Scientific strategy and ad hoc response: The problem of typhoid in America and England, c. 1910-50

Journal of the History of Medicine and Allied Sciences

Volumn 69, Issue 1, 2014, Pages 3-37

  Hardy, Anne ^a  

^a LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE   (United Kingdom)

Author keywords

American Public Health Association; bacteriology; carriers; education; immunization; laboratories; milk; oysters; pasteurization; typhoid

Indexed keywords

HISTORY; HUMAN; INFECTION CONTROL; MICROBIOLOGY; TYPHOID FEVER; UNITED KINGDOM; UNITED STATES;

COMMUNICABLE DISEASE CONTROL; ENGLAND; HISTORY, 20TH CENTURY; HUMANS; MICROBIOLOGY; TYPHOID FEVER; UNITED STATES;

EID: 84890459015     PISSN: 00225045     EISSN: 14684373     Source Type: Journal    
DOI: 10.1093/jhmas/jrs005     Document Type: Article

References (196)

1. Margaret Pelling, Cholera, Fever and English Medicine, 1825-1865 (Oxford: Oxford University Press, 1978).
2. For the wider nineteenth-century public health movement, see Dorothy Porter, ed., The History of Public Health and the Modern State (Rodopi: Amsterdam, 1994).
3. Anne Hardy, "'Straight Back to Barbarism': Anti-typhoid Inoculation and the Great War, 1914," Bull. Hist. Med., 2000, 74, 265-90, 265.
4. Refer to Table 1. Recorded typhoid death rates should be treated as approximate since the diagnosis is difficult; deaths from paratyphoid are also included in the diagnostic category.
5. Symptoms range from severe to subclinical, and may be confused with those of malaria or typhus where these diseases are also current.
6. By the twentieth century, neither typhus nor malaria were endemic in England.
7. The situation in the United States remained more variable.
8. On the eve of World War II, malaria had reappeared in five mid-Western states, while typhus was problematic in the cities of Georgia and Maryland.
9. See Abel Wolman, "The Public Health Engineer and the City Health Officer," Am. J. Public Health, 1941, 31, 435-39, 436.
10. M. Vallin, "Rapport," Bull. de L'Acad. Med., 1909, 62, 207-9, 207.
11. Chief Medical Officer's Report for England and Wales (London: HMSO, 1927), 31.
12. For Scotland, see A. K. Chalmers, The Health of Glasgow 1818-1925 (Glasgow: Glasgow Corporation, 1930), 302.
13. The term "England" is used here as short hand for the administrative unit of England and Wales.
14. Both Scotland and Ireland had separate public health administrations.
15. H. Vincent, "Rapport générale sur les épidémies observées en France en 1907," Bull. de L'Acad. Med., 1909, 62, 544-98, 548;
16. William C. Hanson and Lyman A. Jones, "A Plea for More Widespread Interest in the Investigation and Control of Typhoid Fever," Am. J. Public Health, 1913, 3, 737-41, 737.
17. Charles-Edward Winslow, The Conquest of Epidemic Disease (Princeton, New Jersey: Princeton University Press, 1943), 337-46, 379;
18. Judith Walzer Leavitt, Typhoid Mary: Captive to the Public's Health (Boston: Beacon Press, 1996);
19. J. Andrew Mendelsohn, "'Typhoid Mary' Strikes Again: The Social and the Scientific in the Making of Modern Public Health," Isis, 1995, 86, 268-77.
20. Martin Melosi, The Sanitary City: Urban Infrastructure in America from Colonial Times to the Present (Baltimore: Johns Hopkins University Press, 2000), 137-38, 144-45.
21. See also John Duffy, The Sanitarians: A History of American Public Health (Urbana and Chicago: University of Illinois Press, 2000), 201-2.
22. The universal inoculation of U.S. service personnel and the work of the Metropolitan Life Assurance Company in encouraging typhoid immunization among its policy holders were probably also significant factors in this decline.
23. See Anon., Notes and Comments, "The Passing of Typhoid Fever," Med. Officer, 1921, 25, 261.
