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Typhoid Bacilli Carriers, William H. Park, M.D.
The obscurity of the origin of a large percentage of typhoid fever outbreaks led many observers to the supposition that perhaps some saprophytic member of the colon group might change under bad hygienic conditions to the typhoid bacillus.
Further investigation revealed the fact that a small percentage of persons after recovering from typhoid fever pass typhoid bacilli in the urine. The attack of typhoid fever in some of these cases had been a number of years before. Continued examinations showed that these cases were comparatively rare, and it did not seem possible that they could account for all outbreaks of typhoid fever, where one could not trace the infection to those having the disease.
In 1902 won Drigalski and Conradi found typhoid bacilli in stools of four persons who had had no typhoid fever symptoms, but had been in contact with typhoid patients. Soon it was found that a number of typhoid convalescents continued to pass typhoid bacilli for long periods after recovery. Examinations of persons who had had typhoid fever years before revealed the remarkable fact that 1 or 2 per cent, of them were passing typhoid bacilli, sometimes in enormous numbers. The knowledge that the gall bladder had been found infected at operations for calculi suggested this as the source of the bacilli.
A number of autopsies or operations have since been held on these typhoid bacilli carriers and proven this to be the case. Thus, Levi and Kayser reported, in 1906, a case of a woman, 49 years old, who had had typhoid fever in 1903 and made a good recovery. In 1906 the woman died from some other disease; autopsy was held nineteen hours after death. Typhoid bacilli were present in the liver, in the wall of the gall bladder and inside a number of calculi.
Kayser reports that in Strassburg during the years 1904-5 13.5 per cent, of all the cases of typhoid were traced to 6 of these typhoid carriers, all of whom were women and gave histories of having had typhoid from one to 27 years before.
A large number of cases of typhoid fever have now been traced to these chronic bacilli carriers. Thus Lentz states, in 1905, that seven physicians had then reported typhoid cases from bacilli carriers. The first reports the case of a patient who had had typhoid 3 years before, who was known to cause 2 cases of typhoid: the second reports 4 typhoid carriers, who had had typhoid as long ago as 42 years, 15 years, 13 years and 12 years, respectively. To these 4 ere traced 12 cases of typhoid. The third reports a typhoid carrier who had typhoid 19 years before, who caused 6 cased of typhoid. The fourth reprots a carrier who had had typhoid 1 _ years before, but to whom no cases had been traced; the fifth had a patient who had had typhoid 17 years before and had caused 27 cases; the sixth had a patient who had had typhoid 10 years before and had caused one other case, and the seventh reported a bacilli carrier who had the disease 17 years before. To this last individual 2 cases were due.
Out of 400 recorded typhoid patients Lentz found that 6 retained the bacilli at the end of period ranging from 3 1/3 months to 13 months. Klinger examined the feces of 1,700 healthy persons who had never knowingly had typhoid and found bacilli in 11.
When the bacilli were in the stools of typhoid carriers, Lentz found that he could not get rid of them by any treatment. Their retention is due, he thinks, to faulty metabolism and concomitant chronic disease. Faulty care during convalescence may also be a cause.
He notes the predominance of women who are carriers over men, and especially married women who have borne children.
In most cases, the bacilli are present in great numbers. Lentz suggest that the gall bladder may not be the only source, but that the appendix and the deeper folds of the intestine may also be involved.
In conclusion, he suggests the following procedures for controlling these carriers. These, as we note later, can hardly be carried out except in special cases.
INVESTIGATIONS ON TYPHOID CARRIERS AT THE RESEARCH
LABORATORY DEPARTMENT OF HEALTH.
History.On March 20, 1907, a cook was brough to the laboratory to have the feces and urine examined. The history as developed by Soper revealed the fact that during the past eight years she had been employed in eight families and in seven of these typhoid fever had broken out within a few weeks or months of her arrival. In all twenty-six cases and one death occurred. Just before her removal to the Department of Health two cases had developed in the family where she resided and one patient died. Bacteriologie examination revealed the fact that fully 30 per cent of all the bacteria voided with the feces were typhoid bacilli. The urnie was negative. Careful cultural and agglutination tests showed that they differed in no respect from bacilli obtained from acute cases. The repeated outbreaks occurring after her entrance in families were in themselves proof that the virulence of the bacilli had remained intact. A curious feature of the case is that the woman denies that she ever had typhoid fever.
Treatment.This woman had now been isolated for sixteen months. Weekly examinations of the stools have usually revealed large number of bacilli, but there have been several intervals when for one or two weeks no bacilli could be detected. Treatment by intestinal antiseptics has proved unavailing. Hexamethylenamin in doses gradually increasing from 100 up to 150 grains a day, has been given for a number of weeks with no apparent benefit. Attention to diet and mild laxatives has caused the greatest reduction, but not their disappearance. This suggests that the chief development of the bacilli is in the intestines, although the source of the infection is probably the gall bladder.
The case of this woman brings up many interesting problems. Has the city a right to deprive her of her liberty for perhaps her whole life? The alternative is to turn loose on the public a woman who is known to have infected at least twenty-eight persons.
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