EPIDEMIC DIARRHOEA 307 



bacillus was carefully studied, and the main facts respecting it may 

 be stated briefly here : — 



B. enterUidis spm-ogenes (Klein) is an anaerobic bacillus: l'6-4'8 /i long, and 

 '8 fi. broad ; stains by Gram's method and ordinary stains. Motile ; spore forma- 

 tion present ; large, oval spores often situated near one end of bacillus ; grows well 

 on gelatine and agar. In the former gas is produced and the gelatine liquefies. 

 On agar there is also gas fermentation, and the colonies in the depth are round, 

 white by reflected light, brown and granular in transmitted light. On the surface 

 of agar plates flat, circular, moist, grey colonies appear in twenty-four to forty- 

 eight hours ; thicker in centre than at margin, and showing granularity. Bacillus 

 grows well in milk, producing the "enteritidis change." After thirty-six hours of 

 anaerobic incubation at 37° C. in milk, the cream is torn or disassociated by develop- 

 ment of gas, so that the surface of the medium is covered with stringy, pinkish- 

 white masses of coagulated casein enclosing a number of gas-bubbles. The main 

 portion of the tube of milk contains a colourless, thin, watery whey, with a few 

 casein lumps here and there adhering to the sides of the tube. The whey has a 

 smell of butyric acid, and is acid in reaction. It contains many bacilli. Patho- 

 genesis — If 1 c.c. of milk whey containing the bacUlus be injected into a guinea-pig 

 (200 to 300 grammes), a swelling appears in six hours, extending over abdomen 

 and thigh, and death occurs in eighteen to twenty- fom- hours. Post mortem : sub- 

 cutaneous gangrene, with much sanguineous exudation, in which bacilli and spores 

 will be found. Klein considers this organism to be the cause of epidemic diarrhoea. 



B. enteritidis sporogenes 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 £. enteritidis sporogenes fulfils in a 

 somewhat exceptional degree the requirements suggested by Ballard. 



That epidemic diarrhoea is caused by the JB. 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, con- 

 cluded 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.f Lesage also formed the opinion 

 that the disease was due to B. coli, and investigated the agglutinative 

 properties of the serum of children suffering from epidemic diarrhoea 

 on B. coli isolated from the intestine. He obtained a positive resxilt 

 in 40 out of 50 cases, and the serum of each of these 40 cases, also 

 agglutinated samples of B. coli from 39 other children seized with 



* Revorts of Medical Officer of Local Oovernment Board, 1897-98, pp. 210-51 ; 

 1902, p.'406. 



t International Medical Magazine, February 1897. 



