days after onset of illness 1 
Total 239 
