434 A MANUAL OF BACTERIOLOGY 



2. A relatively slight rise may occur, followed by a fall 



towards the former level. 



3. A marked rise may occur synchronous with the rise- 



in paratyphoid agglutination titre, and subse- 

 quently followed by the usual fall towards the 

 former level. 



Meanwhile the titre of paratyphoid agglutination runs the 

 normal course of rapid rise to a maximum (usually exceeding the 

 maximum typhoid titre) followed by a fall, at first rapid and then 

 slower as already described for typhoid subjects, and falling 

 below the persistent base line of typhoid agglutination of inoculated 

 persons. 



C. In the case of mixed infections, whether in inoculated or 

 non-inoculated persons, the agglutinin curves for the different 

 infecting organisms are usually not synchronous, and they pursue 

 their ordinary course independently of each other. 



(III) Ophthalmo -diagnosis. -Chantemesse (loc. cit.) devised a 

 method analogous to the ophthalmo -diagnosis for tuberculosis 

 (p. 400). The material is prepared from agar cultures of typhoid 

 which are emulsified, dried, triturated, and extracted, and the 

 extract is precipitated with absolute alcohol, dried, and dissolved 

 in water (for details see Hewlett's Serum Therapy, p. 382). A 

 drop of this solution is instilled into the conjunctival sac ; in a 

 case of typhoid, a conjunctivitis develops in two to three hours, 

 reaches a maximum in six to ten hours, persists for one to 

 three days and then passes off. In healthy persons and in other 

 diseases no conjunctivitis ensues. A cutaneous reaction has also 

 been devised. 



(IV) Puncture of the spleen with a sterilised needle. After punc- 

 ture, a little of the blood and pulp is withdrawn with the syringe, 

 and cultivations are made as in (I). Now that the blood-culture 

 method and agglutination reaction have been introduced, splenic 

 puncture is little used. 



(V) Examination of pus. Cultivations may be made as in (I) 

 if the bacillus is present, apparently in pure culture. If not, 

 plate cultivations, preferably on litmus lactose agar, Conradi- 

 Drigalski, malachite- or brilliant -green, agar, may be prepared 

 (see " Water "). 



(VI) Examination of the faeces and urine, See pp. 438, 456. 



