2o8 DISEASES DUE TO BACTERIA 



Convalescence may be rapid, or a secondary febrile condition sets 

 in and lasts two days to tAvo weeks. 



The status typhosus is not uncommon, especially just before death. 



Raised temperature, dry brown tongue, low muttering delirium, 

 tremblings, toxic rashes, erythematous, papular or ha^mcrrhagic in 

 nature. 



Other forms may show predominance of purgation symptoms. 



Other forms may show predominance of cramps. 



Others may show signs of collapse and die before diarrhoea and 

 vomiting sets in. 



Other forms ma}^ show nothing but vibrios in fasces. 



Cases are usually worst at the commencement of an epidemic. 



The case mortality averages about 50 per cent. 



A coagulum in the R. heart or spasm of the pulmonary vessel 

 refusing to transmit the thickened blood may cause sudden death. 



COMPLICATIONS. 



Hyperpyrexia is rare. Abortion the result of contraction (cramp) 

 of uterus possible. 



Secondary infections account for most complications as pneumonia, 

 enteritis, nephritis, parotitis, corneal ulceration. There may be errors 

 of refraction. 



DIAGNOSIS. 



Easy in epidemic, difficult in sporadic cases. 



An extremely careful bacteriological examination is necessary to 

 detect the true \^ibrio choleras of Koch. In dispatching material for 

 diagnosis, collect and sample a piece of bowel ligatured into a boiled 

 glass bottle well stoppered. No antiseptic to be used. 



Methods of diagnosis: — 



(i) Make ordinary films of the white flakes. Stain with diluted 

 carbol fuchsin (i in 50) 10 minutes, or with Lofifler's blue 5 

 minutes. 



If a fish-in-stream arrangement of curved rods be seen cholera 

 can be strongh^ suspected. 



(2) Smear the surface of a lactose-agar plate (MacConke^-'s media) 

 w4th a rice-like flake, using a bent sterile glass rod. Inoculate 

 whh ihe same rod not recharged two more plates and inoculate 

 at 35°C. 



If small, delicate, yellowish, roundish dots appear within twelve 

 to eighteen hours, cholera vibrio can be suspected. 

 Examine the germs of a colony, if very active, comma-like or 

 straight, if it agglutinates with anticholera serum in a dilution 

 down to I in 4,000, it is in all probability cholera vibrio. 



