The significance of the typhoid serum reaction in the offspring of patients suffering from enteric fever / by Charles Bolton.

  • Bolton, Charles.
Date:
1901
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Licence: In copyright

Credit: The significance of the typhoid serum reaction in the offspring of patients suffering from enteric fever / by Charles Bolton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    20) gave at once a good serum reaction. The blood of the foetus gave no reaction whatever to the test, and its organs presented no post-mortem lesions. Cultivations were taken from the liver, spleen, gall bladder, and peritoneal fluid, but no growths were obtained from them. Case 2.—Enteric fever in the mother without infection of the foetus.—The patient was set. 41, and eight months pregnant. Her attack of the fever was fairly severe, and she gave birth to a living child during the third week of the disease, subsequently recovering. Her blood (1 in 20) at once gave a good serum reaction. The child died twelve hours after birth. Its blood gave no reaction, and its organs presented no lesions. Cultivations were taken from the spleen, mesenteric gland, gall bladder, and kidney. From each organ the same growth was obtained upon agar. The growth consisted of very small, feebly motile, bacilli, which did not give any reaction on testing with enteric blood serum, and which were decolorised by Gram’s method. The bacillus clotted milk and formed acid, fermented dextrose, formed a large amount of indol, and formed gas bubbles in shake-cultures of gelatin. The growths were evidently pure cultivations of the B. coli communis, as, on repeatedly making subcultivations on gelatin and agar plates, the same bacillus was invariably obtained. Case 3.—Enteric fever in the mother, with infection of the foetus by the B. typhosus.—The patient was set. 19, and five months pregnant. On the twenty-fifth day of a relapse she gave birth to a stillborn child, subsequently recovering. Her blood (1 in 40) at once gave a good serum reaction. The blood of the child (1 in 20) reacted in a quarter of an hour. There were no lesions in its organs, and cultivations were taken from the gall bladder and spleen. The growth obtained on agar was in each case the same. It consisted of actively motile bacilli which gave the reaction with enteric blood serum, and also with the blood of the foetus. The bacilli were decolorised by Gram’s method, and neither clotted milk nor formed gas from dextrose or in shake-cultivations of gelatin, but formed a little indol. The same bacillus was obtained from sub- cultures. Hot having the opportunity of employing more extensive tests, I sought the aid of Dr. Bulloch, bacteriologist to the London Hospital, who very kindly examined a subculture from the gall bladder, and confirmed my opinion that the bacillus which I had found was the B. typhosus. Conclusions. In the only one of my own cases in which the foetus gave a serum reaction, it had been infected with typhoid bacilli, and had presumably formed its own agglutinin. With regard to the passage of agglutinin from the mother to the foetus through the placenta, although experimental evidence shows that on repeated inoculation of the mother a little agglutinin may pass to the foetus, I can find no clinical case on record in which the child gives a positive reaction to the serum test, and in which the organs have been proved free from B. typhosus. Until this is shown, the passage of agglutinin through the placenta in the human subject must be considered unproved. On the other hand, as stated above, agglutinin has been proved to exist in the milk and colostrum of a woman whose blood gives the serum reaction, and it has also been proved that it is absorbed from the milk by the suckling child. I desire, finally, to express my indebtedness to Dr. Bulloch for