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.