24. Melosi, Sanitary City, Table 7.9, 148.
25. Although I refer on occasion to Britain in this article, the focus is on the administrative unit of England and Wales. Scotland and Ireland each had their own public health administrations and death registration systems.
26. For U.S. typhoid death rates in 1900-60, see United States, CDC, "Summary of Notifiable Diseases, 1997." Available online at: www.wikimedia.org/wikipedia/en/a/a8/Typhoid-stats.png (accessed January 4, 2012). 13.
27. See the extraordinary statement of intent issued by the Committee on Journal (sic) in the first issue of the new journal: Anon., Editorials: "Announcement of Committee on Journal," Am. J. Public Health, 1911, 1, 1-3.
28. It was the view of that Committee that "the establishment of our own journal marks one of the most radical steps in the history of the A.P.H.A.," 3.
29. For the specialist journal as a marker of professionalization, see George Rosen, The Specialization of Medicine with Particular Reference to Ophthalmology (New York: Froben Press, 1944), 34;
30. Lindsay Granshaw, St Mark's Hospital, London: A Social History of a Specialist Hospital (London: King Edward's Hospital Fund for London, 1985), 124-25, 227-28, 431;
31. John J. Hanlon, Fred B. Rogers, and George Rosen, "A Bookshelf on the History and Philosophy of Public Health," Am. J. Public Health, 1960, 50, 445-58, 450.
32. In 1923, Charles-Edward Amory Winslow wrote of a "wholly new chapter" in the American practice of preventive medicine opening between 1910 and 1920.
33. Charles-Edward Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven: Yale University Press, 1923), 49.
34. The evidence presented in this article suggests that the "new public health" was not without its limitations.
35. Charles F. Bolduan, "Typhoid Fever in New York City Together with a Discussion of the Methods Found Serviceable of Studying Its Occurrence," Am. J. Public Health, 1912, 27, 538-50.
36. Hanson and Jones, "Plea," 737.
37. Charles R. Grandy and C. J. Andrews, "Municipal Control of Typhoid Fever," Am. J. Public Health, 1913, 3, 746-49;
38. Thomas Tetreau, "The Yakima Sanitary Campaign," Am. J. Public Health, 1913, 3, 729-33;
39. R. M. Simpson, "Rural Typhoid in Manitoba," Am. J. Public Health, 1913, 3, 734-36;
40. Allen W. Freeman, "The Prevention of Typhoid Fever in the Rural Districts of Virginia," Am. J. Public Health, 1913, 3, 1322-25;
41. William H. Peters, "An Epidemiological Survey of All Typhoid Fever Cases Reported to the Cincinnati Health Department during the Year 1912," Am. J. Public Health, 1913, 3, 1279-89;
42. Horatio N. Parker, "An Outbreak of Typhoid in Belleville, Illinois," Am. J. Public Health, 1913, 3, 486-91.
43. Anon., "Typhoid in the Large Cities of the United States in 1912," J. Am. Med. Assoc., 1913, 60, 1702-3.
44. Hanson and Jones, "Plea," 738, 741.
45. See note 16.
46. Parker, "An Outbreak," 486.
47. Hanson and Jones, "Plea," 739, 741;
48. Grandy and Andrews, "Municipal Control," 746;
49. Freeman, "Prevention of Typhoid," 1323;
50. Parker, "An Outbreak," 491;
51. Joseph K. Billings, "Principles of Administrative Control of Communicable Diseases in Large Cities," Am. J. Public Health, 1915, 5, 1204-8, 1208.
52. Tetreau, "Rural Typhoid," 734.
53. William Estis Brown, "Sewage Disposal Problems of a Coast Summer Resort," Am. J. Public Health, 1917, 7, 944-48, 945.
54. Boldnau, "Typhoid Fever," 439;
55. Billings, "Principles," 1206 (Billings was an exception to this rule);
56. Major George Soper, "Typhoid Mary," Mil. Surg., 1919, 45, 1-15, 14.
57. Parker, "An Outbreak," 491.
58. John Duffy has noted the 1920s as one of "only limited gains" in typhoid mortality; "a period of government inaction": Duffy, Sanitarians, 202.
