348 TYPHOID FEVER. 



lated from the Payer's patches, lymphatic glands, etc., by a 

 similar method. 



During life, typhoid bacilli may be obtained in culture in the 

 following ways : — 



(a) Front the Blood. — As stated before, several observers 

 have shown that in about 80 per cent of all cases of typhoid 

 fever, in the earlier weeks of the disease, it is possible to obtain 

 the bacilli from the blood by use of appropriate methods (see 

 p. 72). 



(b) From the Spleen. — This is the most certain method of 

 obtaining the typhoid bacillus during the continuance of a case. 

 The skin over the spleen is purified, and, a sterile hypodermic 

 syringe being plunged into the organ, there is withdrawn from 

 the splenic pulp a droplet of fluid, from which plates are made. 

 In a large proportion of cases of typhoid the bacillus may be 

 thus obtained, failure only occurring when the needle does not 

 happen to touch a bacillus. Numerous observations have shown 

 that, provided the needle be not too large, the procedure is quite 

 safe. Its use, however, is scarcely called for. 



(c) From the Urine. — Typhoid bacilli are present in the 

 urine in about twenty-five per cent of cases, especially late in 

 the disease, probably chiefly when there are groups in the 

 kidney substance. For methods of examining suspected urine, 

 see p. 74. 



(^) From the Stools. — During the first ten days of a case of 

 typhoid fever, the bacilli can be isolated from the stools by the 

 ordinary plate methods — preferably in phenolated gelatin. 

 After that period, though the continued infectiveness of the 

 disease indicates that they are still present, their isolation is 

 practically hopeless. 



Numerous special media have from time to time been devised for the pur- 

 pose of readily isolating and identifying the bacilli from the stools. The most 

 have for their object the restraining of the majority of intestinal bacteria by 

 having materials incorporated which prove unfavorable to their development, 

 whilst readily permitting that of B. typhosus. Such media are commonly 

 known by their author's names, e.g.., Eisner, Capaldi, Remey, Hiss, Piorkow- 

 ski, Drigalski and Conradi (see references in chapter on Bibliography). All 

 are more or less of doubtful value owing to difficulties presented in acquiring 

 proficiency in their manufacture or application. 



We have seen that after ulceration is fairly established by 

 the sloughing of the necrosed tissue, the numbers present in 



