HMMOCULTURES 



1 391 



200 or 300 c.c. of faintly alkaline broth. A dilution of about i in 

 100 to I in 200 is generally sufficient. The flasks are incubated 

 at 37° C. Generally, after twelve to twenty-four hours in positive 

 cases, the broth becomes cloudy, and shows a growth of the germ. 



The germ, of course, must be further identified in the usual 

 way by cultivation in milk, various sugar broths, and by the agglu- 

 tination test. The method gives satisfactory results, the5. typhosus 

 having been found by Schottmliller, Auerbach, Widal, Pinot, 

 Vegres, and others, in a percentage varying from 70 to 100 per cent. 

 The novelty of the method is the dilution of the blood in a very large 

 amount of broth instead of employing the usual small quantities 

 of the medium. This simple innovation makes all the difference 

 in the result. With the old methods the majority of observers 

 failed to detect the germ. These satisfactory results are probably 

 due to the fact that the blood being greatly diluted, the agglu- 

 tinins are also diluted, and any bactericidal properties of the blood 

 serum greatly weakened. 



Gildemeister recommends dilution in sterile water, while Cummins and 

 Cumming consider a solution of 0-5 per cent, taurocholate of soda to be a 

 very efficient medium. 



Drigalski and Conradi's Bile- Enrichment Method.- — We use the 

 following modification: 2 to 5 c.c. of blood are withdrawn from 

 a vein by means of a sterile syringe (see above), or if a vein 

 puncture is objected to, a deep prick is made in a finger, and the 

 blood collected and dropped in Coleman and Buxton's glycerine- 

 ox-bile medium, which consists of ox-bile 90 c.c, glycerine 10 c.c, 

 peptone 2 grammes, distributed in small flasks, each containing 

 20 c.c. of the medium. If the blood is taken in the evening the 

 percentage of positive results seems to be larger. 



Ophthalmo-Diagnosis. — Chantemesse has introduced a method of diag- 

 nosis similar to the ophthalmo-diagnosis of tuberculosis. An extract of 

 typhoid bacilli, specially prepared, is used. A drop is instilled into the con- 

 junctival sac; after two to three hours, if the case is typhoid, the conjunctiva 

 becomes very red, and the inflammation persists for two or three days. 



Cuti-Reaction.^ — ^Attempts have been made by several authors to evolve 

 a method of cuti-reaction for enteric in analogy to that which has been done in 

 tuberculosis. The results have not been very satisfactory. 



SiLVESTRiNi's Test. — A small amount of broth typhoid culture killed by 

 heat is injected subcutaneously. If the case is typhoid, this procedure induces 

 a sharp rise of the temperature for a day or two. 



Complement Fixation.— A complement fixation test has been worked out 

 for typhoid, para A and para B, by several authors, but its use has not 

 become general. 



Vincent's Spleno-Reaction.— Vincent has noticed that in many cases 

 after the subcutaneous injection of dead vaccine the spleen becomes tem- 

 porarily distinctly larger. The reaction is specific — viz., a patient suffering 

 from typhoid shows an enlargement of the spleen if he is injected with typhoid 

 vaccine, but not if injected with paratyphoid A or paratyphoid B vaccines. 



Spleen Puncture. — The point of maximum spleen dulness is found, the 

 skin is disinfected by painting with tincture of iodine, and the puncture made 

 by using a sterile syringe supplied with a long, strong needle. A few drops 

 of splenic blood and juice are obtained with facility, and should be immediately 



