TYPHOID FEVER IN DISTRICT OF COLUMBIA. 23 
It is recommended that the manufacture of ice and the traffic in 
natural ice in the District of Columbia should be placed under close 
sanitary control of the local health authorities, and that bacteriolog- 
ical and chemical facilities should be provided for the frequent exam- 
ination and control of this product. 
TYPHOID BACILLUS-CARRIERS. 
It is now well knovm that some persons in good health discharge 
typhoid bacilli in live and virulent form, in their urine and feces for 
periods of months and years. Such persons are known as ^ffiacillus- 
carriers ” (bacillen-trager) . 
The fact that persons in average health may harbor the cholera 
vibrio in the intestinal tract or the diphtheria bacillus in the throat 
has been known and its importance in preventive medicine appreciated 
for some years; but it is only recently that a similar relationship in the 
case of typhoid fever has actually been confirmed. It must be plain 
that bacillus carriers may be particularly active agents in spreading 
the infection throughout a community in view of their undiminished 
activities and the total ignorance of the fact that they are foci of 
infection. 
The question of typhoid bacillus carriers complicates the epidemi- 
ological studies, inasmuch as cases contracting their infection by this 
means are verv difficult to trace. 
TYPHOID FEVER A “CONTAGIOUS” DISEASE. 
Our studies confirm the trend of modern opinion that t}q)hoid 
fever may be communicated directly from man to man. This 
emphasizes the importance of isolation and disinfection in this disease. 
THE SUPPOSED ROLE OF INTESTINAL WORMS AS INOCULATING 
AGENTS IN TYPHOID FEVER. 
* 
In view of the theory advanced by Guiart that intestinal worms, 
especially whipworms, commonly play an inoculating role in typhoid 
fever, somewhat similar to the role played by fleas in bubonic plague, 
200 of the present typhoid cases (selected at random) were examined 
for intestinal worms. Statistically considered, the infections found 
correspond approximately to the infections which would be expected 
among these patients independent of their typhoid condition. Only 
15 cases (7.5 per cent) showed a total of 16 infections (8 infections per 
hundred), of which 14 cases (7 per cent) showed whipworms. This 
represents only 1.3 infections (0.65 infections per hundred persons) 
over what was expected in general helminthiasis, and an increase of 
only 1.32 per cent over what was expected in whipworm infections. 
Considering the very wet season, and especially in view of the negative 
