INFECTIONS OF THE DIGESTIVE TRACT 291 



H. THE SACCHARO-BUTYRIC TYPE OF CHRONIC EXCES- 

 SIVE INTESTINAL PUTREFACTION 



This form of intestinal derangement is characterized 

 by a chronic putrefactive process (having its seat mainly 

 in the large intestine and lower ileum) and due to the 

 action of very large numbers of strictly anaerobic 

 butyric-acid-producing bacteria capable of multiplying 

 by means of spore formation. A thorough study of the 

 anaerobes concerned with this type of decomposition 

 has not yet been made, but it may confidently be stated 

 that the organism most prominently concerned in at 

 least a large number of the cases is B. aerogenes capsu- 

 latus (B. Welchii). The characters of this organism 

 have already been elsewhere described. Associated 

 with B. aerogenes capsulatus may be found B. putrificus 

 and possibly in some cases the bacillus of malignant 

 oedema. In many cases, however, B. putrificus has not 

 been found in the fermentation tubes or in the flasks 

 containing various media into which suspensions of 

 the mixed faecal flora have been inoculated. Anaerobic 

 plates made from the suspensions, heated for twenty 

 minutes to 80 C., have shown B. aerogenes capsulatus to 

 be the dominant or even the exclusive strict anaerobe 

 growing upon sugar-blood agar or blood agar. In a 

 certain proportion of cases the fsecal fields have shown 

 B. aerogenes capsulatus to be associated with large 

 numbers of Gram-positive diplococci, and these Gram- 

 positive diplococci have been grown very abundantly 

 in the fermentation tubes; that is, they have assumed a 



