370 A MANUAL OF BACTERIOLOGY 



examined culturally for the typhoid bacillus. Coleman and Buxton 

 recommend the following culture medium : Ox-bile, 90 c.c., glycerin 

 10 c.c., and peptone 2 grm. Distribute in small flasks, 20 c.c. in 

 each, and sterilise. Each flask is inoculated with 2 to 3 c.c. of 

 blood, incubated for eighteen to twenty-four hours, then streaks 

 from each are made on to litmus lactose agar plates, which are 

 incubated for a few hours. If the growth does not redden the medium 

 and a typhoid-like bacillus is present, it is tested for agglutination 

 with typhoid-immune serum. 



(2) Agglutination reaction. This is carried out by the micro- 

 scopic or the macroscopic (sedimentation) method described at 

 p. 190. Dilutions of 1 : 30, 1 : 50, and 1 : 100 should be made. 

 The microscopic method is the more rapid. Various apparatus 

 (agglutinometers) can be obtained, consisting of measuring devices 

 and a supply of dead culture, with which the sedimentation test 

 can be carried out by any one, but are unsatisfactory in the tropics. 



(3) Ophthalmo-diagnosis. Chantemesse (loc. cit.) has devised a 

 method analogous to the ophthalmo-diagnosis for tuberculosis 

 (p. 330). The material is prepared from agar cultures of typhoid 

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

 extract is precipitated with absolute alcohol and dried (for details 

 see Hewlett's Serum Therapy (p. 382). The dry substance is 

 powdered in an agate mortar, and for use 8 to 10 mgrm. are dissolved 

 in 1 c.c. of sterile water. Of this solution a drop is instilled into the 

 conjunctival sac ; in a case of typhoid, after a lapse of two to three 

 hours the conjunctiva becomes red and there is a sensation of heat, 

 after six to ten hours there is a marked conjunctivitis, which may 

 persist 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. 



(4) Puncture of the spleen with a sterilised hypodermic needle and 

 syringe. A little of the blood and pulp is withdrawn with the 

 syringe, and cultivations are made as in (1). This method seems 

 hardly justifiable, and now that the blood-culture method and 

 agglutination reaction have been introduced should be discarded. 



(5) Examination of pus. Cultivations may be made as in (1) 

 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 "). 



(6) Examination of the stools. This is hardly practicable for 

 clinical diagnosis ; it takes too long, is tedious and uncertain. 

 Plate cultivations from the dilated stools are made on Conradi- 

 Drigalski, malachite- or brilliant-green, agar (see "Water"). 



