378 MANUAL or BACTERIOLOGY. 



malin solution, and that i c.c. of this diluted blood be added to 4 c.c. of the 

 dead culture. This mixture is set aside along with a control tube made with 

 normal .blood or with distilled water. If agglutination takes place, the dead 

 organisms settle down in a flocculent precipitate in an hour or two. 



By the use of a medium consisting of 90 c.c. of ox-bile, 10 r, c. of glycerin, and 

 2 grams of peptone. Coleman and Buxton* have come to the conclusion that the 

 typhoid bacillus is present in the blood in every case of typhoid fever throughout 

 its course. These investigators distribute this medium into small .flasks, 20 c.c. 

 into each, which are then sterilized. The blood to be examined is drawn by 

 means of an all glass syringe from the vein at the bend of the elbow, and 3 c.c. 

 of it introduced into each of three of the flasks of ox-bile medium. After 

 incubation over night, streak cultures are made from the surface of the liquid 

 in the flasks on the surface of Utmus-lactose-agar plates. Further procedures 

 for the identification of the organism are those already given. 



Considerable experience is necessary to acquire the judgment needed in 

 using this test. 



The agglutinating power becomes lessened after recovery, and usually is 

 wanting at the end of a year. Rarely it may be present for a longer time, a 

 fact that is to be borne in mind in making a diagnosis. 



Various observers have obtained the Widal reaction with serum patients 

 suffering from other diseases than typhoid. 



Typhoid bacilli have frequently been obtained from the 

 stools of cases offhe disease, but they are isolated only with 

 considerable difficulty. At autopsies they are best cultivated 

 from the spleen, in which, however, it is to be remembered, 

 the Bacillus coli communis may also be present. Cultures 

 made from the blood, where several cubic centimeters are taken, 

 show that a few bacilli occur in the blood in a large proportion 

 of cases of the disease— probably in a majority. Typhoid 

 bacilli appear in the urine in about 20 per cent, of all cases, 

 and the examination of urine for them has been used in 

 diagnosis. The bacilli often occur in the gall-bladder. They, 

 as well as the colon bacillus, have been found inside of gall- 

 stones, and have been supposed to be one of the causes for 

 the formation of gall-stones, f They may remain present in 

 the gall-bladder or in the urinej long after convalescence from 

 the disease. They have been demonstrated in the "rose 

 spots" on the abdomen. They may be present in the lesions 



*Reprint Am. Jour. Med. Sci. June, 1907. 



tPratt. American Journal Medical Sciences. Vol. CXXIT tqot Also 

 Kramer. Journ. Exper. Med. Vol. IX. 1907. pp «9-,2, 



IM. W. Richardson. Journal Experimental Medicine. Vol.' IV. 1899. 