59. Persis Putnam, "The Trend of Typhoid Fever Mortality in the United States," Am. J. Hyg., 1927, 7, 762-81, 776.
60. For this epidemic, see L. L. Lumsden, H. E. Hasseltine, J. P. Leake, and M. V. Veldee, "A Typhoid Fever Epidemic Caused by Oyster-borne Infection," U.S. Public Health Reports Washington, Supplement, 1925, 50, 101-2. The affected cities were: Washington, DC;
61. Chicago, Illinois; New York City;
62. Pittsfield, Massachusetts;New Haven, Connecticut; Rochester, New York;
63. Providence, Rhode Island; Buffalo, New York;
64. Scranton, Pennsylvania; Pittsburgh, Pennsylvania; Cincinnati, Ohio;
65. Detroit, Michigan; Grand Rapids, Michigan.
66. Putnam, "Trend," 778.
67. On the small town problem, see Allen W. Freeman, "The Small Town: The Neglected Unit in Sanitary Administration," South. Med. J., 1916, 9, 126-31;
68. Charles N. Leach and Kenneth F. Maxcy, "The Relative Incidence of Typhoid Fever in Cities, Towns, and Country Districts of a Southern State," Public Health Rep., Washington, 1926, 41, 705-10.
69. Putnam, "Trends," 780.
70. Anon., Editorial: "The Carrier," Am. J. Public Health, 1923, 23, 119-20.
71. Hanson and Jones, "Plea," 739.
72. Tetreau, "Yakima," 731-32.
73. See also Putnam, "Trend," 762.
74. Grandy and Andrews, "Municipal Control," 747.
75. S. R. M. May, "Understanding Smallpox Variola Minor in England and Wales, 1919-193500 (DPhil diss., Oxford University, 1999), 174-81.
76. Smallpox vaccination was done by incision at this period, but in the United States and Canada, only one incision was made, whereas in Britain, it was the custom to make several. Typhoid vaccine was delivered by injection.
77. See Almroth Wright, A Short Treatise on Anti-Typhoid Inoculation (London, Eyre and Spottiswode, 1904), 37;
78. Colonel J. F. Siler et al., Immunisation to Typhoid Fever (Baltimore: Johns Hopkins University Press, 1947), 127.
79. Editorial header to F. W. Hachtel and H. W. Steer, "Inoculation against Typhoid in Maryland," Am. J. Public Health, 1916, 16, 703-6, 703.
80. Anon., Editorial: "The Use of Anti-typhoid Vaccine during Epidemics," Am. J. Public Health, 1938, 28, 378-79.
81. Walter M. Dickie, "Sanitation in the St. Francis Dam Disaster," Am. J. Public Health, 1928, 18, 865-70, 868.
82. Paul R. Hawley and James Stevens Simmons, "The Effectiveness of Vaccines Used for the Prevention of Typhoid Fever in the United States Army and Navy," Am. J. Public Health, 1934, 24, 689-709;
83. S. S. Cook, "Efficacy of Typhoid Prophylaxis in the United States Navy," Am. J. Public Health, 1935, 25, 251-55;
84. Colonel J. F. Siler et al., "Protective Antibodies in the Blood Serum of Individuals after Immunization with Typhoid Vaccine," Mil. Surg., 1937, 80, 91-103.
85. The annual supplements carry reports on everything from drinking water standards to the bacteriological monitoring of dairy products, and the processes for ensuring clean glasses in public eateries.
86. Billings, "Principles," 1205.
87. Anon., Editorial: "The Bad Milk in Our Small Towns," Am. J. Public Health, 1928, 18, 70.
88. Edwin O. Jordan, "Essentials of Typhoid Fever Control Today," Am. J. Public Health, 1934, 24, 349-55, 351.
89. Anon., Editorial: "Pasteurization in England and America," Am. J. Public Health, 1937, 37, 920-21.
90. See also Anon., Editorial: "Safe Milk for England?" Am. J. Public Health, 1938, 38, 647-49;
91. Peter J. Atkins, "The Pasteurisation of England: The Science, Culture and Health Implications of Milk Processing, 1900-1950," in David Smith and Jim Phillips, eds., Food, Science, Policy and Regulation in the Twentieth Century (London: Routledge, 2000), 37-51;
92. see also Peter J. Atkins, Liquid Materialities: A History of Milk, Science and the Law (Farnham: Ashgate Publishing, 2010), 223-77.
