COLOX-TYPHOID INTERMEDIATES 251 



Diagnosis. The only reliable criteria for diagnosis are absence of 

 the Gruber-Widal reaction in proper dilution (not less than 1 : 40) with 

 a positive reaction against a known paratyphoid bacillus or the 

 recovery of a paratyphoid bacillus from the blood, urine, or compli- 

 cating inflammatory process. 



The clinical type of the disease is of little value in a single case. It 

 has already been stated that the reported cases of paratyphoid infection 

 have been both mild and severe. 



The cases of paratyphoid infection are too few to state what the 

 prognosis should be. It can only be said that the majority of the cases 

 have been mild, though there have been about 9 per cent, of deaths 

 among the cases reported. 



EPIDEMIC MEAT-POISONING TYPE. Gartner announced his dis- 

 covery of bacillus enteritidis as the cause of epidemic meat poisoning 

 in 1888. A cow sick for two days with profuse diarrhoea had been 

 slaughtered in Saxony and the meat sold for food. Of the persons who 

 ate of the meat 57 became ill, and 1 died. Gartner recovered the 

 bacillus from the meat and from the organs in the fatal case. 



Previous to Gartner's discovery the cause of meat poisoning had 

 been held to be bacterial products, and while this may still be true in 

 certain instances there is no satisfactory evidence to support the con- 

 tention. All cases in which a thorough bacteriological examination has 

 not been made must be excluded. 



Two kinds of bacilli are concerned in the production of meat poison- 

 ing: 1. Anaerobic bacillus botulinus of Van Erminghem, a saprophyte. 

 2. Bacillus enteritidis of Gartner, including the different strains of 

 this organism. 



Of these bacilli, bacillus enteritidis is the more important, having 

 been concerned in the greater number of epidemics, and causing true 

 meat poisoning. It seems advisable, however, to say a few words, by 

 way of distinction, on infection by bacillus botulinus. 



"Botulism," "allantiasis," and "sausage poisoning" are the names 

 given to infection by bacillus botulinus. The infection of the meat 

 takes place after the animal has been slaughtered. The meat is of 

 unsound appearance and odor and can readily be seen to be unfit 

 for food. 



The symptoms begin from twelve to twenty-four hours after inges- 

 tion of the meat, with repeated attacks of vomiting and abdominal 

 pain. Soon the characteristic symptoms appear: partial or complete 

 paralysis of the inner and outer recti muscles of the eye, and disturb- 

 ances of the innervation of the pharynx and larynx. These are mani- 

 fested by imperfect vision, difficulty of speech and deglutition, and 

 dry ness of the throat. There are" no disturbances of sensation or 

 impairment of consciousness and the disease runs its course without 

 fever. Constipation and retention of urine follow; dyspnoea and car- 

 diac failure appear, and bulbar paralysis may supervene, causing death. 

 In earlier years the mortality from sausage poisoning was from 30 per 

 cent, to 50* per cent., but this has been much reduced through a better 



