392 THE COLI— CLOACA—PROTEUS GROUP 
this connection. They isolated colon bacilli from the blood stream in a 
small series of cases which i)resented symptoms indistinguishable from 
those of tyj)hoid fever. Such cases are uncommon, howe\'er. They 
are not infrequently septicemic in character. No typhoid bacilli were 
ever found in these patients, and no specific agglutinins for the typhoid 
bacillus were demonstrable. Specific agglutinins for the homologous 
strains of B. coli persisted until recovery. Colon septicemia occasion- 
ally occurs in the new-born, and the condition is known as Winckel's 
disease, or hemoglobinuria neonatorum.^ A severe infection, with 
fatty degeneration of the ^'iscera is sometimes referred to as Buhl's 
disease. Cystitis and pyelonephritis, particularly the former, are fre- 
quently found to be pure colon infections. B. coli is occasionally iso- 
lated from the center of gall-stones; it is surmised that the organism, 
or clusters of them, act as nuclei around which the cholesterin is grad- 
ually deposited. Colon bacilli have been isolated in rare instances 
from purulent cerbrospinal fluids, and they may cause bronchopneu- 
monia. Perirectal abscesses also may contain pure cultures of colon 
bacilli. 
Immunity and Immunization.— The constant occurrence of B. coli in 
large numbers in the normal intestinal tract is an index of the rela- 
tive immunity of man to infection with this organism. Occasionally 
very small numbers of bacilli may gain entrance to the tissues, par- 
ticularly in young children. The blood serum usually contains agglu- 
tinins in small amounts for the organism. In practice no attempt is 
made to increase the immunity to colon bacilli, except in cases of 
cystitis or other local infection. A accines of the homologous strain of 
B. coli are occasionally administered in such instances. The results 
have been variously interpreted 
Bacteriological Diagnosis.— The methods of isolation, identification 
and significance of B. coli in water supplies will be discussed in the 
chapter on Water. Isolation of colon bacilli from the intestinal con- 
tents or feces is readily accomplished by plating methods. The 
organisms far outnumber any others normally present in adolescents 
and adults, and even in severe diarrheal disorders colon bacilli do not 
entirely disappear. Prolonged starvation does not eliminate B. coli 
from the intestinal canal.^ The morphology and staining reactions are 
not distinctive. Plating methods— principle involved: lactose agar, 
containing litmus or decolorized fuchsin (Andrade indicator) as an 
indicator is infected with material suspected to contain B. coli. The 
organism ferments the lactose with the production of acid; the acid 
changes the color of the indicator immediately surrounding the colon 
bacilli; red if litmus is used, pink if fuchsin is employed. The red 
1 Kamen: Ziegler's Beitrjige, 189.3, 14, 132. 
- At the end of thirty-one days' abstinence from all food, typical colon bacilli were 
present in the lower part of the large intestine. Kendall: Observations upon the 
Bacterial Intestinal Flora of a Starving Man, Publication No. 203 of the Carnegie 
Institute of Washington, 1915, p. 232. This experiment emphasizes the fallacy of 
' 'starving out" intestinal bacteria by witholding food. 
