350 THE ALCALIGENES DYSENTERY TYPHOID 



cient. The endotoxins of the bacilli, furthermore, are relatively 

 thermostabile. Thorough cooking of such meat is essential to insure 

 safety. 



(b) Paratyphoid Fewr. Bacteriologically, paratyphoid fever may 

 be caused either by B. paratyphosus alpha or B. paratyphosus beta. 

 Clinically there is little or no difference between the two infections. 

 According to Bainbridge, 1 paratyphoid fever in Asia, particularly 

 in India, is more frequently an infection with the alpha organism; in 

 Europe the beta organism is much more frequently reported. Both 

 types are found in the United States. 2 The organisms are occasionally 

 found in the intestinal contents and feces of young children and adults 

 who give no history of infection. 



The incubation period of paratyphoid fever varies from eight to 

 twenty days; the average is about two weeks. The onset is gradual; 

 the usual prodromal symptoms are severe head- and backache, malaise 

 and anorexia. Bronchitis and sore throat are common. There may 

 be an initial chill, then the temperature rises rather rapidly to a maxi- 

 mum of 103 to 105 C.; after the fifth to the seventh day it falls 

 slowly; it is normal by the end of the second week. Rose spots are 

 occasionally seen early in the disease. Less commonly acute gastro- 

 enteric symptoms, resembling those of meat poisoning, complicate the 

 clinical picture. Paratyphoid fever is a bacteremia, very similar to 

 typhoid fever in this respect. The mortality is low, averaging from 

 1 to 2 per cent, of all cases. The lesions observed postmortem are 

 intense hyperemia of the gastro-intestinal tract, usually with superficial 

 ulcerations in the ileum and cecum, not necessarily, however, involv- 

 ing Peyer's patches. Acute splenic tumor is usually not a feature of 

 paratyphoid infections. The bacilli may be isolated from the heart 

 blood and visceral organs. 



Bacterial Diagnosis. (a) Isolation of Bacilli. Blood cultures made 

 during the first week are frequently positive. The organisms are 

 usually present in the feces, occasionally in the urine. The identifi- 

 cation of the bacilli depends upon the cultural characters outlined 

 above; gas production in dextrose and mannite, no liquefaction of 

 gelatin, and a permanent acidity in litmus milk (alpha type) or a 

 transient acidity followed by a progressively alkaline reaction in this 



1 Loc. cit. 



2 Gwyn, Bull. Johns Hopkins Hospital, 1898, vol. ix. Gushing, ibid., 1900, vol. xi; 

 Buxton and Coleman, Proc. Path. Soc. New York, February, 1902; Proescher and 

 Roddy, Jour. Am. Med. Assn., 1909, lii, No. 6; Kendall, Bagg and Day, Boston Med. 

 and Surg. Jour., 1913, clxix, 741; Kendall and Day, ibid., 1913, clxix, 753. 



