236 THE INFECTIOUS DISEASES. 



DISTRIBUTION OF THE TYPHOID BACILLUS IN THE BODY IN TYPHOID 



FEVER. 



In the early stages of the disease the bacillus may be found in the 

 'latic structures of the intestines and in the mesenteric lymph-nodes 

 and hie spleen. It may be present Jii 

 lesions involving the bone marrow^ kid- 



lungs, pleura, uterus, testicle. 

 and skiiij 1 as well as in the blood. 2 

 Typhoid bacilli have been repeatedly 

 found in the urine and in the bile, and 



- ^^^ ^ ^^~^ -^. -^^^^ 



may persist here long after the establish - 

 menjj^of con valescen ce^. a They may be 

 found, though not in such abundance as 

 was formerly assumed, in^the intestinal 

 contents, aftgrjthe disease has become wq]| 

 establisjj^d. Their abundance here ap- 

 pears to depend somewhat upon the de- 



no. 115.-Cu:sTicR OF TYPHOID BA- ,. . 7" , T -, , ,, 



CILLI IN THE SPLEEN. gree of intestinal ulceratioir. In the vis^ 



cera they are apt to occur in larger and 



smaller masses or clusters (see Fig. 115). TlTe typhoid bacillus may 

 be traiismitted~fhrough the placenta to the foetug. 4 " 



Typhoid bacilli mav be present alone, or in association with other 



* ^^ * I ' ^p ^^.^^ ^^^ -^^^ 



germs iu_the foci of suppuration which so frequently complicate typhoid 

 fever, also in the exudate in inflammations of the serous membranes and 

 in the ejjxjocardial vegetations. 5 



Some of the infla.Tnmit^prv complications which occur in typhoid fever 

 are due^ojhe growth of the bacillus in unusual places in the body ; but 

 many of them are due to a secono|ar^j^f ection with other jeering, notably 

 with the pyogenic cocci^ 6 also with the colon bacillus and the pueumo- 

 coccus. 7 



MODES OF iNFJ.riTTQN WITH THE TYPHOID BACILLUS. 



Infection with the typhoid bacillus seems usually to occur through 

 the gastro-intestinal canal.^ In a large proportion of cases tEe bacilir 

 by rnftans of food^ and especially of milk and drinking- 



See Pratt, Jour. Boston Soc. Med. Sciences, vol. iii., p. 170, 1899. 



2 See Auerbach, Deutsche med. Wochenschr. , December 6th, 1900, bibliography; 

 also Hewlett, N. Y. Med. Rec., vol. lx., 1901, p. 849. 



3 Gwyn, Johns Hopkins Hosp. Bull., vol. x., p. 109, 1899; also Curschmann, on 

 typhoid cystitis, Munchener med. Wochenschr., October 16th, 1900. 



4 Kef. Lartigau, New York Med. Jour., June 16th, 1900. 



5 See Flexner, Journal of Pathology and Bacteriology, vol. iii., p. 202, 1895, and 

 Johns Hopkins Hospital Reports, vol. v., p. 343; also Mace, "Traite de Bacte"riologie," 

 1901. 



6 For full consideration of the pyogenic powers of the typhoid bacillus, consult 

 Dmochowski and Janowski, Ziegler's Beitr. /. path. Anat., etc., Bd. xvii., p. 221, 1895. 



7 Keen, " The Surgical Complications of Typhoid Fever," 1898. Ha,re, " The Medi- 

 cal Complications of Typhoid Fever," 1899. 