93. Anne Hardy, "Exorcising Molly Malone: Typhoid and Shellfish Consumption in Urban Britain 1860-1960," Hist. Workshop J., 2003, 55, 73-90, 84-85.
94. Supervision of the industry was conducted by the Fishmongers' Company, not the Ministry of Health.
95. Carleton Bates, "The Sanitary Control of Shellfish Industries," Am. J. Public Health, 1915, 5, 453-55.
96. Anon., Editorial: "Oysters and Typhoid Fever," Am. J. Public Health, 1925, 15, 437-38.
97. Anon., Editorial: "Oyster Production and the Sanitarians," Am. J. Public Health, 1925, 15, 894.
98. See also L. L. Lumsden et al., "A Typhoid Fever Epidemic Caused by Oyster-borne Infection," Public Health Rep., 1925, Supp. 50, 101-2.
99. Editorial, "Oysters and Typhoid Fever," 437-38.
100. Editorial, "Oyster Production," 894.
101. General, "Co-operation on Oyster Control," J. Am. Med. Assoc., 1925, 85, 911-12.
102. Editorial, "Oyster Production," 894 59.
103. "Shellfish," Am. J. Public Health, 1940, 30, Suppl. 1939-40, Part II, 59-66, 59.
104. William H. Best, "Is Routine Examination and Certification of Food Handlers Worthwhile?" Am. J. Public Health, 1937, 27, 1003-6.
105. See also Leavitt, Typhoid Mary, 52-53.
106. Best, "Routine Examination," 1004.
107. D. Evelyn West, Earle K. Borman, and Friend Lee Mickle, "The Detection of Carriers among Food Handlers in Connecticut," Am. J. Public Health, 1934, 24, 493-504.
108. Best, "Routine Examination," 1003-6.
109. Edwin O. Jordan, "Essentials of Typhoid Fever Control Today," Am. J. Public Health, 1934, 24, 349-54, 352;
110. George H. Ramsey, "What Are the Essentials of Typhoid Fever Control Today?" Am. J. Public Health, 1934, 24, 355-62, 359.
111. Jordan, "Essentials," 352-53.
112. Ramsey, "Essentials," 362.
113. Best, "Routine Examinations," 1005;
114. Ramsey, "Essentials," 359.
115. Anne Hardy, "Questions of Quality: The Danish State Serum Institute, Thorvald Madsen and Biological Standardisation," in Standardising Therapeutic Agents 1890-1950, ed. Christoph Gradmann and Jonathan Simon (Basingstoke: Palgrave, 2010), 139-52;
116. see also Anon., Notes and Comments, "Bacteriology and Preventive Medicine," Med. Officer, 1921, 26, 124.
117. Report of the Referee, "Serological and Bacteriological Procedures in the Diagnosis of Enteric Fevers," Am. J. Public Health, 1935, 25, Suppl. 1934-35, Part III, 147-51.
118. Thomas G. Hull, "The Widal Test as Carried out in Public Health Laboratories," Am. J. Public Health, 1926, 16, 901-4, 903.
119. Aubrey H. Straus, "Enteric Infections Simulating Typhoid in Virginia," Am. J. Public Health, 1927, 17, 247-50.
120. Abel Wolman and Arthur E. Gorman, "Water-borne Typhoid Fever Still a Menace," Am. J. Public Health, 1931, 21, 115-29, 119.
121. Jordan, "Essentials," 350.
122. Anon., "Water-borne Outbreaks in the United States and Canada, 1930-1936 and Their Significance," Am. J. Public Health, 1938, 28, Suppl. 1937-38, Part III, 137-56, 155-56.
123. Wolman and Gorman, "Water-borne Typhoid," 129.
124. Archibald S. Dean, "The Olean City [sic] Epidemic of Typhoid Fever in 1928," Am. J. Public Health, 1931, 21, 309-402.
125. H. N. Old and S. L. Gill, "A Typhoid Fever Epidemic Caused by Carrier 'Bootlegging' Oysters," Am. J. Public Health, 1940, 30, 633-40.
126. The fisherman had previously been investigated as a carrier, but had evaded detection.
127. See, for example, Roy E. Feemster and Helen M. Smith, "Laboratory Criteria of the Cure of the Typhoid Carrier," Am. J. Public Health, 1945, 3, 368-72;
128. A. Littman et al., "The Chronic Typhoid Carrier: The Natural Course of the Carrier State," Am. J. Public Health, 1948, 38, 1675-879.
129. Anon., Editorial: "Municipal Public Health Engineering: An Urgent Situation," Am. J. Public Health, 1941, 31, 182.
130. Thomas Parran, "Public Health in the Conversion Period," Am. J. Public Health, 1947, 35, 987-92, 989.
