REVIEW — TROPICAL MEDICINE, ETC. 57 



from " carriers," 117 (30 per cent.) to contact infection, 45 (12 per cent.) were indefinite, Enteric 



and the remainder due to food or water infection. Gall bladder symptoms should be Fever- 

 looked for in persons who have recovered from enteric fever, and if the stools are to be continued 

 examined it is well to previously administer a laxative or cholagogue. 



Preventive measures are very difficult. Strict cleanliness and the regular employment 

 of disinfectants are indicated. Cholagogues, intestinal antiseptics, the introduction of lactic 

 acid bacilli and anti-typhoid immunisation have all been used in order to try and dislodge 

 the bacilli, but in vain. Some obstinate cases have apparently been cured by cholecystotomy 

 or cholecystectomy. (Dehler). 



For much interesting information regarding carrier cases and the etiology of the 

 disease, the reader may be referred to the papers^ read at a recent discussion on typhoid 

 fever. One of these, by Hamer, puts forward his bold and heterodox views regarding the 

 etiological role of i?. typhosus. He does not think this organism necessary for the production 

 of typhoid fever, but his ingenious arguments do not appear to have convinced many of his 

 hearers. 



One may next pass in review the several recently devised methods for facilitating the 

 diagnosis of enteric fever. 



These may be classed as : (a) clinical, (b) bacteriological. The former may be 

 divided into the ophthalmo-reaction test and the observance of certain special symptoms, 

 the latter into the agglutination test, the blood culture test and the recovery by new, special 

 methods of the specific organism from the stools or urine. 



After the introduction of the ophthalmo-diagnostic method for the diagnosis of 

 tuberculosis, it occurred to Chantemesse-* to try a like reaction in the case of enteric fever. 

 He killed cultures of B. fi/phosus by heating them ; dried, powdered, and emulsified them 

 in water. This emulsion was sedimented and eentrifugalised till it was only slightly 

 opalescent, and an active principle (a soluble toxin) was then obtained by precipitation with 

 absolute alcohol. This precipitate is dried and keeps well. 1/oOth of a milligramme of 

 this powder is the dose, and it is used in solution, being instilled into the conjunctival sac of 

 the patient. If the latter has enteric fever and gives the Widal test, an inflammatory reaction 

 occurs which lasts for several days. Positive results were obtained in 63 cases of enteric 

 fever and negative results in 50 patients who were not suffering from typhoid and did not 

 give the Widal test. If rabbits be inoculated subcutaneously with typhoid bacilli and then 

 after 48 hours tested in this way, they are found to give the reaction while healthy rabbits 

 yield negative results. 



Philipowicz's sign is regarded by Eegis'* as pathognomonic. It consists of a more or 

 less definite yellow coloration of the palms and soles. It is said to be most common in 

 children, less so in women and least of all in men. It commonly appears during the first 

 week, vanishes when convalescence is established, but reappears if a relapse occurs. The 

 same author mentions Bernard's sign, which consists in the presence of two or three small 

 swellings, varying in size from a filbert to an almond, and to be made out by careful 

 palpation in the right iliac fossa. They are believed to be due to swollen Peyer's patches 

 in the lowest part of the ileum, lie parallel to the long axis of the colon, and are from a half 

 to one inch distant from each other. 



EoUeston^* has drawn attention to the value of the condition of the abdominal reflex 

 as a diagnostic and also as a prognostic sign. He says : — 



1. The .ibdominal reflex is affected in a very large number of cases of enteric fever, the percentage of 

 cases in which it is entirely lost exceeding those in which its normal activity is only diminished. 



2. From its absence under the age of fifty being confined to certain nervous disease and acute abdominal 

 conditions, notably appendicitis and enteric fever, the absence of the abdominal reflex in a given case of coutinued 

 pyrexia in any patient below fifty is of considerable value. 



3. The comparatively transient nature of the affection of the abdominal reflex in enteric fever is a striking 

 contrast to the more chronic affection of the knee and ankle-joints in diseases associated with peripheral neuritis, 

 e.g. diphtheria. 



4. Return of a lost reflex, and, a fortiori, resumption of its normal activity, are a valuable indication of 

 commencing convalescence, and often correspond with lysis and characteristic changes in the fseces and urine. 



' Procecdimjs of Royal Society of Medicine (April, 1908), Epid. Section, Vol. I., No. 6, p. 169. 

 = Chantemesse. Deutsche Med. JVoch., No. 39, and Bull Acad. Midecine, July 23rd, 1907. 

 ' Regis, L. (July 4th, 1906). Medical Press. 

 * Rolleston, J. D. Brain, 1906, p. 99. 



* Article not consulted in the original. 



