366 THE ALCALIGENES— DYSENTERY— TYPHOID GROUP 
meninges, bone-marrow, certain muscles and the tonsils. Parenchy- 
matous degeneration of the heart, liver and kidneys is common, 
as is a catarrhal inflammation of the respiratory tract and a severe 
inflammation of the entire intestinal mucous membrane. Somewhat 
unconnnonly, typhoid cases have been recorded in which there are no 
intestinal lesions. In these cases it would appear that the disease is 
septicemic in character.^ In typhoid fever there is leukopenia, due 
apparently to some interference with the activity of the bone-marrow. 
The febrile reaction is usually attributed to the liberation of endotoxin 
from typhoid bacilli, which are dissohed in the blood stream by 
specific lysins. This toxin exhibits both a general and local reaction. 
The general reaction is characterized chiefly by fever and symptoms 
of generalized toxemia; the local reaction is particularly marked in 
those areas where typhoid bacilli undergo solution, as in the spleen 
and Peyer's patches. 
Various complications of typhoid fe^er are occasionally reported, 
caused by the localization of typhoid bacilli either alone or in asso- 
ciation with other bacteria, as the streptococcus, staphylococcus or 
pneumococcus in various organs. Peritonitis, usually following per- 
foration of an ulcer in the intestinal w'all, is one of the most severe of 
these complications. Abscess formation in various deep-seated organs, 
as the spleen and psoas muscle, is not uncommon. Bronchopneu- 
monia, pleurisy, pericarditis, osteitis and inflammation of the mem- 
branes of the cord (meningitis) and brain have also })een attributed 
to the typhoid bacillus. 
Carriers.— Typhoid bacilli cannot be isolated from the majority 
of typhoid patients after the fifth week of the disease. In a small 
percentage of cases, however, the organisms may be excreted in the 
urine, or more commonly in the feces, for months or even years after 
recovery. Thus, Philipowicz^ isolated typhoid bacilli from a case of 
cholecystitis who had had typhoid fever thirty-eight years previous 
to the operation. In this case very few typhoid bacilli were present 
in the feces, and it is probable that the few organisms were over- 
whelmed by the intestinal bacteria during their passage through the 
intestinal tract. From 1 to 4 per cent of all typhoid cases which 
recover appear to become fecal typhoid carriers; a smaller percentage 
become urinary carriers. No history of typhoid fever can be elicited 
from some of these carriers, and the supposition is that either the 
carrier had in the past a mild unrecognized case, or less commonly, 
that the organism had become acclimatized in the intestinal tract 
without inducing disease. Many carriers give a positive Widal 
reaction. 
The residual focus of typhoid bacilli in carriers is usually the gall- 
bladder and the ducts of the gall-bladder, less commonly the urinary 
1 Possett: Atypische Typhusinfektion. Lubarsh and Ostertag: Ergeb. d. allgem. 
Pathol., 1912, 16, 184. 
2 Wien. klin. Wchnschr., 1911, 24, 1S02, 
