TYPHOID FEVER. 377 



be found in the urine. P. Horton Smith l found the ba- 

 cilli in the urine in three out of seven cases which he 

 investigated. They did not occur before the third week, 

 and remained in one case twenty-two days after cessation 

 of the fever. Sometimes they were present in immense 

 numbers. Their occurrence, no doubt, depends upon 

 their growth in the kidney and descent with the urine. 

 It is of importance from a sanitary point of view to 

 remember that the urine as well as the feces is infec- 

 tious. Occasionally the bacilli succeed in entering the 

 general circulation, and, finding a lodgement at some 

 remote part of the body, set up local inflammatory pro- 

 cesses sometimes terminating in suppuration. 



Weichselbaum has seen general peritonitis from rup- 

 ture of the spleen in typhoid fever with escape of the 

 bacilli. Ostitis, periostitis, and osteomyelitis are very 

 common results of the lodgement of the bacilli in bony 

 tissue, and Ohlmacher has found the bacilli in suppura- 

 tions of the membranes of the brain. The bacilli are 

 also encountered in other local suppurations occurring 

 in or following typhoid fever. Flexner and Harris 2 have 

 seen a case in which the distribution of the bacilli was 

 sufficiently widespread to constitute a real septicemia, 

 the bacillus being isolated from various organs of the 

 body, and shown to be the true bacillus of Eberth by 

 all the specific laboratory tests, but in which there were 

 no intestinal lesions. 



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- 



1 Brit. Med. Jour., Feb. 13, 1897. 



2 Bull, of the Joints Hopkins Hospital, Dec , 1897. 



