236 



KOUR CASES OK rVKKXIA 



relationships 



I'reseiicp of 

 the organism 

 in the excreta 



In carrying out these tests the organisms that were used for the absorption of the 

 agghitinins were ohtained from aj^ar cultures twenty-four hours old. Tlie dilutiott of 

 tile serum used was 1 : 20. 



Tlie tecimiquc was as follows :— The scrum of tlio ral)l)it immunised against tlit; 

 new organism was saturated for 3 hours at :{? C. with a 24-hnui>i' culture of this organism. 

 Tlie serum was then centrifuged and tiie clear supernatant fluid withdrawn and inixetl in 

 dilutions of 1 : 20 with (a) tiie new organism (fc) B. fi/phnsus {r} R. parati/plmid B., and the 

 results observed were as follows : — 



In (n) mixture no agglutination occurred as all the agglutinins for this organism 

 liad been previously absoibed when the serum was saturated with it. In (/<) a)id (<;) 

 agglutination occurred. 



Pressure of work ]ireveiited further research l)eiiig carried out to diflferentiate this 

 organism, and, hati it lieen possible to perforin them, absorption tests with other allied ones 

 would doubtless have assisted one in coming to a more definite conclusion as to its type. 



From the cultural reactions obtained, there can be no doubt that it is closely allied 

 to the <•(>//■ group, but its reactions do not appear to correspond with any identified organism. 



The fact that it gives a positive Voges-Proskauer reaction, lather i)oints to its 

 belonging eitiier to the li. rloaae or H. lactin .vrnyenes group. Tiie latter group may be 

 excluded as all liaeilli belonging to it are lactose fermenters. 



MacConkey,' in iiis carefully worked out investigations on the lactose fermenters in 

 fffices, has looked for the Voges-Proskauer reaction in a large number of organisms but 

 only found it when organisms of the li. Imiia .vrnijenes or B. cloacie group were present. 



In tiie H. rhiiine group, I'ord' descrihed four different varieties and, according to 

 that observer, they are not all lactose fermenters. 



H. rliiiine is an organism frequently found in the f;eces of cattle, but its common 

 habitat is the soil. Clemesha,-' in India, found it frc(|iu'iitly in liie beds of lakes and 

 rivers, and it has a greater resisting power against tiie action of sunlight than all otlier 

 coli types with the exception of li. cogroroha. 



.•\ttempts were also made to recover the organism from the urine and fa'ces of 

 these cases. In Case 1. and Case IV. it was found to lie i)r(>scnt in the faeces in the 

 second and fifth weeks of the disease, respectively. No evidence of it was found in 

 either tiie fa>ces or urine of Cases II. and III., nor was it present in tiie urine of Case I. 

 Unfortunately, no attempts were made to isolate it in the urine of Case I\'. 



The method of infection in tiiese cases was, in all probability, due to food or water 

 contamination. The three cases occurring in the same battalion were probably infected 

 fiom the same source. Case IV. occurred in an Englishman living in Khartoum North, 

 where the water-supply is frequently obtained from wells. 



To sum up the leading points : — 



1. There exists in Khartoum an irregular remittent fever wliicii is due to a systemic 

 infection with a coli type of organism akin to the B. r]oaci>e group. 



2. The fever is a characteristic one, commencing witli high initial pyrexia lasting 

 for three or four days, falling to normal on the seventh or eighth day, aftei- which a relapse 

 occurs and an irregular remittent fever is produced, lasting for an indefinite period and 

 liable to be associated with complications. 



' MacConkey, A. (Jnly, 1905), " Lactose forincntin^ bacteria in Fteccs." Journal of Hjiyicin-. 



■■• Ford, W. W. (1901), Jmirunl nf Medical J!e.i.arrl,, Vol. VI., p. 211. 



• Clemesha, Win. (1909), " A study on tlie bacteriology of drinking-water supplies in Tropical Climates." 

 ylf)/n-/iili.i- fit flif Annnnl lli-piift iif Ihf Kiinj /tmtilliff of I'lrffnth' 



M„/iii,i., MadRi-i. for 19na. 



