Foreign Title :
Les Porteurs de Germes et leur Importance dans l'Epidémiologie et la Prophylaxie du Choléra.
Bulletin de l'Office International d'Hygiene Publique
During1 the 1911 epidemic at Naples 10 per cent, over all of healthy " contacts " were found to be carrying the vibrio of Koch. The numbers varied greatly in different cases. In some instances none or few of the contacts associated with a case were found to be carriers, in other instances most or all of the immediate contacts were infected, and in the latter it was nearly always found that the infection was conveyed through a common food-supply. The organisms found in carriers were no less virulent than those isolated from actual cases, but they were present always in smaller numbers. This fact, combined with the absence of diarrhoea in the carrier, reduces the danger which they bring to the community; but that the danger is real is shown by a number of examples which are given. Thus, in various institutions case succeeded case until a systematic examination of all inmates was made, when the presence of one or more carriers was discovered, and immediately on their isolation cases ceased. If no such examination and isolation were carried out, the cases continued, and in places where examination was made before admission to the institution, no cases occurred.
Healthy earners usually stopped excreting the vibrios in 3-5 days, but 15 per cent, continued to carry them for 6-12 days. Whether those who carried for more than 5 days were really mild cases of the disease could not be definitely decided; but Jatta is satisfied that the period of 5 days usually taken as sufficient is not enough, and in practice carriers were kept isolated until repeated examination showed them to be free. If a carrier became subject to a gastro-intestinal disturbance from some other cause, he might develop cholera, and in this fact perhaps lies the explanation of those cases which develop several days after the last contact.
In the Naples epidemic 90 per cent, of the cases were due to infection through direct communication with patient or carrier. Even when infection occurred through taking contaminated food, the presence of a case or a carrier was nearly always demonstrated in connection with the food-supply, as in the kitchen or dairy, etc.
An account is given of the measures adopted to check the spread of the disease. These follow the recognised lines and were thoroughly carried out, directed in principle rather against the human source of infection than against other things. J. H. S.
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Office International d'Hygiene Publique
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