BACTERIOLOGY OF DIARRHOEA 365 



other children seized with the same disease.^ Some of the most 

 recent work on the relationship existing between B. coli and 

 epidemic diarrhcEa has been done by Delepine, who examined 

 milk in the outbreak of epidemic diarrhoea which occurred in 

 Manchester in 1894 {vide infra), and has also examined a large 

 number of town and country milks. His conclusion is that : — 



" Epidemic diarrhoea of the common type occurring in this 

 country is apparently, in the great majority of instances, the result 

 of infection of food by bacilli belonging to the colon group of 

 bacilli, and which are present at times in faecal matter. It appears 

 that this infection of food does not generally lead to serious conse- 

 quences, unless the infection is massive from the first, or the food 

 is kept for a sufficient length of time, and under conditions of 

 temperature favouring the multiplication of these bacilli. 



" Milk, which is the most common cause of epidemic diarrhoea 

 in infants, is usually infected at the farm, or (through vessels) in 

 transit. Of the bacilli of the colon group which are capable of 

 rendering the milk infectious, those which do not produce a large 

 amount of acid, and do not coagulate milk, are the most virulent, 

 and are probably the essential cause of epidemic diarrhoea." - 



Flugge and Lubert ^ believe that cows' milk contains at certain 

 seasons aerobic spore-bearing bacilli of the subtilis type, which have 

 the power of decomposing and peptonising milk, producing meta- 

 bolic products, which, when swallowed by animals, cause diarrhoea, 

 etc., and which may therefore produce diarrhoea in infants. 



It is evident that our knowledge of the bacteriology of diarrhoea 

 is not sufficiently established to permit of any very definite con- 

 clusion on the matter. It may be that the whole group of 

 choleraic, enteric, and diarrhoeal diseases are caused by a group 

 of micro-organisms having many similarities and relationships to 

 each other ; or it may be that different forms of diarrhoea have 

 their own specific causal organism ; or, lastly, it may be a question 

 of association of organisms which brings about the disease. In any 

 event, there is abundant evidence to prove that epidemic diarrhoea 

 is a bacterial disease in the same way as typhoid fever. 



Conditions favourable to epidemic diarrhoBa. — The pro- 

 visional results of Ballard's inquiry into the causation of epidemic 

 diarrhoea may be stated as follows : — 



" The summer rise of diarrhoeal mortality does not commence 

 until the mean temperature recorded by the four-foot earth ther- 



^ La Semaine Med., October 1897. 



^ Jour, of Hygiene, 1903, vol. iii., No. i, p. 90. 



^ Zeitschrift f. Hyg., xvii., p. 272 ; and xxii., p. i. 



