TYPHOID FEVER. 377

be found in the urine. P. Horton Smithl found the ba-
cilli in the urine in three out of seven cases which he
investigated. They did not occur before the third week,
and remained in one case twenty-two days after cessation
of the fever. Sometimes they were present in immense
numbers. Their occurrence, no doubt, depends upon
their growth in the kidney and descent with the urine.
It is of importance from a sanitary point of view to
remember that the urine as well as the feces is infec-
tious. Occasionally the bacilli succeed in entering the
general circulation, and, finding a lodgement at some
remote part of the body, set up local inflammatory pro-
cesses sometimes terminating in suppuration.

Weichselbaum has seen general peritonitis from rup-
ture of the spleen in typhoid fever with escape of the
bacilli. Ostitis, periostitis, and osteomyelitis are very
common results of the lodgement of the bacilli in bony
tissue, and Ohlmacher has found the bacilli in suppura-
tions of the membranes of the brain. The bacilli are
also encountered in other local suppurations occurring
in or following typhoid fever. Flexner and Harris2 have
seen a case in which the distribution of the bacilli was
sufficiently widespread to constitute a real septicemia,
the bacillus being isolated from various organs of the
body, and shown to be the true bacillus of Eberth by
all the specific laboratory tests, but in which there were
no intestinal lesions.

The bacilli can be found in the intestinal lesions, in
the mesenteric glands, in the spleen, in the liver, in the
kidneys, and in any local lesions which may be present
Their scattered distribution and their occurrence in
minute clumps have already been alluded to. They
should always be sought for at first with a low power
of the microscope.

Ordinarily no bacilli can be found in the blood, but
it has been shown that the blood in the roseolse some-

1 Brit. Med.Jour., Feb. 13, 1897.

2 Bull of the Johns Hopkins Hospital, Dec., 1897.