412 PATHOGENIC MICROORGANISMS 



gall-stone seventeen years after the occurrence of typhoid fever revealed 

 the presence of the bacilli in the gall-bladder. In such cases typhoid 

 bacilli may be constantly discharged from the intestine with the feces 

 and prove a menace to the health of the community. An extremely in- 

 teresting example of such a typhoid carrier has been carefully studied 

 and reported by Park. 1 



Typhoid earners are much more- common than formerly supposed. 

 Lentz 2 believes that about 4 per cent of all cases become chronic car- 

 riers and Goldberger, averaging the cases of other workers, calculates 

 that of 1,782 cases of typhoid, 53 or about 3 per cent became chronic 

 carriers. This problem therefore is of the utmost sanitary import- 

 ance. Even when detected the cure of such carriers is very difficult, 

 and perhaps in some cases impossible without cholecystectomy. Vac- 

 cine treatment has not been encouraging and no other form of uni- 

 formly successful treatment has so far been devised. 



Typhoid Bacilli in the Rose Spots. Neufeld 3 obtained positive re- 

 sults in thirteen out of fourteen cases. According to his researches and 

 those of Frankel, 4 the bacilli are localized not in the blood, which is 

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

 bers 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, 5 Frankel, 6 and a number of others. Empyema, 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 of the long 

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

 described by Welch, Richardson, 7 and others. They usually take the 

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



1 Park, "Pathogenic Bacteria," N. Y., 1908. 



2 Lentz, Hyg. Rundschau, vol. 16, 1906. 



3 Neufeld, Zeit. f. Hyg., xxx, 1899. 4 Frankel, Zeit. f. Hyg., xxxiv, 1900. 

 B Chantemesse and Widal, Arch, de physiol. norm, et path., 1887. 



6 Frankel, Deut. med. Woch., xv and xvi, 1899. 



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



