Vol. 60, 1909 - University of North Carolina at Chapel Hill

312 THE CHARLOTTE MEDICAL JOURNAL. ]i
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twenty-one out of thirty cases of typhoid in Krehl's clinic, found that inflltratiou of
fever that come to autopsy at the Boston the lymphatic tissue of the intestine occurred !
City Hospital. It is now almost universally not only in the second, but also in the third, 'i
admitted that the micro-organisms become fourth and even fifth week. Necrosis and ;|
widely iHsseminated throughout the body, sloughing of the swollen Peyer's patches j
They have been recovered in a single sub- were observed as early as the second and i
ject at autopsy from the heart's blood, the as late as the seventh week, lie concluded i
spleen, the liver, the kidney, a mesenteric that the characteristic typhoid symptoms :
lymph node, the gall 1)ladder, the urinary are not the result of the intestinal lesions, j
bladder, the right middle ear, and the bone but the two are co-ordinate. Typhoid fever i
marrow (Pratt). It has been isolated from is tlius a general infection in which intesj
the urine in a large percentage of all cases tinal alterations can occur. Not only are ,J
examined. Jacobi and Munch report that these cases of typhoid fever without intesj
they found it in 25 per cent, of their cases, tinal lesions, but \'elich has observed severe I
Petruschky calculated that in one of his typhoid ulceration of the intestine without j
cases each cubic centimetre of urine con- any disturbance of the health; in other
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tained 172,000,000 typhoid bacilli, and words, without typhoid fever. In an article i.j
Gwynn estimated that 500,000,000 per c.c. published in the Jour. A. M. A. in 1907,
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were present in a case reported by him. A from which we quote at length, Pratt, Peaj
number of recent investigators have found body and Long conclude that it is probable |
typhoid bacilli more often in the urine than
in the stools. Among ninety-eight convathat
the typhoid bacilli in the intestine I
come chiefly from the bile. There isnc:)
lescents studied by Herbert, only three evidence that they are thrown off in large -j
showed typhoid bacilli in their stools, while numbers from the ulcers as was formerly :fl
they were present in the urine of eighteen, taught. If so, one would expect to find an (
He found they occurred in the urine in large increased number in the lower part of the I
number, in the stools only in small number, ileum, but Foster and Kayser, as well as >
The presence of the typhoid bacilli in the v. Drigalski, showed they were more abund- il
rose spots is well known. Richardson, ant in the upper portion of the small intes- i
Drigalski, Jehle, and Rau have found it tine. Councilman says that he has not inrepeatedly
in the sputum when bronchitis frequently been unable to demonstrate t
was associated with the typhoid infection, bacilli in sections through the base of ty- I
and Dieudonne even recovered typhoid phoid ulcers. Jurgens reported that typhoid 4
bacilli from the sputum seven weeks after bacilli may be present in the intestinal con- i
fever had disappeared. Still more upset- tents in the usual number when the ulcers j
ting to our older ideas, however, is the fact have entirely healed.
that undoubted cases of typhoid fever with- i
out intestinal lesions have been reported by
structurb or opsopsins.
such investigators as Opie and Bassett. Numerous investigators, among them I
Jehle observed a case in which there were Savtchenko, Besredka, Loehlein and Dean, j
no characteristic changes in the intestine, have regarded opsonins as identical with ;
and yet the sputum contained typhoid amboceptors. Muir and Martin have shown i
bacilli. Rau \so\aied dar/7//is /jpkosas from that not every immune body produces an !
the sputum when cultures from the stools opsonizing effect. Hektoen has, from a'
were negative. Years ago Bumgarlen stated series of experiments, decided that opsonins
that the typhoid ulcers in the intestines are distinct substances or antibodies. New- I
should be regarded as metastases rather feld and Rimiiau, Newfeld and Toepfer, I
than as primary lesions, a theory which Keith, Bulloch and Atkin, agree with Hekwas
revived by Scholtmuller in 1902. Later toen and Wright and Douglas that opsonic |
knowledge has shown that in cases of ty- action is due to the presence of hitherto
phoid cholecystitis, in spite of the discharge unknown distinct bodies. Before this c^ i
of enormous numbers of typhoid bacilli into be accepted, says Schorer, it will be neces-' i
the intestine with the bile, there are no in- sary to repeat many of the experiments !
testinal manifestations. Not only are there that have been made, inasmuch as in Eng- j
no intestinal symptoms, but in a fatal case land and America especially, these inves- i
reported by Burlew there were no typhoid ligations were made at a time when no dis- i
ulcers in the intestine, although the bile tinction was made between normal and: j
containing typhoid bacilli entered the immune opsonins. The existence of nor- j
duodenum freely. In chronic typhoid mal and immune opsonins is now (luite, i
bacillus carriers, although the typhoid generally accepted. Newfeld in a consid- )
bacillus may be the predominating micro- eration of the causes of phagocytosis, states |
organism in the intestinal contents, no in- that he believes bacteria and foreign bodies f
testinal disturbances are produced and are only taken up by the leucocytes when! i
health is maintained. Wennagel, working the latter are stimulated. He bases this;
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