Pathogenesis 639 



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 primarily 

 upon a typhoid 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 bacilh 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. 



BaciUi 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 contains them. Richardson, * 

 however, found it necessary to examine a number of spots in each 

 case. He carefully disinfected the skin, freezing it with chlorid of 

 ethyl, made a crucial incision, and cultivated 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 

 disease. Cases of this kind have been reported bv Chantemesse and 

 WidalfandFrankel.t 



The pyogenic power of the typhoid bacillus was first pointed 

 out by A. Frankel, who observed it in a suppuration that occurred 

 four months after convalescence. Low§ found virulent typhoid 

 bacilH in the pus of abscesses occurring from one to six years after 

 convalescence. 



Weichselbaum has seen general peritonitis from rupture of the 

 spleen in typhoid fever, with escape of the bacilli. Otitis media, 

 ostitis, periostitis, and osteomyelitis are common results of the 

 lodgment of the bacilli in bony tissue. Ohlmacher|| has found the 

 bacilli in suppurations of the membranes of the brain. The 'bacilli 

 are also encountered in other local suppurations occurring in or 

 following typhoid fever. Flexner and Harris** have seen a case in 

 which the distribution of the bacilli was sufficiently widespread to 

 constitute a real septicemia. 



* "PhUa. Med. Jour.," March 3, 1900. 



t "Archiv. de physiol. norm. et. path.," 1887. 



I "Deutsche med. Wochenschrift," 1899, xv, xvi. 



§"Sitz. der b. k. Gesellschaft d. Aerzt. in Wien.," "Aerztl. Central-Anz.," 

 1898, No. 3. 



II "Jour. Amer. Med. Assoc," Aug. 28, 1897. 

 ** "BulL Johns Hopkins Hospital," Dec, 1897. 



