CHOLERA NOSTRAS AND SUMMER DIARRHEA. 199 



conditions, when the point to be determined is whether 

 the disease in question is true Asiatic cholera or not, the 

 mode of procedure must in every instance be precisely 

 that which has been described in the preceding chapter for 

 Asiatic cholera. 



Closely related to cholera nostras is the so-called sum- 

 mer diarrhea of children. The probable cause of this 

 condition is thought to be the so-called bacteria of bitter 

 milk, which are known under the collective name of bacillus 

 lactis Fliigge. Fliigge has isolated twelve varieties of this 

 organism, all of which belong to the group of the hay- 

 bacillus, and with which they have many points of resem- 

 blance in common. (See Hay-bacillus and Potato-bacillus 

 in Appendix.) These microorganisms cause peptonization 

 of the casein of milk hence the designation peptonizing 

 milk-bacteria in consequence of which the milk acquires 

 a bitter taste. Some of them give rise to toxic metabolic 

 products, which, when fed to young dogs, cause diarrhea, 

 muscular weakness, and decline of temperature. The 

 whole group of these milk-bacteria is characterized by the 

 formation of highly resistant spores that withstand boiling 

 for several hours without injury. It is on this account that 

 the sterilization of milk is attended with so much difficulty ; 

 even the method of Soxhlet is incapable of destroying the 

 peptonizing microorganisms. If such an insufficiently or, to 

 use the common expression, partially sterilized milk is pre- 

 served at a moderate temperature as, for instance, 22 C. 

 (71.6 F.) or above the spores develop, and the poisons 

 mentioned are generated. For this reason great care must 

 be taken that milk prepared by the Soxhlet method is kept 

 in a cool place until shortly before it is used, and in 

 summer best in a refrigerator. The custom of sending 

 with children a supply of milk for a considerable time, 

 heated and kept in special warming bags, should be aban- 

 doned, as in the presence of numerous spores germination 

 and beginning multiplication may set in speedily (in the 

 course of one or two hours). These, however, are to be 

 considered as dangerous, as, according to the investigations 

 of Liibbert, " the active principle of the decomposed milk 

 is to be looked for in the bodies of the bacilli." The 

 anaerobic microorganisms to be found in milk the bacillus 

 butyricus Botkin and that of Fliigge probably play no 

 part in the etiology of the intestinal catarrh of infants. 