131. Bonnie Bullough and George Rosen, Preventive Medicine in the United States 1900-1990: Trends and Interpretations (New York: Science History Publications, 1992), 61. 85.
132. See Earle K. Borman et al., "Salmonella Typing in a Public Health Laboratory," Am. J. Public Health, 1943, 33, 127-34;
133. A. D. Rubenstein, Roy E. Feemster, and Helen M. Smith, "Salmonellosis as a Public Health Problem in Wartime," Am. J. Public Health, 1944, 38, 841-53.
134. The impetus for this new interest may be associated with the opening of a Salmonella Center at the Beth Israel Hospital, New York, in April 1939, where the focus was on animal-origin salmonella infections in humans.
135. Up to this point, interest in the salmonellas of animal origin had existed mainly among veterinarians and agriculturalists in the United States. The National Salmonella Centre under the direction of the veterinarian Philip Edwards was opened at Lexington, Kentucky, at about the same time.
136. Milton Feig, "Diarrhea, Dysentery, Food Poisoning and Gastroenteritis: A Study of 926 Outbreaks and 49,879 Cases Reported by the USPHS (1945-1947)," Am. J. Public Health, 1950, 40, 1372-94, 1372.
137. Chief Medical Officer's Annual Report (London: HMSO, 1923), 18-27.
138. Charles Thomson, "A Christmas Carol: The Passing of Typhoid Fever," Public Health, 1923-24, 30, 287-89.
139. On immunization, see Anne Hardy, "'Straight Back to Barbarism'": 270-90;
140. for pasteurization, see note 50.
141. C. V. Craster, "The Medical Examination of Food Handlers," Public Health Basingstoke, 1930, 43, 102-7.
142. Significantly, George Newman did not bother to record annual death totals in his reports, only the number of notifications.
143. Anon., "Two Symposia on the Enteric diseases," Public Health Basingstoke, 1937-38, 51, 215-20, 215.
144. W. H. Bradley, "The Control of Typhoid Fever," Public Health Basingstoke, 1949, 62, 159-61.
145. Anon., Editorial: "The Suppression of Typhoid Fever," Br. Med. J., 1903, 1, 506.
146. William Savage, "Recent Work on the Bacteriology of Typhoid Fever," Public Health Basingstoke, 1907-8, 20, 12-19.
147. Theodore Thomson, "The Enteric Fever Carrier," Proc. Royal Soc. Med., 1910-11, 4, 1-26, 24.
148. David S. Davies, "Carriers of Disease with Special Reference to Typhoid Carriers," J. Sanitary Inst., 1911, 32, 6-16, 10. 104.
149. See Annotation, "Compulsory Segregation of Carriers?" Lancet, 1947, 2, 474.
150. Anon., Notes and Comments, "Typhoid Carriers," Med. Officer, 1939, 62, 252.
151. Davies, "Carriers," 12. Some families may have taken extreme measures. It was reported in 2008 that between 1907 and 1992, at least forty-three women had been detained for life in the Long Grove lunatic asylum, at Epsom, Surrey, because of their typhoid carrier status.
152. Anon., "Typhoid Carriers 'Detained for Life,'" The Independent, July 28, 2008; www.independent.co.uk/life-style/health-and-family/health-news (accessed January 4, 2012).
153. Harold Kerr, "Refuse Disposal in Relation to the Enteric Group of Diseases," Proc. Royal Soc. Med., 1924, 7, 33-46, 41.
154. James P. Watt, "Typhoid Carriers in Aberdeenshire," J. Hyg., 1923-24, 22, 417-37, 417.
155. Anon., "Typhoid Carriers in West Hartlepool," Med. Officer, 1932, 47, 62-63.
156. Chief Medical Officer's Report (London: HMSO, 1920), 134.
157. Graham S. Wilson, "The Public Health Laboratory Service," Br. Med. J., 1948, 1 677-82;
158. R. E. O. Williams, Microbiology for the Public Health: The Evolution of the Public Health Laboratory Service 1939-1980 (London: HMSO, 1985), 2.
159. Anon., "The County Bacteriological Laboratory," Med. Officer., 1931, 45, 14-15.
160. Williams, Microbiology, 2-3.
161. Wilson, "The Public Health Laboratory Service," 27.
