BACILLI OF THE COLON-TYPHOID-DYSENTERY GROUP 651 



to the direct reaction caused in the intestine by local growth of the 

 bacilli. Secondarily, the bacilli appear and can be cultivated from 

 the spleen, the liver, and can be demonstrated in the sinuses and 

 tissues of the lymphatic and retroperitoneal lymph nodes. 



Typhoid Bacilli in the Blood during the Disease. The investigations 

 of many workers have shown that typhoid bacilli are present in the 

 circulating blood of practically all patients during the early weeks of the 

 disease. Series of cases have been studied by Castellani, 21 Schottmul- 

 ler 22 and many others. More recently Coleman and Buxton 23 have 

 reported their researches upon 123 cases, and have at the same time 

 analyzed all cases previously reported. Their analysis of blood cultures 

 taken at different stages in the disease is as follows 



Of 224 cases during first week, 89 per cent were positive. 

 Of 484 cases during second week, 73 per cent were positive. 

 Of 268 cases during third week, 60 per cent were positive. 

 Of 103 cases during fourth week, 38 per cent were positive. 

 Of 58 cases after fourth week, 26 per cent were positive. 



The technique recommended by Coleman and Buxton for obtaining 

 blood cultures is that recommended by Conradi, 24 slightly modified. 

 The blood is taken into flasks each containing about 20 c.c. of the 

 following mixture : 



Ox-bile 900 c.c. 



Glycerin 100 c.c. 



Pepton 20 grams 



About 3 c.c. of blood are put into each flask. The ox-bile, besides pre- 

 venting coagulation, may possibly neutralize the bactericidal sub- 

 stances present in the drawn blood. The flasks are incubated for eigh- 

 teen to twenty-four hours, at the end of which time streaks are made 

 upon plates of lactose-litmus-agar and the organisms identified by 

 agglutination or by cultural tests. 



European workers have generally preferred to make high dilution of 

 the blood in flasks of bouillon, small quantities of blood, 1 to 2 c.c., 

 being mixed with 100 to 150 c.c. of nutrient broth. 



Epstein 25 has reported excellent results from mixing the blood in 



21 Castellani, Riforma medica, 1900. 



22 Schottmuller, Deut. med. Woch., xxxii, 1900, and Zeit. f. Hyg., xxxvi, 1901. 

 2! Coleman and Kuxton., Am. Jour, of Med. Sci., 133, 1907. 



24 Conradi, Deut. med. Woch., xxxii, 1906. 



25 Epstein, Proc. N. Y. Path. Soc., N. S., vi, 1906. 



