RECENT BACTERIOLOGICAL EXPERIENCES WITH TYPHOIDAL DISEASE AND DYSENTERY
Authors: J. C. G. Ledingham, W. J. Penfold
Journal: BMJ (1915)

ONE result of the extension of hostilities to the Near East has been the opportulnity afforded to tlle medical profession at lhonme of studying on a fairly extensive scale certain infectiouis diseases met with only sporaclically in time of peace.During time past two imonitlsi (tlhat is, sinlce the middle of August, 1915) this hlospital has adlmitted from the Dardianelles area a considerable num'.er of cases presenting a recent history of acute dysentery witlh tlle classical symptolmis of tenesmus and frequent evacuations of blood and mucus.In tlle great majority of these cases the stools on admission lhad either regained their normal clharacter or were for a varying tinme after admission 1persistently loose, unformied, or semnifluid.In a small mlinority of eases the disease at thec time of adlmission still colntinued in a subactute or clhrolnie form, witlh constant or intersiitteiit diselharge of blood and mucus in tlle dejecta.Simultaneously witlh these admissions of convalescent or subacute cases of dysentery there has been a succession of cases of typhoidal disease, in tlle main due to B. para, typhosats A. The bacteriological supervision of tllese cases, necessitating, on tIle one Iland, tlle examiniation of numerous samples of excreta, and on the otlher, the carrying out of blood cultures and srological tests for purposes of dia.gnosis.has been no lighlt addition to tlle ordinary routine of a bacteriolo,ical departmeint attached to a lhospital of 1,600 beds.We ventire to com-imunicate the following notes on our bacteriological experiences, solely in the hope that they m-ay be of interest and perchance of service to others working in similar fields and possibly under less advan- tageous surroundings.Ex.IIINATION oF FAECES.In the first place, it mnay be advisable to detail briefly our rouitine teclmiqeLu for the bacteriological examination of stools, urine, and blood, and for the performance of serological tests witlh the serums of patients.Wthen large numbers of stools have to be dealt witl, tile development of rapid and reliable metlhods of identifi- cation is of paramiount imnportance, otherwise reports are apt to get in arrears, and confusion is-likely to reian in tlje laboratory.Further, it is to tlhe interest of thle clinician that bacteriological diagnosis sliould be forthcominga at tile earliest possible moment.The technique for faeces exanlinationis hsere detailed is that to which we have been led by gradual nmodifications of the scheme with wlicillwe cotllnllenced operations, and it -has proved very satisfactory.ESSENTIALS. 1. 3.MacConley 's l)ile-salt-lactose-neutral-red-adar.2. Mannite peptone water containing Durliam's ttube.3. TlhorouLghly tested specific agglutinating serums of high poteucy for 1. tlyphosts, D.paratyphosis A, B. paretqyp/host B13, B. enteritidis Gaertner, B. dysenteriace Shhiga, and B. dyseniiter-iae Y.These serumu obtaiis from the Lister Institute.The following diltutions of these serums are made vitli car- b)olized saline (0.5 per cent.carholic in nornmal saline) aisd kept in bulk preferably h)ut Iiot niecessarily in tile cold chest.1. P.G. m)ixtutre containing in equal parts, Paratyphosu-s A serum-1 (1 in 66), Paratyphotsns B serum (1 in 66), anid earlntier serum (1 il 66).Concentration of eacll il inal minture -1 ill 200.2. P.T'1'.mli.mtneconltaininig in equal parts, Pnratyiphosns A serum (1 ill 66), 1P'at!ptyphosus B seruLm (1 iii 66), anid typhoid scrumni (1 ill 66).Conceiltration of eaclh in.filal mixture _1 ill 200. 3. Y seru¢m diluted I in 100, or 1 in 200. 4. Shiga serumzn diluted 1 in 100, 6rl in 200.5. Paaratyphosuts 4 serumiii diluted 1 in 200.6.-Paratyphosus B serutmsl diluted 1 in 200.7. Typhloid serun diltited 1 in 200.8. (iaertter serutm diltuted 1 in 200.STEPS.Portion of faeces emulsified in brothi andl allowedl to staud oln bench for an hotir.One or two drops from the upper layers of the fluid are spread on the bile-salt-agar plates.N?ext loriiing.-Pickoff several nio's-lactose colonies (discrete colonies wherever possible) and inoculate each-colouiy inlto maiinite and inito ordinary brotlr.The nLumber of colonies taken off will depend on many factors-for example, (1) the nuLmber of whive colonies present, (2) the appearanice of the colonies, (3) the clinical symptoms of the case if known, (4) thje appearances of the stool.Index No. 899.