The use of streptokinase bile salt broth for clot cultures in the diagnosis of enteric fever.

In spite of the constant reiteration in almost every publication on typhoid fever that bacteriological examination of the blood is the diagnostic method of choice in the early stage of the disease, coupled with the steady stream of post-war publications emphasizing the uselessness of the Widal test at this time, it is remarkable how many requests for the latter are still made as the primary test and how few for the former. The determining factor is probably convenience, and although it has been possible to insist on blood cultures being done in hospital practice, it will be a long time before a similar routine can be effectively established in the mission outstations or in the field. A practical routine for the demonstration of the causative organism in the clotted blood specimen sent for the Widal test would turn a probably useless specimen into one of certain diagnostic value. As early as 1906 Fornet demonstrated that clot culture was a practical procedure. We know that many tropical and sub-tropical laboratories use such a technique, as we have done in West Africa, India, and China, but the only references to it in the literature of the last 30 years appear to be those of Felix (1924) and Downie and Fairbrother (1934).