598 Typhoid Fever 



". . . Histologically the typhoid process is proliferative and 

 stands in close relationship to tuberculosis, but the lesions are diffuse 

 and bear no intimate relation to the typhoid bacillus, while the 

 tubercular process is focal and stands in the closest relation to the 

 tubercle bacillus." 



The growth of the bacilli in the kidneys causes albuminuria, and the 

 bacilli can be found in the urine in about 25 per cent, of the cases. 

 Smith* found them in the urine in 3 out of 7 cases which he investi- 

 gated; Richardson,t in 9 out of 38 cases. 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, the urine being actually clouded by their presence. 

 Petruschkyt found that albuminuria sometimes occurs without 

 the presence of the bacilli; that their presence in the urine is infre- 

 quent; that the bacilli never appear in the urine in the early part of 

 the disease, and hence are of little importance for diagnostic pur- 

 poses. Gwyn§ has found as many as 50,000,000 typhoid bacilli 

 per cubic centimeter of urine, and mentions a case of Cushing's in 

 which the bacilli persisted in the urine for six years after the primary 

 attack of typhoid fever. Their occurrence, no doubt, depends pri- 

 marily upon a t)^hoid bacteremia, by which they are brought to the 

 kidney. Their persistence in the urine after recovery from typhoid 

 fever, depends upon continued growth in the bladder and not upon 

 continuous escape from the blood. It is of importance from a 

 sanitary point of view to remember that the urine as well as the feces 

 is infectious. 



The bacilli pass from the lymphatics to the general circulation, so 

 that all cases of typhoid fever are true bacteremias during part or all 

 of their course. 



Bacilli can be found in the circulating blood. The eruption 

 may be regarded as one of the local irritative manifestations of the 

 bacillus, as the blood from the roseolae always contains them, and 

 Richardson 1 1 found it necessary to examine a number of spots in 

 each case. He carefully disinfected the skin, freezing it with 

 chlorid of ethyl, making a crucial incision, and cultivating from 

 the blood thus obtained. He was able to secure the typhoid 

 bacillus in 13 out of 14 cases examined. 



As a means of diagnosis the matter is of some importance, as the 

 rose spots may precede the occurrence of the Widal reaction by a 

 number of days. 



In rare instances the bacillus may be found in the expectoration, 

 especially when pulmonary complications arise in the course of the 



* "Brit. Med. Jour.," Feb. 13, 1897. 



t "Journal of Experimental Medicine," May, 1898. 



i "Centralbl. f. Bakt. u. Parasitenk.," May 13, 1898, No. 13, p. 577. 



§ "Phila. Med. Jour.," March 3, 1900. 



II "Phila. Med. Jour.," March 3, 1900. 



