BACILLI OF THE COLON-TYPHOID-DYSENTERY GROUP 655 



to be present for weeks, months, and, in isolated cases, for years after 

 convalescence, the examination thus having much hygienic importance. 

 They are probably present in about 12 per cent of cases during the early 

 days of convalescence. In most of these, albumin is present in the 

 urine in considerable quantities. The bacilli usually appear and dis- 

 appear with the albuminuria. 



An obstinate cystitis caused by typhoid bacilli may follow in the 

 path of typhoid fever. Such cases have been reported by Blumer, 39 

 Richardson, 40 and others. Suppurative processes in the kidneys are 

 less frequent. It is noteworthy, also, that in the course of, and fol- 

 lowing, typhoid fever Bacillus coli is often present in the urine. This 

 may obstinately persist for considerable periods after convalescence. 



For examination of the urine for typhoid bacilli, specimens should be 

 taken with aseptic precautions and planted directly into equal volumes 

 of broth. Direct plates on Endo can also be made, or had better be 

 made at the same time. It is relatively easy under such circumstances 

 to obtain the organism if present. 



Typhoid Bacilli in the Rose Spots. Neufeld 41 obtained positive 

 results in thirteen out of fourteen cases. According to his researches 

 and those of Frankel, 42 the bacilli are localized not in the blood, which is 

 taken when the rose spots are incised, but are crowded in large numbers 

 within the lymph spaces. 



Typhoid Bacilli in the Sputum. In rare cases typhoid bacilli have 

 been found in the sputum of cases complicated by bronchitis, broncho- 

 pneumonia, and pleurisy. Such cases have been reported by Chante- 

 messe and Widal, 43 Frankel, 44 and a number of others. Empyemia, 

 when it occurs in connection with such cases, is usually accompanied by a 

 mixed infection. From a hygienic point of view the spread of typhoid 

 fever by means of the sputum is probably of rare occurrence. 



Suppurative Lesions Due to Typhoid Bacillus. In the course of 

 typhoid convalescence or during the latter weeks of the disease, sup- 

 purative lesions may occur in various parts of the body. The most 

 frequent localization of these is in the periosteum, especially on the long 

 bones, and in the joints. A considerable number of such lesions have 



39 Blumer, Johns Hopk. Hosp. Rep., 5, 1895. 



40 Richardson, loc. oit. 



41 Neufeld, Zeit. f . Hyg., xxx, 1899. 



ri Frankel. Zeit. f. Hy^., xxxiv, 1909. 



4:i ('hantemesse and Widiil, Arch. d(> physiol. norm, ct path., 1887. 



44 Frankel, Dent. med. Woch., xv and xvi, 1899. 



