596 Typhoid Fever 



case studied by Dean,* they were present in the stools of a man 

 twenty-nine years after he had had an attack of typhoid fever. 

 Cushingt 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 and calculous formation begun. The presence 

 of gall-stones, together with the long-lived infective agents, may 

 at any subsequent time provoke cholecystitis. Gushing collected 

 6 cases of operation for cholecystitis with calculi in which typhoid 

 bacilli were present, and 5 in which Bacillus coli was present 

 in the gall-bladder. 



Fig. 250. — Intestinal perforation in typhoid fever. Observe the threads of 

 tissue obstructing the opening. (Museum of the Pennsylvania Hospital.) 

 (Keen, "Surgical Complications and Sequels of Typhoid Fever.") 



With the most approved methods yet devised, Peabody and 

 Pratt t were unable to recover the micro-organism from the intestinal 

 contents in more than 21 per cent, of febrile cases, and only in small 

 numbers as a rule. The greatest number was obtained when there 

 was much blood in the stool. 



There is always well-marked blood-infection during the first 

 weeks of the disease, and upon this depends the occurrence of the 

 rose-colored spots. 



* "British Medical Journal," March 7, igo8, i, p. 562. 



t "Bull. of the Johns Hopkins Hospital," K, No. 86. 



t "Journal of the American Medical Association," Sept. 7, 1907, XLDf, p. 846. 



