BACILLUS OF TYPHOID FEVER 411 



Typhoid Bacilli in the C/nne.— Careful investigation by a number of 

 workers has revealed typhoid bacilli in the urine in about twenty-five 

 per cent of all patients. Neumann* discovered the bacilli in eleven out 

 of forty-six cases and Karlinski ^ in twenty-one out of forty-four cases. 

 Investigations by Petruschy,' Richardson/ Horton-Smith/ Hiss/ 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 hav- 

 ing much hygienic importance. They are probably present in about 

 twelve per cent of cases during the early days of convalescence. In 

 most of these cases where typhoid bacilli are found, albumin is present 

 in the urine in considerable quantities. The bacilli usually appear and 

 disappear with the albuminuria. 



It is not infrequent that an obstinate cystitis caused by typhoid ba- 

 cilli may follow in the path of typhoid fever. Such cases have been re- 

 ported by Blumer,' Richardson,* and others. Suppurative processes in 

 the kidneys are less frequent. It is noteworthy, also, that in the course 

 of, and following, typhoid fever there often occurs voiding of Bacillus 

 coli with the urine. This may obstinately persist for considerabe periods 

 after convalescence. The reasons for this are not entirely clear. 



Typhoid Bacilli in the Gall-Bladder. — Typhoid bacilli have been 

 frequently observed in the gall-bladder at autopsy. They have also 

 been found jjresent in this organ, at operations for cholecystitis, months 

 and years after the occurrence of typhoid fever. Miller ° has reported a 

 case in which typhoid bacilli were present in the gall-bladder seven 

 years after the disease; v. Dungem *" has cultivated them from an in- 

 flamed gall-bladder fifteen years after the disease. Zinsser has had 



' Neumann, Berl. klin. Woch., xxvii, 1890. 



^Karlinsky, Prag. med. Woch., xv, 1890. 



'Pelruschy, Cent. f. Hyg., xxiii, 1898. 



^Richardson, Jour. Exp. Med., 3, 1898. 



' Horton-Smith, Lancet, May, 1899. 



'Hiss, Med. News, May, 1901. 



' Blumer, Johns Hopkins Hosp. Reports, 5, 1895. 



8 Richardson, loc. cit. 



9 Miller, Johns Hopkins Hosp. Bull., 1898. 



'"■!). Dunqern, Miinch. med. Woch., 1897. 

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