412 PATHOGENIC MICROORGANISMS 



occasion ' to observe a case in which an operation for gall-stone seven- 

 teen years after the occurrence of typhoid fever revealed the pres- 

 ence 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 interesting 

 example of such a typhoid carrier has been carefully studied and re- 

 ported by Park.^ 



Typhoid Bacilli in the Rose Spots. — A number of observers have 

 succeeded in isolating typhoid bacilli from the rose spots. Neufeld,^ who 

 made an extensive investigation of this question, obtained positive 

 results in thirteen out of fourteen cases. According to his researches 

 and those of Frankel,* the bacilli are localized not in the blood, which 

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

 numbers 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 byChantemesse 

 and Widal,^ Frankel," 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 must be considered, but 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, suppurative 

 lesions may occur in various parts of the body. The most frequent locali- 

 zation 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,' and others. They usually take the form of periosteal ab- 

 scesses, often located upon the tibia, occurring either late in the disease 

 or even months after convalescence, and are characterized by very 

 severe pain. Osteomyelitis may also occur, but is comparatively rare. 

 Subcutaneous abscesses and deep abscesses in the muscles, due to this 

 bacillus, have been described by Pratt. ^ Synovitis may also occur. 



^Zinsser, Proc. N. Y. Pathol. Soc, 1908. 



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



s Neufeld, Zeit. f. Hyg., xxx, 1899. 



'Frankel, Zeit. f. Hyg., xxxiv, 1900. 



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



'Frankel, Deut. med. Woeh., xv and xvi, 1899. 



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



8 Pratt, Jour. Boston Soc. Med. Sci., 3, 1899. 



