244 BACTERIA PATHOGENIC TO MAN 



Numerous epidemics of acute diarrhoea in children from one to five 

 years of age have been noted in which almost pure cultures of colon 

 bacilli have been found. The symptoms begin with high fever which 

 often rapidly falls, and frequent stools containing mucus and streaks 

 of blood or only watery. These symptoms may quickly abate or go 

 on to a toxic state characterized by heart weakness and drowsiness. 

 This may lead to lung complications or death. In many such cases in 

 America when blood has been present we have found one of the mannite 

 fermenting types of the dysentery bacillus. Here the lesions must be 

 considered as being due to mixed infection. 



The colon group as exciters of inflammation are much less apt to 

 produce pus than the pyogenic cocci. The peritoneum, the bile tracts, 

 and the urinary tracts are most frequently affected, but it also causes 

 inflammation in wounds and various organs of the body. 



Experimental evidence goes to show that the injection of cultures of any 

 of the varieties of colon bacilli into the peritoneal cavity produces intense 

 and fatal peritonitis. Some varieties when freshly isolated are espe- 

 cially virulent. Not only perforation of the intestines in man, but injury 

 to the intestinal walls, allows colon infection of the peritoneum to 

 take place, and if foreign bodies are present in the peritoneum, or the 

 epithelium injured, or absorption interfered with, such acute general 

 peritonitis is very probable. At first most of these cases were believed 

 to be a pure colon infection, but now it is known that this idea came 

 largely from the overgrowth of colon bacilli in the cultures. More 

 careful investigations, through cultures and smears, have demonstrated 

 the fact that streptococci, and less frequently staphylococci and pneu- 

 mococci, are present in peritonitis arising from intestinal sources. 

 The colon bacilli found even in the same case commonly comprise many 

 varieties. 



The Colon Group in Inflammation of the Bile Tract. The contents of 

 the gall-bladder are usually sterile. This is true in spite of the fact 

 that bile is apparently a good culture medium for the colon group. 

 Simple tying of the neck of the gall-bladder usually causes a colon 

 infection to take place within twenty-four hours. Obstruction of the 

 bile-duct through various causes is fairly common in man. The gall- 

 bladder then becomes infected, and following the inflammation of the 

 mucous membranes there is often the formation of gallstones. Some cases 

 of jaundice are believed to be due to colon inflammation of the gall-ducts. 



Inflammation of the Pancreas. Welch was the first to record a case 

 -of pancreatitis with multiple fat necroses due to colon infection. A few 

 more cases have since been reported as due to members of the colon 

 group, either alone or in conjunction with the pyogenic cocci. 



Inflammation of the Urinary Tract. As far back as 1879 Bouchard 

 noted cystitis due to bacilli of the colon group. After injury of the 

 bladder mucous membrane, or by ligature of the urethra, it is possible 

 to excite cystitis in animals by injection of colon bacilli. When cystitis 

 is established the bacterial infection frequently spreads to the pelvis 

 of the kidneys, causing a pyelitis or suppurative nephritis. The same 



