INTRODUCTION 367 



The bacillus also sometimes passes into the urine of enteric fever patients. Besson 

 from an examination of thirty-three cases came to the conclusion that the bacillus 

 was only present when there was albumin in the urine and found it in 40 per cent, 

 of such cases : the bacillus disappears synchronously with the disappearance of the 

 albumin. Vincent found the bacillus in the urine in about 1 case in 5 of enteric 

 fever; he noticed that occasionally the bacillus remained in the urine after the 

 patient had recovered, and considered that under those conditions the organism 

 multiplied in the bladder. Horton Smith showed that the bacillus ~may set up 

 slight cystitis with pyuria. 



The bacillus is also the cause of many of the complications of enteric fever, such 

 for instance as inflammation of the fauces, naso-pharynx and larynx, broncho- 

 pneumonia and various suppurative affections : deep seated abscesses, osteitis, 

 adenitis, pleurisy, pericarditis, etc. It may also become localized in lesions existing 

 before the onset of the infection. Widal observed instances of this hi a case of 

 ovarian cyst and in a case of tuberculous adenitis. 



Chantemesse was the first to put forward the opinion afterwards supported 

 by Remlinger and Schneider that the typhoid bacillus might live a sapro- 

 phytic existence in the intestines of healthy persons. The investigations of 

 Remy and others, however, seem to prove that the bacillus is only found as 

 a saprophyte in the intestines of those who have recently been either in 

 contact with cases of the disease or in some other way exposed to infection. 

 But further, in a certain percentage (according to Schneider, 3 per cent.) of 

 patients who have recovered from the disease, and especially in women, 

 the bacillus may remain for several months and even years : it is said to take 

 up its abode principally in the gall bladder from whence it is discharged into 

 the intestine. It is easy to appreciate the prominent part which such 

 " carriers," to use Drigalski and Conradi's expression, may take in the dis- 

 semination of enteric fever. 



The bacillus has been frequently found in drinking water and in ice destined 

 for human consumption. Wherever enteric fever is epidemic the drinking 

 water should be examined for the presence of the typhoid bacillus. 



The organism has also been isolated from soil and from the dust of wards 

 in which cases of enteric fever have been nursed, etc. 



The attention of observers has been drawn to the part which flies may possibly 

 play in the propagation of the disease. During an epidemic of enteric fever at 

 Chicago, Mrs. Hamilton on several occasions obtained cultures of the typhoid, 

 bacillus by sowing flies which had been caught in water-closets, enteric wards, etc. 

 Ficker has shown that flies which have been in contact with cultures of the typhoid 

 bacillus may specifically contaminate objects on which they settle even as long 

 as 23 days afterwards. 



The typhoid bacillus and the colon bacillus are in many ways very like one 

 another and both have their usual habitat in the intestines of man and the 

 lower animals. The analogies which undoubtedly exist between these two 

 organisms have led some observers to express the opinion that they are 

 identical. This view however has not met with general acceptance and it is 

 now clear that the colon bacillus and the bacillus of enteric fever have each 

 their own characteristic properties and are in fact two distinct though closely 

 related species 



SECTION I. EXPERIMENTAL INOCULATION. 



The lower animals are not naturally susceptible to enteric fever. The 

 inoculation of laboratory cultures is in most cases without result ; some 

 observers indeed have noticed symptoms of intoxication in guinea-pigs, 

 rabbits and mice, but they have not been able to produce a generalization of 

 the bacillus. If, however, a virus of increased virulence be inoculated these 



