232 KOIU CASES OK I'YRKXIA 



Tho fuver pruseiUtil the fullowinf,' characteristics :- - 



Severe headache was usually a marked symptoin on admission, associated more or less 

 with drowsiness and sometimes delirium. The tongue was furred and dry, and the pulse 

 was usually rapid. The initial pyrexia was a high one, running between 101' F. and 103 F. 

 No rash was present, and only in Case IV. did the spleen show- any evidence of being 

 distinctly enlarged. In Gases I., II. and HI. the spleen was just i)ali)able and somewhat 

 ijliiiii.:il signs tender. Diarrhuja was not a marked symptom, nor was tympanites present. The clinical 

 appearance of the patients was very suggestive of enteric in the second week. A noticeahlc 

 feature was the tendency of the temperature to become normal at the end of the lirsl 

 week, to be invariably followed by a remittent type of pyrexia which lasted a variable 

 period. Complications presented themselves in three out of the four cases. Case I. 

 devcldpiil parotitis on the fourth day, followed on the tenth day of the disease by an 

 outbreak of multiple boils. Case II. developed pneumonia on the seventh day, while 

 Case III. showed signs and symptoms of femoral thrombosis on the eighth day. Jilood 

 serum was taken on several occasions from all four cases and subjected to agglutination 

 tests with strains of /)'. ////i/kwh.s-, 1L jmratifplitniK.i, and 11. ilijavutcriiv Shiga, but all with 

 negative results. These agglutination tests were undertaken at the end of the fever as well 

 as during the first week. 



In Cases I. and II. blood cultures were carried out on the fourth and third days of 

 the disease respectively, while in Case IV. the blood culture was not undertaken till the 

 fifth week. As previously stated, the ^m "^^^i'.tiii 



same micro-organism was present ^ ^ M^ 



in the blood of these three cases. t»w 



Owing to pressure of work, no 

 blood culture was carried out in 

 Case III., but the serum reaction 

 of this patient was tested with the 

 micro-organisms found in the blood 

 of Cases I., II. and IV., and a ' 



positive agglutination was obtained *■» ^ "dfe 



in a dilution of 1 : 100. It will now ' " 



be convenient to note the characters ^^ 



of this organism. 



In carrying out the blood 

 culture, the usual careful precautions 4l 1^^ 



for sterilising the skin over the 

 median basilic vein were observed. 



By means of a sterile hypodermic 'J> 7tBR'\ 



syringe 5-10 c.c. of the patient's — o«,iiim from ci... ;v 



Isulatiuiiuf blood were withdrawn, and flasks containing Coleman's' and Bunton's bile glycerine medium 

 theurganUin were inoculated, as well as flasks containing sterile broth. These flasks were then incubated 

 at 37 C. for 48 hours, and examined for the presence of micro-organisms. Samples from all 

 the flasks were then plated out on Drigalski-Conradi agar, bile-salt neutral-red agar, and 

 ordinary agar, the colonies picked off, and various culture media inoculated in order to 

 study more in detail the characters of the organisms isolated. These were as follows : 



On Drigalski-Conradi, at the end of 48 hours, there w'ere snuill circular translucent 

 pearl-like colonies present. By transmitted light such colonies appeared to have a small 



' Coluumu, H.. and Buiitou (June, 1907), American Joarnnl nf Mer/ictil Hcirnce. Quoted in K/)il. Brilish 

 Malical Jountul, April ih, 1908, p. 68. 





