246 BACTERIA PATHOGENIC TO MAN 



patient usually agglutinates the cultures from the urine in 1 : 20 or 1 : 50 

 dilutions, but this property is sometimes absent, especially in light cases. 



The colon variety found in the urine can ordinarily be detected also 

 in the feces. This would suggest an autoinfection. Cystic infection in 

 the female usually takes place through the urethra. In both male 

 and female any injury or disease of the rectal mucous membranes 

 contiguous to the bladder creates a possibility of the invasion of the 

 colon through the lymph channel of the inflamed tissues and cause a 

 colon cystitis. It is also possible that at times an infection may take 

 place through the kidney, this organ having received the bacilli from 

 the blood. Besides the above-mentioned ways, we may have direct 

 infection carried in by the catheter, sound, etc. 



In all cases in addition to the introduction of the colon bacillus a 

 predisposing condition must be present, such as more or less marked 

 retention of urine by an enlarged prostate or stricture, any unhealthy 

 state of the mucous membrane or general depression of vitality. 



The Colon Group as Pus Formers. Members of this group are fre- 

 quently the cause of abscesses in the region of the rectum, urethra, 

 and kidney. They are rarely met with in other locations. 



Jhe Colon Group in Inflammation Not Previously Mentioned. Broncho- 

 pneumonia, lobar pneumonia, and pleurisy have occasionally been 

 caused by colon bacilli, probably from blood sources. Not a few cases 

 of meningitis and spinal meningitis in infants, following localized colon 

 infections, are due to colon bacilli. The symptoms are not well devel- 

 oped, as a rule. Some cases of endocarditis have also been noted. 



The Colon Group as Producers of Absorbable Toxins. Through intes- 

 tinal fermentation substances are formed which when absorbed produce 

 marked nervous symptoms. The presence of indican in the urine 

 usually means that such improper fermentation is present. 



Methods of Isolation. While the isolation of typhoid bacilli from 

 feces, water, dust, etc., is attended, as a rule, with difficulty, pure cul- 

 tures of colon bacilli can usually be obtained from such substances by 

 the simplest procedures. The following methods may be recommended : 



1. Inoculate 10 c.c. of fluid 2 per cent, lactose or dextrose litmus 

 agar with feces or suspected material. The melted agar should be at a 

 temperature of about 41 C. After shaking pour in Petri dish. Several 

 dilutions should be made. After eighteen hours examine the plates and 

 inoculate the contents of a number of tubes containing 2 per cent, 

 dextrose agar with any colonies showing a red color. The colon bacilli 

 will produce gas and acid. 



2. Inoculation of increasing quantities of the material (water) in 2 

 per cent, dextrose nutrient bouillon. The presence of colon bacilli in 

 the inoculated portion produces after twelve to twenty-four hours active 

 fermentation in the tube. (Plate and isolate as in 1.) 



3. The inoculation of glucose bouillon to which small amounts of 

 carbolic acid or of hydrochloric acid have been added to inhibit .the 

 growth of many other varieties of bacteria. This method has not given 

 any better results than 2. 





