640 Typhoid Fever 



bacillus are in the tissues and not in the intestine, as seems 

 to be a widely prevalent error. It is contrary to most of 

 our knowledge of the organism that it should easily adapt 

 itself to saprophytic existence among the more vigorous 

 intestinal organisms. Those who look for it in the feces 

 are usually surprised at the difficulty of finding it, or at the 

 small numbers they succeed in isolating. It is far more 

 easy to isolate the organism from the blood than from the 

 feces, and much greater numbers occur in the urine than in 

 the feces. It probably escapes from the blood into the 

 bile, where it grows luxuriantly, and entering the gall-bladder 

 may take up permanent residence there, escaping into the 

 intestine each time the gall-bladder is emptied. Many 

 bacilli thus discharged probably meet with destruction in the 

 intestine, though some convalescents from typhoid fever for 

 years have a periodic appearance of bacilli in the feces. 

 Such individuals have become known as "typhoid carriers" 

 and are a menace to the public. 



In a case studied by Miller* they were found in the gall- 

 bladder seven years after recovery from typhoid fever; in a 

 case studied by Drobaf bacilli were found in both the gall- 

 bladder and a gall-stone seventeen years after recovery from 

 typhoid fever ; in a case of Humer, J in the gall-bladder of a 

 patient suffering from cholecystitis, eighteen years after re- 

 covery from an attack of typhoid fever, and in a case studied 

 by Dean,' in the stools of a man twenty-nine years after 

 he had had typhoid fever, and who had probably been 

 carrying them about in his gall-bladder ever since. Gush- 

 ing || invariably found the bacilli in the bile in clumps re- 

 sembling the agglutinations of the Widal reaction. He 

 thinks it probable that these clumps form nuclei upon which 

 bile salts can be precipitated and calculous formation begun. 

 The presence of gall-stones, together with the long-lived 

 infective agents, may at any subsequent time provoke a 

 cholecystitis. Gushing collected 6 cases of operation for 

 cholecystitis with calculi in which typhoid bacilli were 

 present, and 5 in which Bacillus coli communis was present 

 in the gall-bladder. 



* "Bull, of the Johns Hopkins Hospital," May,i898. 



t "Wiener klin. Wochenschrift," 1899, xn, p. 1141. 



J"Bull. of the Johns Hopkins Hospital," Aug. and Sept., 1899. 



"British Medical Journal," March 7, 1908, I, p. 562. 



|| "Bull, of the Johns Hopkins Hospital," ix, No. 86. 



