326 TYPHOID FEVER. 



The results of a great many independent observers, 

 with which our own agree, go to show that this is a specific 

 reaction, occurring only in typhoid fever, and that the test 

 is one of great value in diagnosis. In applying it, however, 

 a control specimen should always be made with normal 

 blood treated in the same way, at least till the observer is 

 quite familiar with the details of the method. It is interest- 

 ing to note that the reaction is not given when the B. coli 

 is used instead of the typhoid bacillus, the serum of patients 

 suffering from typhoid fever having no more effect on the 

 former organism than normal serum. It may be again 

 pointed out that this forms additional evidence that the 

 typhoid bacillus is really the causal agent in the disease, and 

 furnishes an additional test by which cultures of the two 

 organisms can be distinguished. 



Methods of Examination. The methods of microscopic 

 examination, and of isolation of typhoid bacilli from the 

 spleen post mortem, have already been described. They may 

 be isolated from the Peyer's patches, lymphatic glands, etc. 

 by a similar method. 



During life, typhoid bacilli may be obtained in culture 

 in the following ways : 



(a) From the Spleen. This is the most certain method 

 of obtaining the typhoid bacillus during the continuance 

 of a case. The skin over the spleen is purified and, a sterile 

 hypodermic syringe being plunged into the organ, there is 

 withdrawn from the splenic pulp a droplet of fluid, from 

 which plates are made. In a large proportion of cases of 

 typhoid the bacillus may be thus obtained, failure only 

 occurring when the needle does not happen to touch a 

 bacillus. Numerous observations have shown that pro- 

 vided the needle be not too large, the procedure is quite 

 safe. Its use, however, is scarcely called for. 



(b) From the Urine. Typhoid bacilli are present in the 

 urine in some cases, especially late in the disease, but prob- 

 ably only when there are groups in the kidney substance. 

 The urine may be received (preferably drawn off with a sterile 

 catheter) in a sterile vessel, and plate cultures or successive 



