654 PATHOGENIC MICROORGANISMS 



After eighteen hours growth, the plates should be examined for typical 

 colonies. Suspicious colonies should be immediately inoculated upon tubes 

 of Russell double-sugar medium. Slide agglutinations against 1 :100 dilution 

 of a high titer stock typhoid antiserum should be made for preliminary 

 identification from suspicious colonies, of course together with morphological 

 determination by smear and stain. 



Much information can be obtained after twelve more hours, by observa- 

 tions of the growth in the Russell double-sugar medium. From this tube, 

 then, the growth can be emulsified in salt solution, and macroscopic agglu- 

 tinations set up. This usually is sufficient to identify the organism, but it is 

 always well to set up a few sugar fermentation tubes. 



Duodenal examinations are made by means of the Einhorn duodenal tube, 

 which is sterilized by boiling, and given to the patient the evening before 

 the examination is to be made, about three hours after the last meal. We 

 take our description chiefly from Garbat who has had considerable experience 

 with this method. The patient, properly instructed, swallows the tube without 

 gagging, with ease, and retains it throughout the night. On the following 

 morning it has usually passed into the duodenum, and bile can be aspirated 

 with a sterile 20 c.c. Luer syringe. Suction must usually be exerted, and 

 Garbat recommends a well fitting syringe because such suction must often 

 be strong. In about 5 per cent of Garbat's cases the tube remained in the 

 stomach and more difficulty was experienced with the test. When there is 

 difficulty in obtaining sufficient bile, the patient is made to sit up in bed 

 with His head bent forward, pressing upward on the abdomen with the palms 

 of his hands. Sometimes the flow of bile can be stimulated by a cold drink. 

 The bile is handled bacteriologically on Endo plates. 



Typhoid Bacilli in the Urine. Careful investigation has revealed 

 typhoid bacilli in the urine in about 25 per cent of all patients. Neu- 

 mann 33 discovered the bacilli in eleven out of forty-six and Karlinsky 34 

 in twenty-one out of forty-four cases. Investigations by Petruschy, 35 

 Richardson, 36 Horton-Smith, 37 Hiss, 38 and others have confirmed these 

 results. In general the bacilli have not been found before the fifteenth 

 day of the disease, and examination of the urine, therefore, can be of 

 little early diagnostic value. A series of seventy-five cases examined 

 by Hiss before the fourteenth day of the disease did not once reveal 

 typhoid bacilli in the urine. On the other hand, they have been found 



33 Neumann, Berl. klin. Woch., xxvii, 1890. 



34 Karlinsky, Prag. med. Woch., xv, 1890. 



35 Petruschy, Cent, f . Hyg., xxiii, 1898. 



36 Richardson, Jour. Exp. Med., 3, 1898. 



37 Horton-Smith, Lancet, May, 1899. 

 *Hi88, Med. News, May, 1901. 



