394 PATHOGENIC MICROORGANISMS 



colon-bacillus infection may possibly take place simply because of unu- 

 sual temporary reduction of the resistance of the host. Whether or not 

 altered cultural conditions in the intestine may lead to marked enhance- 

 ment in the virulence of the colon bacilli can not at present be decided. 

 The opinion has been frequently advanced, however, without adequate 

 experimental support. 



Septicemia, due to the colon bacillus, has been described by a large 

 number of observers. It is doubtful, however, whether many of these 

 cases represent an actual primary invasion of the circulation by the 

 bacilli, or whether their entrance was not simply a secondary phenomenon 

 occurring during the agonal stages of another condition. A few unques- 

 tionable cases, however, have been reported, and there can be no doubt 

 about the occurrence of the condition, although it is probably less 

 frequent than formerly supposed. The writers have observed it on 

 two occasions in cases during the lethal stages of severe systemic 

 disease due to other causes. An extremely interesting group of such 

 cases are those occurring in new-born infants, in which generalized 

 colon-bacillus infection may lead to a fatal condition known as 

 Winckel's disease or hemorrhagic septicemia.' Prominent among 

 disease processes attributed to these microorganisms are various diar- 

 rheal conditions, such as cholera nostras and cholera infantum. The 

 relation of these maladies to the colon bacillus has been studied es- 

 pecially by Escherich,^ but satisfactory evidence that these bacilli may 

 specifically cause such conditions has not been brought. While it is not 

 unlikely that under conditions of an excessive carbohydrate diet, colon 

 bacilli may aggravate morbid processes by a voluminous formation of 

 gas, they do not, of themselves, take part in actual putrefactive proc- 

 esses. It is likely, therefore, that in most of the intestinal diseases 

 formerly attributed purely to bacilli of the colon group, these micro- 

 organisms actually play but a secondary part.^ 



It is equally difficult to decide whether or not these bacilli may be 

 regarded as the primary cause of peritonitis following perforation of 

 the gut. Although regularly found in such conditions, they are hardly 

 ever found in pure culture, being accompanied usually by staphylococci, 

 streptococci, or other microorganisms, whose relationship to disease is 

 far more definitely established. Isolated cases have been reported, 

 however, one of them by Welch, in which Bacillus coli was present in 



1 Kamen, Ziegler's Beitr., 14, 1896. 



2 Escherich, loc. cit. 



'Herter, " Bact. Infec. of Digest. Tract," N. Y., 1907. 



