FREQUENCY OF PARENTERIC—PROPHYLAXIS 



Frequency of Parenteric. — It is well to keep in mind that par- 

 enteric is on the whole much less frequent than true enteric (typhoid, 

 para A, para B). The observation has been made that persons 

 inoculated against enteric (typhoid, para A, para B) seem occasion- 

 ally to become more prone to contract parenteric, in the same manner 

 that persons inoculated against typhoid only, seem at times to de- 

 velop a tendency to contract paratyphoid A and paratyphoid B 

 more frequently than non-vaccinated individuals. This, however, 

 cannot be used as an argument against vaccination by the enteric 

 or triple vaccine (typhoid, para A, para B), because, although 

 individuals vaccinated therewith may develop a slight tendency 

 to contract parenteric, still the total number of enteroidea fevers 

 (enterica and parenterica) observed in such individuals is greatly 

 less than in non- vaccinated people or in people vaccinated only 

 with typhoid mono vaccine. 



Diagnosis. — When a patient is suffering from enteric-like symp- 

 toms, while all serological and bacteriological investigations for 

 enteric remain constantly negative, the practitioner is justified in 

 suggesting the possibility of parenteric. The diagnosis, however, 

 should always be confirmed by a complete and repeated bacterio- 

 logical examination of the blood, stools, and urine, with the object 

 of isolating the causative organism and of determining from what 

 variety of parenteric the patient is affected. We should like to 

 emphasize here that the mere presence of an intestinal germ in the 

 blood is not sufficient to come to the conclusion that this fever is 

 due to that germ. Repeated examinations may show that it is 

 present in association with true B. typhosus, B. paratypliosus A, 

 or B. paratyphosusB, and may have little or no part in the causation 

 of the symptoms, quite a number of faecal bacteria being capable of 

 entering the general circulation through intestinal ulcers. If, 

 however, the germ not only is found in the blood, but the blood 

 contains specific agglutinins for it, while hsemocultures and serum 

 reactions are constantly negative for enteric, the probabilities 

 are that the germ isolated is the real aetiological agent of the 

 fever. 



Prognosis. — This is, on the whole, much more favourable than in 

 enteric (typhoid, paratyphoid A, paratyphoid B). 



Treatment. — This should be on the same lines as for enteric. 

 Complete rest in bed and fluid diet are necessary. Drugs are of 

 little or no use except occasionally. Urotropine may be given in 

 doses of 10 grains three or four times a day. The vaccine treatment 

 with autogenous vaccines seems to give better results than in enteric. 



Prophylaxis. — As regards general prophylactic measures (sanitary 

 improvements, destruction of flies), these are the same as for 

 enteric. The usual enteric vaccination (TAB) does not, of course, 

 protect against parenteric, and when certain forms of parenteric 

 become frequent the bacteria causing them may be added to the 

 enteric bacilli in the preparation of a prophylactic vaccine. 



