414 BACTERIAEMIA 



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agar. For culturing blood in septicaemic conditions, the blood should always 

 drawn from the vein and cultured either by mixing i to 2 c.c. with melted agar 

 and then pouring plates or by transferring to bouillon in excess (at least ten times 

 as much bouillon as blood) and after eighteen to twenty-four hours' incubation 

 plating out. For Streptococcus and Pneumococcus blood agar plates are to be pre- 

 ferred, the Pneumococcus giving green colonies with only a suggestion of haemolysis 

 while the Streptococcus gives an opaque colony with a distinct haemolytic zone 

 surrounding it. We rarely culture blood anaerobically as the important patho- 

 genic anaerobes (tetanus, gas gangrene and malignant oedema) do not tend to 

 invade the blood stream during life. Recently a case has been reported where the 

 gas bacillus was isolated from the blood of a soldier with gas gangrene. There is 

 an anaerobic streptococcus S. putridus which grows anaerobically on blood agar giving 

 porcelain white colonies without haemolysin. The cultures have a putrid odor. 

 Not pathogenic for animals. 



Warren and Herrick have recently published a very important study 

 of 134 cases of bacteriaemia. Bacteriaemia signifies the mere presence 

 of bacteria in the blood without reference to symptoms, while sepsis 

 denotes conditions due to invasion of the blood stream by bacteria or 

 their toxins with marked systemic reaction. 



Of 25 cases with endocarditis 22 died and 3 were unimproved. Of 55 cases of 

 sepsis 39 died and 10 recovered. In postpartum infections 10 died and i recovered. 

 In osteomyelitis 5 died and 4 recovered. In otitis media 2 died and 4 recovered. 



Thirty-one cases were due to Streptococcus hamolylicus of which 21 died. 



Forty cases were due to S. viridans and 25 died. One case from S. mucosus died. 



Of 39 cases with Staphylococcus aureus 22 died and in 3 cases of S. albus 

 2 died. 



Of 10 cases of Pneumococcus bacteriemia 6 died. Six of B. coli infection gave 4 

 deaths; two of B. influenzas 2 deaths; three of anaerobic streptococci, 2 deaths and 

 two of B. mallei, 2 deaths. 



Seven cases of mixed infections gave 6 deaths. 



The ordinary leukocyte and differential count procedures were of very little value 

 in prognosis. 



The average white count in fatal cases of S. hamolyticus infection was 18347 

 with 81% of polymorphonuclears while in cases recovering it was 18742 and 85%, 

 respectively. Fatal S. viridans infections gave an average white count of 15976 with 

 polymorphonuclear percentage of 78, while nonfatal cases gave 17222 and 75%, 

 respectively. 



Of 25 cases treated with vaccines, 81% died; while of 47 under surgical treatment, 

 50% died and with 50 treated pallia tively, 50% died. 



Typhoid cultures are best obtained in the first week of the disease, 

 after that time the Widal is the test of preference. 



If a paratyphoid serum is not at hand for testing, it may suffice to inoculate a 

 glucose bouillon tube or a Russell lactose glucose litmus slant; gas production 

 indicates paratyphoid. This test should be applied when a very motile organism 





