TYPHOID FEVER. 479 



provoke a cholecystitis. Cushing has collected six cases 

 of operation for cholecystitis with calculi in which ty- 

 phoid bacilli were present, and five in which the Bacillus 

 coli communis was present in the gall-bladder. 



The bacilli can be found in the intestinal lesions, in 

 the mesenteric glands, in the spleen, in the liver, in the 

 kidneys, and in any local lesions which may be present. 

 Their scattered distribution and their occurrence in 

 minute clumps have already been alluded to. They 

 should always be sought for at first with a low power of 

 the microscope. 



Ordinarily no bacilli can be found in the blood, but 

 it has been shown that the blood in the roseolae some- 

 times contains them, so that the eruption may be re- 

 garded as one of the local irritative manifestations of the 

 bacillus. 



A particularly careful work upon this subject has been 

 done by Richardson, 1 who found that by carefully disin- 

 fecting the skin, freezing it with chlorid of ethyl, making 

 a crucial incision, and cultivating from the blood thus 

 obtained, he was able to secure the typhoid bacillus in 

 thirteen out of fourteen cases thus examined. It was, 

 however, necessary to examine a number of spots in each 

 case. 



As a means of diagnosis the matter is of some impor- 

 tance, as the occurrence of rose spots and the cultivation 

 from them of the bacilli often preceded the occurrence 

 of the Widal reaction by a number of days. 



The amount of local disturbance, in proportion to the 

 constitutional disturbance, is, in the majority of cases, 

 slight, and almost always partakes of a necrotic charac- 

 ter, which suggests that in typhoid we have to do with a 

 toxic bacterium whose disease-producing capacity resides 

 in the elaboration of a toxic substance. This, indeed, 

 is true, for Brieger and Frankel have separated from 

 bouillon cultures a toxalbumin which they thought to be 

 the specific poison. Klemperer and Levy also point out 



1 Phila. Med. Jour., Mar. 3, 1900. 



