84 BACTERIOLOGICAL DIAGNOSIS. 



a prolonged and careful examination of pure cultures. 

 It is quite certain that the disease might be diagnosed 

 in this way ; indeed, it has been done, but the task is 

 an extremely difficult one and the diagnosis would be 

 delayed for a considerable period. 



In other regions in which the typhoid bacillus occurs 

 during an attack of typhoid fever the search is usually 

 facilitated by the absence of other organisms, especially 

 by the absence of the bacillus coli. The specific bacillus 

 occurs in the blood, spleen, spots, mesenteric glands, 

 liver, and frequently in the urine. 



It may often be demonstrated in the blood, but a 

 large quantity must be taken, and the technique is diffi- 

 cult. The results obtained in this way are of great 

 scientific interest, but the process is of no value as a 

 means of diagnosis. The same remark applies to the 

 spots ; it is in fact somewhat doubtful whether the 

 bacilli which appear to be present in this situation do 

 not actually come from the blood which is drawn in the 

 process. 



The mesenteric glands and liver are of course not 

 available for the purposes of diagnosis. 



The demonstration of the bacilli in the urine is some- 

 times quite easy, and might be of some diagnostic value. 

 But they do not always occur in this excretion ; and the 

 bacillus coli may do so. 



The only way in which typhoid fever can be dia- 

 gnosed with ease and certainty by a demonstration of the 

 specific bacillus is by an examination of material drawn 

 directly from the spleen by means of a hypodermic 

 needle. The organism occurs constantly in this situa- 

 tion, and its demonstration is not difficult. The neces- 

 sary operation, however, is by no means devoid of risk, 

 and is now generally abandoned. 



