BACILLUS OF TYPHOID FEVER 411 



agglutination may be done in a Strong immune serum, either directly 

 from the colony by the hang-drop method, or better macroscopically 

 from the growth in the transplant. 



Typhoid Bacilli in the Urine. Careful investigation has revealed 

 typhoid bacilli in the urine in about twenty-five per cent of all patients. 

 Neumann 1 discovered the bacilli in eleven out of forty-six and Kar- 

 linsky 2 in. twenty-one out of forty-four cases. Investigations by Pe- 

 truschy, 3 Richardson, 4 Horton-Smith, 5 Hiss, 6 and others have confirmed 

 these results. In general the bacilli have not been found before the 

 fifteenth day of the disease, and examination of the urine, therefore, 

 can be of little early diagnostic value. A series of seventy-five cases 

 examined by Hiss before the fourteenth day of the disease did not once 

 reveal typhoid bacilli in the urine. On the other hand, they have been 

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

 after convalescence, the examination thus having much hygienic im- 

 portance. They are probably present in about twelve 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 Disappear 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, 7 

 Richardson, 8 and others. Suppurative processes in the kidneys are 

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

 lowing, typhoid fever there often occurs voiding of Bacillus coli with 

 the urine. This may obstinately persist for considerable periods after 

 convalescence. The reasons for this are not entirely clear. 



Typhoid Carriers and Typhoid Bacilli in the Gall-Bladder. Typhoid 

 bacilli have been frequently observed in the gall-bladder at autopsy. 

 They have also been found present in this organ, at operations for 

 cholecystitis, months and years after the occurrence of typhoid fever. 

 Miller 9 has reported a case in which typhoid bacilli were present in the 

 gall-bladder seven years after the disease; v. Dungern 10 has cultivated 

 them from an inflamed gall-bladder fifteen years after the disease. 

 Zinsser has had occasion 11 to observe a case in which an operation for 



1 Neumann, Berl. klin. Woch., xxvii, 1890. 6 Hiss, Med. News, May, 1901. 



2 Karlinsky, Prag. med. Woch., xv, 1890. 7 Blumer, Johns Hopk. Hosp. Rep., 5, 1895. 



3 Pelruschy, Cent. f. Hyg., xxiii, 1898. 8 Richardson, loc. cit. 



4 Richardson, Jour. Exp. Med., 3, 1898. 9 Miller, Johns Hopk. Hosp. Bull., 1898. 

 6 Horton-Smith, Lance}, May, 1899. 10 v. Dungern, Munch, med. Woch., 1897. 



11 Zinsser, Proc. N. Y. Pathol. Soc., 1908. 



