COLUMBENSIS PARENTERIC 



1411 



minor characters. It is not agglutinated by either paratyphoid B 

 or paratyphoid A serum. 



Symptomatology. — ^Two types of the fever may be differentiated, 

 one closely resembling typhoid, the other characterized by numerous 

 relapses. Enlargement of the spleen and meteorism may be 

 present, but are not constant symptoms. Roseola has not been 

 recorded, nor intestinal haemorrhages. Urinary complications 

 (cystitis, etc.) are not rarely met with. All the cases recorded have 

 ended in recovery. 



Prognosis. — Appears to be favourable quoad vitam, but in the 

 relapsing type the disease may last for four to six months, the patient 

 having several attacks of fever, each lasting a couple of weeks. 



Treatment. — This is on the same lines as for enteric, including 

 complete rest in bed and fluid diet. Urotropine is useful, especially 

 when there are urinary complications. 



Prophylaxis. — Castellani has used in Ceylon a B. columbensis 

 vaccine in the form of a combined B. columbensis, B. typhosus, 

 B. paratyphosus A and 5, paratyphosusB vaccine. 



Archibald: Parenteric. 



This fever and its setiological agent were described by Archibald 

 in the Sudan in 1912. The bacillus was believed by Archibald 

 at one time to belong to iheB. cloacce group. It seems to us prob- 

 able that the germ belongs to the genus Salmonella of our classifica- 

 tion, and that it is related toB. columbensis Castellani. 



Symptomatology. — As a rule the symptoms presented by the 

 patient are not unlike those of the second week of enteric fever. 

 There is high fever, ranging from 101° to 103° F., associated with 

 drowsiness and perhaps delirium, but this is often absent, with 

 furred dry tongue, but without diarrhoea or tympanites, and with 

 or without some very slight enlargement of the spleen. Sometimes 

 the temperature falls to normal after a week, but this intermission 

 is followed by a prolonged fever of a remittent type, or, instead, 

 the fever may be more or less remittent from the commencement. 



Complications. — Complications in the form of pneumonia, ab- 

 scesses, femoral thrombosis, etc., may occur. 



AsiATicus Parenteric. 

 This fever was differentiated by Castellani in Ceylon by obtaining 

 the specific bacillus from the blood and motions. There are two 

 varieties of the bacillus, which may be called B. asiaticus Nos. i 

 and 2. (For the specific characters see table in Chapter XXXVI., 

 p. 944.) Culturally these bacilli are identical, but the biological 

 reactions are slightly different. The possibility of a double infection 

 of one of these bacilli or other parenteric germs with those of enteric 

 fever must not be forgotten. The diagnosis will then depend upon 

 the absorption test. 



