COLON-TYPHOID INTERMEDIATES 249 



type may at times produce typhoidal symptoms. He believes it is no 

 more advisable to make a clinical subdivision of these cases than of the 

 cases of pneumonia or infective endocarditis which may be due to one 

 of several different micro-organisms. Paratyphoid infections do not 

 constitute a clinical entity. There is at least as great diversity among 

 the different types of typhoid fever as between typhoid fever and para- 

 typhoid infections. Moreover, typhoidal symptoms may be produced 

 by Petruschky's bacillus faecalis alcaligenus (the author states that it 

 was obtained from the feces of patients suspected to have typhoid fever) 

 and yet this bacillus is not an intermediate. It lies just without the 

 group on the typhoid side, in that it does not acidify any sugar-contain- 

 ing medium (Dunham). It is true that the intestinal lesions are different 

 in that Peyer's patches are not usually markedly involved. Even when 

 fatal hemorrhages occur there are usually found only one or more deep 

 erosions. The average course is milder and the method of infection 

 somewhat different. 



These various considerations make it necessary to abandon the idea 

 of the specificity of the clinical disease typhoid fever. As in the case 

 of abscesses the physician recognizes the clinical fact, the bacteriologist 

 determines the causative agent. It certainly seems better to confine the 

 terms "paratyphoid" and "paracolon" to the domain of bacteriology 

 and to hospital practice, where bacteriological examinations can be 

 carefully made, and to broaden the scope of the etiology of typhoid 

 fever to include these several organisms bacillus fsecalis alcaligenus (?), 

 bacillus typhosus, bacillus paratyphosus, and certain members of the 

 paracolon group (^-paratyphoids). 



Geographical Distribution and Relative Frequency of Paratyphoid 

 Infection. The cases have been widely distributed geographically, 

 having occurred in Paris, Hamburg, Bremen, Strassburg, Liverpool, 

 Philippine Islands, New York City, Baltimore, and Philadelphia. 



Very little can be said of the relative frequency of paratyphoid infec- 

 tions. Gwyn's case was the only one of 265 cases which failed to give 

 the Widal reaction. Six of Schottmuller's cases occurred in a series 

 of 68 and Kurth's 5 in a series of 62 cases whose sera were tested for 

 the Widal reaction. Johnston's 4 cases were found among 194, and 

 Hewlett's 1 in a series of 26 cases of typhoid fever. Hiinermann has 

 reported an epidemic of 38 cases of paratyphoid infection occurring in 

 the garrison at Saarbriick. Falcioni reports 5 cases out of 100 cases 

 of supposed typhoid fever. The proportion of negative Widal reactions 

 is low in the "statistics, but there is a source of error here in that until 

 very recently the tests have not been made in high-enough dilutions 

 that is, at least as high as 1 : 40. 



Post-mortem Findings. Autopsies were performed on 3 fatal cases 

 (Strong, Longcope, Tuttle). The interest in these autopsies naturally 

 centres on the condition of the intestine. Strong states that both the 

 large and small intestines were normal throughout except for moderate 

 catarrh and a few superficial hemorrhages. The solitary and agmin- 

 ated follicles showed no lesions. The mesenteric lymphatics, how- 



