6o6 Typhoid Fever 



Unfortunately, many of the small colonies that develop in Eisner's 

 medium subsequently prove to be those of the colon bacillus, and 

 the method is thus rendered unreliable. 



Remy* prefers to make an artificial medium approximating a 

 potato in composition, but without dextrin or glucose. The com- 

 position is as follows: 



Distilled water looo.o grams 



Asparagin 6.0 " 



Oxalic acid 0.5 " 



Lactic acid 0.15 " 



Citric acid 0.15 " 



Disodic phosphate S .0 " 



Magnesium sulphate 2.5 " 



Potassium sulphate 1.25 " 



Sodium chlorid 2.0 " 



All the salts excepting the magnesium sulphate are powdered in a mortar and 

 introduced into a flask with the distilled water. Thirty grams of Witte's or 

 Grubler's peptone are then added and the mixture heated in the autoclave under 

 pressureforone-quarterhour. As soon as removed, the contents are poured into 

 another flask into which 120 to 150 grams of gelatin had previously been placed. 

 The flask is shaken to dissolve the gelatin, and the contents then made slightly 

 alkaline with soda solution. The mixture is again heated in the autoclave at 

 iio°C., for one-quarter hour, then acidified with a one-half normal solution of 

 sulphuric acid, so that 10 cc. have an acidity neutralized by 0.2 cc. of one-half 

 normal soda solution. This acidity is equal to 0.5 cc. sulphuric acid per liter. 

 After shaking, place the flask in a steam sterilizer for ten minutes, then filter. 

 When filtered, verify the acidity of the medium, correcting if necessary. 

 Finally, add the magnesium sulphate, dissolve, dispense in tubes, and sterihze by 

 the intermittent method. 



At the moment of using, put into each tube i cc. of a 35 per cent, solution of 

 lactose and o.i cc. of a 2.5 per cent, solution of carbolic acid. 



Upon this medium the colonies of the typhoid and colon bacilli 

 show marked differences. The colon colonies are yellowish brown, 

 the typhoid colonies bluish white and small. Fine bubbles of gas 

 from the fermentation of the lactose often occur about the colon 

 colonies. 



By this method Remy was able to isolate the t3rphoid bacillus from 

 the stools in 23 cases which he studied.. He believes that the con- 

 stant presence of the typhoid bacillus in the stools of typhoid fever, . 

 and its absence from them under all other conditions, is a far 

 more important and valuable method of diagnosis than even the 

 Widal reaction. 



Wurtzf and Kashidaf make the differential diagnosis by observ- 

 ing the acid production of Bacillus coli in a medium consisting of 

 bouillon containing 1.5 per cent, of agar, 2 per cent, of milk-sugar, 

 I per cent, of urea, and 30 per cent, of tincture of litmus. This is 

 the so-called litmus-ladose-agar-agar. The culture-medium should 

 be blue. When liquefied, inoculated with the colon bacillus, poured 

 into Petri dishes, and stood for from sixteen to eighteen hours in the 

 incubator, the blue color passes off and the culture-medium becomes 



* "Ann. de I'Inst. Pasteur," Aug., 1900. 



t "Archiv. de med. Experimentale," 1892, rv, p. 85. 



J"Centralbl. f. Bkt. u. Parasitenk, June 24, 1897," Bd. xxi, Nos. 20 and 21. 



