BACTERIOLOG V OF DIARRHCEA 363 



dysenteric enteritis. The actual number of individual bacteria 

 were, he found, as great in the healthy excreta as in the diarrhoeal 

 excreta. Proteus vulgaris was found very generally, and in the 

 most serious cases. No chromogenic bacteria were isolated, and 

 cultures from a large number of green stools failed to develop 

 green colonies. All the varieties of bacteria isolated from 

 diarrhoeal excreta were found to be capable of thriving in milk.^ 

 From these facts Booker concluded " that not one specific organism 

 but many different varieties of bacteria are concerned in the 

 etiology of the summer diarrhcEas of children." From 1889- 1895 

 Booker continued his studies, isolating bacteria from the rectum 

 in 92 infants affected with epidemic diarrhoea, and also from the 

 organs of 33 infants who died from this disease. He found the 

 conditions for the development of bacteria in the intestine of 

 infants affected with summer diarrhoea, different from those in the 

 healthy intestine of milk-fed infants, in that they favoured more 

 varied bacterial vegetation, a richer growth of the inconstant 

 species of intestinal bacteria, and a more uniform distribution 

 through the intestine of the two constant varieties of healthy 

 excreta bacteria {B. coli coviviunis and B. lactis (Brogenes). The 

 first step in the pathological process, Booker believes to be a direct 

 injury to the epithelium from abnormal or excessive fermentation 

 and from toxic products of bacteria ; and secondly, that a general 

 intoxication may be brought about indirectly through the produc- 

 tion of soluble poisons. He holds that bacteriologically and 

 anatomically three principal forms of summer diarrhoea of infants 

 may be provisionally distinguished, viz, : dyspeptic or non-in- 

 flammatory diarrhoea, streptococcus gastro-enteritis, and bacillary 

 gastro-enteritis.- As a result of his extended researches, Booker 

 came to a general conclusion which he expressed as follows : — " No 

 single micro-organism is found to be the specific exciter of the 

 summer diarrhoea of infants, but the affection is generally to be 

 attributed to the result of the activity of a number of varieties of 

 bacteria, some of which belong to well-known species, and are of 

 ordinary occurrence and wide distribution, the most important being 



^ Trans. Ninth International Medical Congress^ vol. iii. Archives of 

 Pediatrics, February 1890. 



2 Johns Hopkins Hospital Reports, 1896, vol. vi., p. 253. See also a paper " On 

 the Growth of Bacteria in the Intestine," by Lorrain Smith and Tennant. — 

 Brit. Med. Jour., 1902, vol. ii., p. 1941. Also Jeffries, Trans. American Pedia- 

 trics Society, vol. i., 1889 ; and Baginsky, Archiv f. Kinderheilkunde, xii., Nos. 

 I and 2 ; and Berliner klin. Woch., 1889. 



