656 PATHOGENIC MICROORGANISMS 



been described by Welch, Richardson, * and others. They usually take 

 the form of periosteal abscesses, often located upon the tibia, occurring 

 either late in the disease or months after convalescence, and are char- 

 acterized by very severe pain. Osteomyelitis rnay also occur, but is 

 comparatively rare. Subcutaneous abscesses and deep abscesses in the 

 muscles, due to this bacillus, have been described by Pratt. 45 Synovitis 

 may also occur. 



Meningitis, due to the typhoid bacillus, occurs occasionally, usually 

 during convalescence from typhoid fever. A case of primary typhoid 

 meningitis has been reported by Farnet. 46 



Peritoneal abscesses, due to the typhoid bacillus, have been reported. 

 The writer 47 has reported a case in which typhoid bacilli were found free 

 in the peritoneal cavity during typhoid fever without perforation of the 

 gut. 



Isolated instances of typhoid bacilli in abscesses of the thyroid and 

 parotid glands and in brain abscesses have been observed. 



Typhoid Fever without Intestinal Lesions, A number of cases have 

 been reported in which typhoid bacilli have been isolated from the 

 organs after death or from the secretions during life of patients in whom 

 the characteristic lesions of typhoid fever have been lacking. Most 

 of these cases must be regarded as true typhoid septicemias. In some 

 cases the bacilli were isolated from the spleen, liver, or kidneys; in 

 others, from the urine or the gall-bladder. In a case observed by 

 Zinsser the bacilli were isolated from an infarct of the kidney removed 

 by operation. In this case the clinical course of the disease had pointed 

 only toward the existence of an indefinite fever accompanied by symp- 

 toms referable to the kidneys. The Widal test, however, was positive. 

 A summary of such cases, together with several personally observed, 

 has been given by Flexner. 48 



Poisons of the Typhoid Bacillus. Investigation of the toxic 

 products of the typhoid bacillus has occupied the attention of a large 

 number of workers. The first to do experimental work upon the sub- 

 ject was Brieger 49 soon after the discovery and cultivation of the 

 bacillus. That toxic substances can be obtained from typhoid cultures 

 is beyond question. There is, however, a definite difference of opinion 



* Richardson, Jour. Boston Soc. Med. Sci., 5, 1900. 

 Pratt, Jour. Boston Soc. Med. Sci., 3, 1899. 



46 Farnet, Bull, de la soc. med. des hop. dc P., 3, 1891. 



47 Zinsser, Proc. N. Y. Path. Soc., 1907. 



48 Flexner, Johns Hopk. Rep., 5, 1896. 



49 Brieger, Deut. med. Woch., xxvii, 1902. 



