Pathogenesis 501 



done by Richardson,* 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 examined. It was, however, 

 necessary to examine a number of spots in each case. 



As a means of diagnosis the matter is of some importance, 

 as the occurrence of rose spots may precede the occurrence 

 of the Widal reaction by a number of days. 



The pyogenic power of the typhoid bacillus was first 

 pointed out by A. Frankel, who observed it in a suppuration 

 that occurred four months after convalescence. Low f found 

 virulent typhoid bacilli in the pus of abscesses occurring 

 from one to six years after convalescence. 



Weichselbaum has seen general peritonitis from rupture 

 of the spleen in typhoid fever with escape of the bacilli. 

 Otitis media, ostitis, periostitis, and osteomyelitis are very 

 common results of the lodgment of the bacilli in bony tissue ; 

 and Ohlmacher J has found the bacilli in suppurations of 

 the membranes of the brain. The bacilli are also encoun- 

 tered in other local suppurations occurring in or following 

 typhoid fever. Flexner and Harris have seen a case in 

 which the distribution of the bacilli was sufficiently wide- 

 spread to constitute a real septicemia, the bacillus being 

 isolated from various organs of the body. 



The bacilli commonly escape from the blood into the bile, 

 where they persist for a long time, as in the case studied 

 by Miller, || when they were found in this viscus seven years 

 after recovery from typhoid fever, and the case of Humer,** 

 who found them in the gall-bladder of a patient suffering 

 from cholecystitis, eighteen years after recovery from an 

 attack of typhoid fever. Gushing |f invariably found the 

 bacilli in the bile in clumps resembling the agglutinations 

 of the Widal reaction. He thinks it probable that these 

 clumps form nuclei upon which bile salts can be precipitated 



* "Phila. Med. Jour.," March 3, 1900. 



f "Sitz. der k. k. Gesellschaft d. Aerzt. in Wien," "Aerztl. Central- 

 Anz.," 1898, No. 3. 



t "Jour. Amer. Med. Assoc.," Aug. 28, 1897. 



"Bull. Johns Hopkins Hospital, Dec., 1897. 



\\lbid., May, 1898. 



** "Bull, of the Johns Hopkins Hospital," Aug. and Sept., 1899. 



ft Ibid., ix, No. 86. 



