512 Typhoid Fever 



(6) Formation of small aggregations without loss of motion of the 

 free bacilli (atypical). 



(c) Complete cessation of motion and formation of a reticulated 

 agglutinated mass of bacilli covering the whole field. 



(d) Complete cessation of motion with the formation of small, fairly 

 uniform aggregations. This usually occurs quickly and is accompanied 

 by distortion of the bacilli. 



(e) Complete cessation of motion and the formation of large-sized 

 aggregations, some of which are enormous. The bacilli are shrunken 

 and twisted. (This form of reaction was usually almost instantaneous 

 in its occurrence, and probably indicated that the highest degree of 

 the blood-alteration had taken place. I saw it most marked in a case 

 with two relapses. It is sometimes succeeded by bacteriolysis.) 



(/) Rapid agglutination and loss of motion followed by prompt and 

 complete solution of the bacteria. The bacteriolysis is probably 

 entirely independent of the other phenomena. It may occur in normal 

 blood, but few of these were examined, and the one case in which I 

 encountered it was typical typhoid fever. 



The precision of the serum diagnosis makes it of great diagnostic 

 value. As shown by the statistics given, the reaction failed to develop 

 in only 4.5 per cent, out of a total of 2393 cases of clinical typhoid 

 fever, and there is little doubt but these cases were not typhoid, but 

 paratyphoid infections. 



Rumpf * and Kraus and Buswell f report a number of 

 cases of typhoid favorably influenced by hypodermic injec- 

 tions of small doses of sterilized cultures of Bacillus pyo- 

 cyaneus. 



Following the principle of Haffkine's anticholera inocula- 

 tions, Wright and Semple J have used subcutaneous injec- 

 tions of sterilized cultures as a prophylactic measure. One 

 cubic centimeter of a bouillon culture sterilized by heat 

 was used. 



The "Indian Medical Gazette" gives the following im- 

 portant figures showing what was accomplished in 1 899 : 

 Among the British troops in India there were 1312 cases of 

 typhoid fever, with 348 deaths (25 per cent.). The ratio of 

 admissions to the total strength was 20.6 per 1000. There 

 were 4502 inoculations and among them there were only 9 

 deaths from typhoid fever 0.2 per cent, of the strength. 

 There were 44 admissions, giving 0.98 per cent, of the 

 strength. Among the non-inoculated men of the same 

 corps and at the same stations, of 25,851 men there were 

 657 cases and 146 deaths, giving the relative percentages 

 of admissions and deaths as 2.54 and o.56. 



*" Deutsche med. Wochenschrift," 1893, No. 41. 

 t "Wiener klin. Wochenschrift," July 12, 1894. 

 J"Brit. Med. Jour.," 1897, I, p. 256. 

 "Phila. Med. Jour.," Oct. 13, 1900, p. 688. 



