METHODS OF EXAMINATION 377 



temporary increased susceptibility to the disease. He therefore 

 recommends that when possible the vaccination should be carried 

 out some time previous to the exposure to infection. There can 

 be little doubt that in this method an important prophylactic 

 measure has been discovered. 



Vaccine Treatment of Typhoid Fever. As in the case of 

 other acute infections, vaccines have been recently used in the 

 treatment of typhoid fever during the acute stage (Leishman 

 and Smallman). The method is to inject hypodermically 100 

 million dead typhoid bacilli, i.e. a fifth of the first dose used for 

 the protective inoculation. If the temperature shows a tendency 

 to fall, this may be repeated about every four days. The results 

 obtained are hopeful, and justify the method being further 

 applied. 



Antityphoid Serum. Chanteim-sse has immunised animals with dead 

 cultures of the typhoid bacillus, and, having found that their sera had 

 protective and curative effects in other animals, lias used such sera 

 in human cases of typhoid with apparent good result. In the hands 

 of others, however, such a line of treatment has not been equally 

 successful. 



Methods of Examination. The methods of miscroscopic 

 examination, and of isolation of typhoid bacilli from the spleen 

 ]*>st 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 Blood. The typhoid bacillus can often be 

 isolated from the blood, especially during the first week, by 

 ordinary methods (see p. 72). A special method has also been 

 used with success. In this 5 c.c. of blood are placed in 10 c.c. 

 of sterilised ox bile. The mixture is incubated for from twenty- 

 four hours to a week, and from time to time the presence of the 

 bacillus is tested for by sub-culturing on such media as those of 

 Conradi or MacConkey. 



(l) 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 syringe being plunged into the organ, there is withdrawn from 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 

 hap]K'n to touch a bacillus. Numerous observations have shown 