162. Anon., "Two Symposia," 218
163. James Ritchie, "The Problem of the Carrier in Enteric Fever," Public Health Basingstoke, 1933, 46, 292-97, 295.
164. Anon., "Two Symposia," 217.
165. Arthur Felix and R. Margaret Pitt, "A New Antigen of B. Typhosus: Its Relation to Virulence and to Active and Passive Immunisation," Lancet, 1934, 2, 186-91.
166. For developments in salmonella bacteriology at this period, see William D. Foster, A History of Medical Bacteriology and Immunology (London: William Heinemann Medical Books Ltd, 1970), 177-95.
167. Anon., "Typhoid Carriers in West Hartlepool," 62.
168. H. Gordon Smith, "The Bournemouth, Poole and Christchurch Typhoid Epidemic," Public Health Basingstoke, 1937, 50, 295-97.
169. W. Vernon Shaw, "An Outbreak of Enteric Fever in the County Borough of Bournemouth and the Boroughs of Poole and Christchurch," Rep. Public Health Med. Subj., 1937, 81, 1-25.
170. Anon., Editorial: "The Report on the Croyden Inquiry," Public Health Basingstoke, 1938, 51, 159-61, 159;
171. Anon., "The Croyden Typhoid Outbreak," Public Health Basingstoke, 1938, 51, 61-62;
172. Anon., "The Croyden Typhoid Outbreak and Inquiry," Public Health Basingstoke, 1938, 51, 119-21.
173. Anon., "The Croyden Typhoid Outbreak," Med. Officer, 1938, 60, 10.
174. Anon., Editorial: "The Report," 159.
175. Anon., Editorial: "A Milk-borne Outbreak and Its Lesson," Am. J. Public Health, 1937, 27, 1042-43;
176. see also Anon., Editorial: "The Croyden Epidemic of Typhoid Fever," Am. J. Public Health, 1938, 28, 644-46;
177. Anon., "Liability for Water-borne Disease," Am. J. Public Health, 1939, 29, 378-79.
178. James G. Cumming, "Should Barriers against Typhoid Be Continued?" J. Am. Med. Assoc., 1932, 98, 93-95.
179. This approach is underscored by the first English review article to be written in many decades.
180. W. M. Scott, "The Control of the Common Fevers: Enteric Fevers," Lancet, 1940, 1, 389-93.
181. James Craigie and Chun Hui Yen, "The Demonstration of Types of B. typhosus by Means of Preparations of Type II Vi Phage," Can. J. Public Health, 1938, 29, 448-63; 483-96.
182. W. H. Bradley, "An Epidemiological Study of Bacterium Typhosum Type D4," Br. Med. J., 1943, 1, 438-41.
183. James Craigie and Arthur Felix, "Typing of Typhoid Bacilli with Vi Bacteriophage," Lancet, 1947, 1, 823-27, 823.
184. Wilson, "The Public Health Laboratory Service," Williams, Microbiology.
185. Anon., Editorial: "Municipal Public Health Engineering: An Urgent Situation," Am. J. Public Health, 1941, 31, 182;
186. Haven Emerson and Martha Luginbuhl, "1,200 local Public Health Departments for the United States," Am. J. Public Health, 1945, 35, 898-904.
187. John E. Gordon, "The Twentieth Century-Yesterday, Today and Tomorrow," in The History of American Epidemiology, ed. Charles-Edward Winslow et al. (London: Henry Kimpton, 1952), 153.
188. Anon., Editorial: "A National Nerve Center for Public Health Laboratory Service," Am. J. Public Health, 1947, 37, 745-47, 746.
189. Chief Medical Officer's Report (London: HMSO, 1949), 43-44.
190. Allen W. Freeman, "Typhoid Fever and Municipal Administration," Public Health Rep., 1917, 32, 642-55.
191. T. Carnwath, "A Brief Survey of Public Health Organization in the United States of America," Proc. Royal Soc. Med., 1925, 18, 11-27, 13.
192. Wolman, "The Public Health Inspector," 435-46.
193. Anon., Editorial: "A Third of the Nation without Health Protection," Am. J. Public Health, 1945, 35, 952-53, 952.
194. Anon., "Vote des propositions," Bull. de l'Acad. Med., 1910, 63, 239-54.
195. John C. G. Ledingham, "'The Carrier Problem in Relation to Enteric Fever and Diphtheria': The Harben Lectures, 1925," J. State Med., 1926, 34, 63-95, 65, 83.
196. Hardy : Problem of Typhoid 37