Experiments have shown that infected cloth ing, surface soil, faces and urine retain active bacilli for many days and there is reason to believe that typhoid is sometimes spread through infected hands, clinical thermometers, water closets, clothing, etc. The New York depart ment of health, which insists upon the im portance of disinfecting the urine as well as the faces of typhoid patients, states that is prob able that in 50 per cent of the cases the typhoid bacilli are present in the urine at some stage of the disease," and recommends keeping the urinal or bed-pan partly filled with a 1 to 20 solution of carbolic acid.
Two important means in the diagnosis of typhoid have come into use within the last few years; namely, Erlich's test, or the diazo-reac tion and the Widal test. The first, which has the advantage of being more readily applied, is as follows: °Equal parts of the suspected urine and a solution (saturated solution of sulphanilic acid in 5 per cent hydrochloric acid 40 parts; 0.5 per cent solution of sodium nitrite 1 part) are mixed and well shaken. On the addition of a few drops of ammonia a brilliant rose-pink color should appear, if the case be one of typhoid fever. The 12-hour sediment is also characteristic, consisting of a dirty gray lower layer and a narrower dark olive-green upper layer." The reports of army surgeons in the great European War (1914-18) show that the affection known as "para-typhoid" is more com mon than typhoid. It has most of the symptoms of typhoid but less pronounced and has been responsible for deaths, which have been im puted to other causes. It is believed that the bacilli responsible are a union of the Eberth and Colon bacilli as shown by the Widal re action. A mixed serum has been used hypo dermically with success against both.
Prophylaxis.—°An epidemic is like a con flagration,— it is more easily suppressed at the beginning." °An ounce of prevention is worth a pound of cure.° These are two sayings quite applicable to typhoid fever. The Ithaca epi demic might have been prevented by keeping the water supply pure; but once started, "all the science of the 20th century could not save all the lives." Purity of water and cleanliness of foods, proper cooking, the thorough removal and destruction of refuse, the use of septic tanks for sewage, the getting rid of flies and other hygienic measures are the means for pre venting the origin and spread of typhoid; hut these measures must be persistent, not spas modic. The term summer typhoid is frequently
applied to typhoid fever appearing in cities in the fall, but originating in country summer re sorts — classed, It may be, as healthful.
It is now that from 2 to 10 per cent of all cases of typhoid become "carriers" of the disease, some "temporary" for about three months, others "chronic" for an indefi nite period, continuously or intermittently for years it may be.
Such carriers as well as walking cases of typhoid are frequent sources of infection. The bacilli collect in the gall bladder, multiply and discharge into the intestines and find their way into the urine. The germs in the•undisinfected excreta of these people are carried by flies or soiled hands to food. Even persons who have never had typhoid may become carriers. '"Ty.
phoid was such a carrier, acting as cook in various families and in a hospital she was responsible for 57 cases of typhoid and three deaths. Boards of health now issue directions to "carriers.° The various efforts that have been made by the use of internal medicines such as sal varsan and unotropin, to rid the body of a carrier of the lurking germs have only been partially successful.
Anti-typhoid scrums and bacterins are used hypodermically with excellent results as immu nizing agents — and as a cure. The prevention of typhoid by such means in armies is a triumph.
In 1901 Parkes and Rideal reported that after detailed experiments made to determine what substances could be added to drinking water containing typhoid or other infecting micro-organisms to make it innocuous, they had decided upon acid sodium phosphate or sodium bisulphate, in compressed tablets of five grains each, to be used three to a pint of water 15 minutes before drinking, and when not in use to be kept in a closed receptacle, as a metallic box. They believe that the substance will be efficacious unless the water is very badly pol luted. The statement has been made repeatedly in newspapers that lemon-juice destroys the typhoid bacillus, and therefore should.be added to suspected drinking-water. W. H. Park, the bacteriologist, shows on the contrary that while the acid kills the micro-organisms it requifts too much acid and too much time for the chem ical action to take place to render lemon-juice a practical agent for their destruction.