REVIEW — TROPICAL MEDICINE, ETC. 59 



alkaline beef broth or peptone water, incubating at 37° C. and sub-cultivating the organisms Enteric 

 which develop. The novelty of the method lies in the great dilution of the blood. Fever— 



Conradi'* introduced the bile method, now generally employed. He took the blood continual 



from the ear in a capillary pipette containing a little fluid. The liquid is then transferred 

 into a small glass tube containing 2 c.c. to 3 c.c. of a peptone glycerin mixture (10 per ceut. 

 peptone and 10 per cent, glycerin with ox bile), and this process of transference is continued 

 till the ear ceases to bleed. Proportion of blood to the bile mixture is 1 to 3. The tube 

 containing the blood and bile mixture is then incubated at 37° C. for ten to sixteen hours, 

 and cultures finally made on Drigalski-Conradi agar plates. The diagnosis is usually 

 established in from 26 to 32 hours. 



Meyerstein-* uses the active bile constituents, the biliary acids, as his medium for 

 increasing the number of bacilli present in the blood. The substance can be prepared by 

 a simple method, and the results are said to be more quickly obtained and to be more reliable 

 than those given by the Widal test. 



It has also been found that typhoid bacilli can be cultivated from the blood-clot of 

 specimens sent for a Widal reaction (Muller and Graff'*), and this has been confirmed, 

 good results being got by spreading the clot on an Endo or Drigalski plate. It would seem 

 that the colonies cannot be obtained from the serum. 



A better and simpler way is to put the clot into a tube containing 5 c.c. of fresh ox bile 

 which has been sterilised in a steam oven or by boiling in water; the tube, after cooling, 

 being plugged with wool as usual. Incubate clot and bile for a night at 37° C. and plate 

 out as mentioned. The bile is said to dissolve the blood and set free the organisms. This 

 method is likely to be useful in the Sudan where blood is often sent from a distance and 

 sometimes arrives in such a condition that it is difficult to obtain sufficient serum for the 

 ordinary Widal test. 



Zeidler^ records his results with the bile method, using 30 drops of blood to 5 c.c. of 

 sterilised ox bile, incubating at 37° C. and plating out on agar or the malachite agar 

 of Loeftler. He concludes that from the fourth day of the fever onwards, both in mild and 

 severe cases, the presence of the specific bacillus in the blood can be demonstrated, and that 

 this method is superior to all others, being the most certain, the most speedy and, when 

 positive, absolutely reliable, while it is at least as simple as the Widal test. 



Coleman and Bunton'* employ a mixture of ox bile 90 c.c, glycerin 10 c.c, and 

 peptone 2 grammes. This is distributed into small flasks, 20 c.c. in each, and sterilised. 

 Three flasks are used for each examination, about 3 c.c. of blood being run into each. 

 The flasks are incubated, and next morning streaks from each are made over the surface of 

 a litmus-lactose-agar plate. The authors believe that B. typhosus is present in the blood in 

 every case of typhoid fever, and that failure to recover it is due to error in technique. 

 The bacilli seem to disappear about the time the temperature falls. They are found equally 

 in the blood, but not with the same persistence in the mild as in the severe cases. To 

 produce typhoid fever it seems necessary that the bacillus must not only be present in the 

 body and growing, but that it should be in a situation whence it has free access to the 

 blood. The bacillaemia does not constitute a true septicaemia, but represents an overflow 

 of bacilli from the lymphopoietic organs. 



Although I have not seen it advocated, save by its author, and have had no personal 



experience of it, mention may be made of Poeppelmann's^* method. After cleaning the 

 finger and pricking it with a sterilised needle, a large drop of blood is squeezed out on a 

 clean slide. Portions of this are transferred to, and spread out on, other slides previously 

 cleaned with alcohol and ether and sterilised. After the films have dried, the slides are 

 placed in E. May-Griinwald solution. 



This fixes and stains at the same time and within 2 to 6 minutes. Wash in distilled 

 water for about one minute and dry rapidly before a fire or between blotting paper. The 



» Conradi, H. (January 11th, 1906). Deut. Med. Woch. 



2 Meyerstein, W. Miinch. Med. Woch., 1908. 



= Muller and Graff, H. Munch. Med. Woch., 1906, No. 2. 



* Zeidler, Q. (August 20th, 1907), " Zur Prage der Typhusanreicherung mittels der Qallenkultur." 

 Cent. f. Bakt. I. Oriij., Bd. XLIV. 



° Coleman, H., and Bunton (June, 1907). American Journal of Medical Science. Quoted in Epit. British 

 Medical Journal, April 25th, 1908, p. 68. 



° Poeppelmann, P. W. Deut. Med. Woch., 14th June, 1906, quoted in Epit. British Medical Journal, 

 December 1st, 1906. 



• Article not consulted in the original. 



