170 
TYPHOID PEVEK IN DISTRICT OF COLUMBIA. 
dysentery from whose discharges they isolated the typhoid bacillus. 
Shortly after this she died, and at necropsy there was found, besides 
a chronic catarrh of the lower intestine, many typical old typhoid 
ulcerations in the small intestine. The gall bladder was full of 
small and large gall stones and the typhoid bacillus was found not 
only in the small intestine but in pure culture in the gall bladder. 
The typhoid bacillus enters the gall bladder from the blood. In 
the gall bladder it finds the bile a satisfactory medium in which to 
live and multiply, which it may do for years, and with which it is 
discharged in variable numbers into the small intestine. In the gall 
bladder it may give rise, as in the case above cited, to gall-stone 
formation and to cholecystitis of varying degrees of intensity. 
Several interesting and valuable contributions on this phase of the 
subject have been made, among which may here be mentioned those 
of Blachstein (1891), Welch (1891), Dupre (1891), Gilbert and 
Girode (1893), von Dungern (1897), Cushing (1898), Miller (1898), 
Droba (1899), Hunner (1899), Brion (1901), Blumenthal (1904), 
Forster and Kayser ( 1905), Doerr ( 1906), and Spartaco Minelli ( 1906). 
The long persistence of the typhoid bacillus in the urine is usually 
associated with more or less marked cystitis, as in the cases reported 
by Blumer (1895), Houston (1899), and Busing (1902). The bacilli 
may find their way into the urinary bladder, as Kurth (1901) suggests, 
by wandering from the anus to the meatus urinarius, especially in 
women, or perhaps by penetrating the recto-vesical septum, as sug- 
gested by Blumer (1895); but during the febrile period of the disease 
they most commonly pass from the blood through the kidneys. In 
the bladder they multiply and are usually found in enormous numbers 
in the voided urine. 
It may be of interest to cite from the literature a few additional 
instances illustrating the dangerous character of bacillus-carriers. 
Walker (1900) reports the case of a yeoman returned from South 
Africa after an attack of typhoid who, by infecting a well, caused 12 
cases of the disease. 
Allbutt (1901) reports an exceedingly interesting and instructive 
observation: A convalescent from typhoid went from Liverpool to 
visit a kinsman on a distant and isolated farm. Shortly after his 
arrival a servant was taken sick. Several weeks after recovering 
from her attack this woman went to serve at another place at some 
distance from the first. Some weeks later a case of typhoid devel- 
oped on the latter farm. 
Donitz (1903) mentions the case of a woman who was discharged 
from the hospital recovered from an attack of typhoid in November. 
In the following June her husband developed the disease, and exam- 
ination showed the wife to be discharging the typhoid bacillus in her 
urine. 
