364 PATHOGENIC BACTERIA IN MILK 



the streptococcus [enteritidis] and Proteus vulgaris" The strepto- 

 coccus termed S. enteritidis varies in morphology, and seems to be 

 associated with two classes of cases, one of which simulates cholera, 

 the other typical enteric fever. " Micrococci are present in all of 

 the cases, in immense numbers in some, being few in others." ^ It 

 may be added that Cumston, Hoist, Escherich, and Hirsch, have 

 also laid emphasis upon the causal relationship of certain strepto- 

 cocci and diarrhoea. 



Klein was one of the first workers to isolate an anaerobic 

 organism from cases of epidemic diarrhoea. This organism, 

 which he named B. enteritidis sporogenes, was found in three 

 successive outbreaks of diarrhoea occurring among patients in 

 St Bartholomew's Hospital. In the first two outbreaks the milk 

 was evidently the channel of infection, in the third it was some 

 rice pudding. The bacillus was carefully studied and the main 

 facts respecting it will be found elsewhere in the present volume. 

 Here it may be said that it is a widely distributed organism and 

 occurs in normal and typhoid excreta, in sewage, manure, soil, dust, 

 and milk.^ The etiological relationship between this bacillus and 

 epidemic diarrhoea has been called in question, and it is, of course, 

 not proved that the organism is the cause of the disease. On the 

 other hand, it has been very frequently found in the mucous flakes 

 of the dejecta in patients suffering from the disease, and, in the 

 outbreak produced by the consumption of cooked rice pudding, it 

 is difficult to understand how any organism except an anaerobe of 

 highly resistant qualities could have produced the condition. It will 

 be apparent, moreover, that B. enteritidis sporogenes fulfils in a some- 

 what exceptional degree the requirements suggested by Ballard. 



That epidemic diarrhoea is caused by the B. coli either alone or 

 in conjunction with other organisms, has been held by a number 

 of authorities. Cumston, who investigated 13 cases of the 

 disease, concluded that B. coli associated with Streptococcus pyogenes 

 was the chief pathogenic agent concerned, and he claims that the 

 virulence of B. coli is exalted by the association.^ Lesage also 

 formed the opinion that the disease was due to B. coli, and investi- 

 gated the agglutinative properties of the serum of children suffering 

 from epidemic diarrhoea on B. coli isolated from the intestine. He 

 obtained a positive result in 40 out of 50 cases, and the serum of 

 each of these 40 cases, also agglutinated samples of B. coli from 39 



^ Johns Hopkins Hospital Reports, 1896, vol. vi., p. 251. 



2 Report of Medical Officer of Local Government Board, 1897-98, pp. 210-251. 



•'' International Medical Magazine, February 1897. 



