SUMMER DIARRHCEA 403 



complete separation of the curd from the whey takes place. The former 

 adheres to the sides of the tube in shreds, and large masses gather with 

 the cream on the top of the fluid, all being torn by the gas evolved. The 

 whey is only slightly turbid, and contains numerous bacilli. The growth 

 has an odour of butyric acid. If a small quantity (say 1 c.c.) of 

 the whey be injected into a guinea-pig, the animal becomes ill in a few 

 hours and dies in twenty-four hours. At the point of inoculation, the 

 skin and subcutaneous tissues, and sometimes even the subjacent muscles, 

 are green and gangrenous and evil-smelling, there is considerable oedema, 

 and there may also be gas formation. The exudation is crowded with 

 bacilli, which, however, are not generally distributed in any numbers 

 throughout the body. These pathogenic properties of the bacillus 

 enteritidis sporogenes are important in its recognition, for its culture 

 reactions taken alone are very similar to those of the bacillus butyricus of 

 Botkin. 



SUMMER DIARRIKEA. 



As has been already stated, the bacillus of dysentery, the 

 b. coli, and the b. enteritidis sporogenes have been found 

 associated with epidemics of this disease. This indicates that 

 the condition may be originated by a variety of organisms, and 

 it is further probable that the clinical features in different 

 epidemics vary. This is to a certain extent illustrated by the 

 condition of the stools. In Britain these are usually green, 

 watery, slimy, and putrid, without blood or mucus, but in many 

 outbreaks in America blood and mucus are present. The 

 multiple origin of the disease has been illustrated by the work of 

 Morgan, who, in a careful investigation of the disease in Britain, 

 has been unable to find evidence of the dysentery bacillus being 

 present. He has, however, very frequently (in 63 per cent, 

 of the cases examined) found in the stools and intestine a 

 bacillus (" Morgan's No. 1 bacillus ") which is a motile Gram- 

 negative organism producing acid and slight gas formation in 

 glucose, Isevulose, and galactose, and no change in mannite, 

 dulcite, maltose, dextrin, cane-sugar, lactose, inulin, amygdalin, 

 salicin, arabinose, raffinose, sorbite, or erythrite; it further 

 causes indol formation, and in litmus milk slowly originates an 

 alkaline reaction. It produces diarrhoea and death in young 

 rabbits, rats, and monkeys when these animals are fed on 

 cultures. It is thus possible that in this bacillus we have 

 still another cause of the disease. Morgan has found that in 

 diarrhoea cases the lactose fermenters, so characteristic of normal 

 faeces, are relatively less frequent and tend to be replaced by 

 non-fermenters of lactose. His bacillus has been found in a 

 certain proportion of normal children, but this especially during 

 the epidemic season ; it has also been found in flies. 



