The campaign against typhoid and paratyphoid B in western Norway. Results of cholecystectomy

Extract

1. The first chronic carrier in western Norway was discovered in 1918. Since then 147 individuals have been found to be chronic carriers, 84 being carriers of S. typhi and 63 of S. paratyphi B.

2. Of the 147 chronic carriers 23 were males and 124 females. Most of the carriers were elderly folk, 96 over the age of 50 and 37 over the age of 70 when their carrier state was discovered. There is a considerable rise in the incidence of gall-stones among women around the age of 50, while a similar rise comes at a higher age in men. This sex difference may be a contributory cause of the larger number of female carriers.

3. Operations were performed on 66 chronic carriers with a view to curing the carrier state. In 2 cases, only cystotomy could be performed because of the state of the gall-bladder. In one of these the carrier state was cured, while it persisted in the other.

4. The gall-bladders of 64 chronic carriers were removed by operation with the following results: 2 died as a result of the operation, 9 remained carriers, and 53 are considered cured. The operation was therefore successful in four-fifths of the cases.

The gall-bladders of 2 individuals who remained carriers were found at operation to be sterile and perfectly normal, without stone formation. Two other individuals who remained carriers have later died, 1½ and 7 years after their operations. In both cases S. paratyphi B was cultivated from the common bile duct and the hepatic duct. The specific process may therefore in a few cases be situated at a higher level in the bile passages of the liver.

5. The interval between infection and operation varied from 3 months to 50 years. The 2 carriers who had the longest interval are both cured.

6. Indications for operation are given on the basis of the experiences provided by the present material.