364 TYPHOID FEVER 



and which in the intestine is sufficiently powerful to cause 

 necrosis. The affections of the other organs of the body suggest 

 the circulation in the blood of poisonous substances capable of 

 depressing cellular vitality, and producing histological changes. 

 The occurrence of bacilli in the blood and organs links typhoid 

 fever with septicsemic processes. 



Suppuration occurring in connection with Typhoid Fever. 

 With regard to the relation of the typhoid bacillus to such 

 conditions, statements as to its isolation from pus, etc., can be 

 accepted only when all the points available for the diagnosis of 

 the organism have been attended to. On this understanding the 

 following summary may be given : In a certain proportion of 

 the cases examined the typhoid bacillus has been the only organ- 

 ism found. This has been the case in subcutaneous abscesses, 

 in suppurative periostitis, suppuration in the parotid, abscesses 

 in the kidneys, etc., and probably also in one or two cases of 

 ulcerative endocarditis. But in the majority of cases other 

 organisms, especially the b. coli and the pyogenic micrococci, 

 have been obtained, the typhoid bacillus having been searched for 

 in vain. It has, moreover, been experimentally shown, notably 

 by Dmochowski and Janowski, that suppuration can be experi- 

 mentally produced by injection in animals, especially in rabbits, 

 of pure cultures of the typhoid bacillus, the occurrence of sup- 

 puration being favoured by conditions of depressed vitality, etc. 

 These observers also found that when typhoid bacilli were 

 injected along with pyogenic staphylococci, the former died out 

 in the pus more quickly than the latter. Accordingly, in clinical 

 cases where the typhoid bacillus is present alone, it is improbable 

 that other organisms were present at an earlier date. 



Occurrence of Gallstones in those who have suffered from 

 Typhoid Fever. As has been stated, foci of bacilli occur in the 

 liver in typhoid fever, and these bacilli are excreted with the 

 bile. In the gall-bladder they apparently not infrequently set 

 up a catarrhal process in the biliary ducts and gall-bladder 

 (cholecystitis typhosa\ and are then in a better position for multi- 

 plication, in consequence of the presence of albuminous catarrhal 

 secretions. There is evidence that the bacilli may persist in the 

 gall-bladder for many years, and probably the catarrhal inflam- 

 mation which they keep up is responsible for many of the cases 

 of gallstones w r hich occur the albuminous matter produced 

 causing a deposit of the bile in a solid form. Typhoid bacilli 

 have actually been isolated from cases of gallstones operated on 

 years after an attack of typhoid fever, and the bacilli have even 

 been found within the calculi. They have also been demon- 



