BACILLUS OF TYPHOID FEVER 413 



Meningitis, due to the typhoid bacillus, occurs not infreciuently, 

 usually during convalescence from typhoid fever. A case of primary 

 typhoid meningitis has been reported by Famet.' 



Peritoneal abscesses, due to the typhoid bacillus, have been re- 

 ported. Zinsser^ has reported a case in which typhoid bacilli were 

 found free in the peritoneal cavity during typhoid fever without per- 

 foration of the gut. 



Isolated instances of typhoid bacilli in abscesses of the thyroid and 

 parotid glands and in brain abscesses have been observed. 



Typhoid Fever without Intestinal Lesions. — A considerable number 

 of cases have been reported in which typhoid bacilli have been isolated 

 from the organs after death or from the secretions during life of pa- 

 tients in whom the characteristic lesions of typhoid fever have been lack- 

 ing. Most of these cases must be regarded as true typhoid septicemias. 

 In some cases the bacilli were isolated from the spleen, liver, or kidneys; 

 in others, from the urine or the gall-bladder. In a case observed by 

 Zinsser the bacilli were isolated from an infarct of the kidney removed 

 by operation. In this case the clinical course of the disease had pointed 

 only toward the existence of an indefinite fever accompanied by symp- 

 toms referable to the kidneys. The Widal test, however, was positive. 

 An excellent summary of such cases, together with several personally 

 observed, has been given by Flexner.^ 



Hygienic Considerations. — Although typhoid fever is frequently 

 spoken of as an epidemic disease, it is, more truly, endemic in character 

 in almost all parts of the world, but subject to occasional epidemic ex- 

 acerbations. In the larger communities of the temperate zones these 

 epidemic increases take place chiefly in the autumn and, unlike epidemics 

 of diseases such as influenza, are usually distinctly circumscribed — 

 limited usually by the distribution of a particular water-supply. 



Since the disease never occurs except by transmission, directly or 

 indirectly, from a previous case, it is amenable more than most other 

 maladies to sanitary regulation, and it may be said without exaggera- 

 tion, in the light of our present knowledge, that any extensive prevalence 

 of typhoid fever in a large community is a direct consequence of some 

 defect in the system of sanitation. The disease is acquired by ingestion 

 of the specific bacteria. Infection by any other channel than that of the 

 alimentary tract has not, so far, been satisfactorily demonstrated. 



^Farnet, Bull, de la soc. m^d. des hop. de P., 3, 1891. 

 ^Zinsser, Proc. N. Y. Path. Soc, 1907. 

 3 i^tea;?ier, Johns Hopkins, Rep., 5, 1896. 



