KALA-AZAR AND ORIENTAL SORE: THE PROBLEM OF TRANSMISSION
Authors: C. M. Wenyon
Journal: BMJ (1928)

The study of perniicious anaenmia is a good illustration of thee way in which abniormiial coniditioins of the, digestive funictions may causo disturbance in the bacter iological relationships of the intestinal conitents, distur-balnces wbhicl are too frequenltly reported as havinig ani etiological relationislhip to tho conditioni unlder investigation.The theory of intestinal toxaenmia is still widely lheld amiionig practitioners, anid has becen favoured by distiniguished members of the profession.The absenlee of compt)aratively simiiple methods for examiiiiinig the organiisms in faeces, and tlhe iniadequacy of our-iniformiationi of the effects of clhanges in diet or the inifluenlee of p)articular foodstuffs, make it extremnely difficul-t to definie the " nornmal " flora.Ignor- alice of tlle variationis wlhichl aie founed in niormnial persons is, unifortunately, reflected in the nuttmerouis conitributions whichlI appear in conniiexion witlh the examiiniationi of the intestinial contents in a variety of diseases, anid associated witlh cure or relief by the adminiistrationl of vaiecines nmade from-l a " pathological " intestinial flora.It is not genierally recognized that maniy varieties of conmmon intestinal organisms can be isolated from.the stools of lhealtlhy persons, particularly if sliglht adju-stimients of the cuilture miiedia are miade, or if special media are used.The ordinary media emuployed in the laboratory for the deemonstration of pathognic intestinial organisms are of use in the isolation of certain strains of coliform or-ganiisms only.The flora of the faeces, eveni -with regard to coliform organisms, becomes considerably widened by tleit use of fluiid media withl differenit degrees of hydrogeni-ion concentration, or by the adlditioii of §ubstances which are inhibitory to certaini common types.Browning has sihown that the additioni of brilliant greenl to peptone wvater results in the suippressioni of typical B. coli and the growtlh of inosite-fermeniting strains, 1id(l that this metlhod will demonlstrate the presence of Morgan's No. 1 bacillus in samples of faeces wlhiicl by direc(t plating oni ordinary medeia do niot yield that orgallism.Similarly a mixed gr ow-thi of faecal organisms wi1l show changes in types as a result of developmenit of aci(lity in fluiid miedia conitaining fermnlentable cai bo- hiyr;lrates.We liave found that a synitlhetic mediunm con- taining sodiuimll citrate as the source of carbon anid ammon m)iii ii hospJhate as the souirce of nitr ogenl (Koser's miietldiuimi) gives a great miiany varieties of coliforimn orgaiisnisms iti tthe stools of nornil persons.Tthe demonstration of any of tihese strainis in a sample of stool from cases of certaini chronic nialadies would, we believe, immediately suggest to certain bacteriologists an " abnormal flora," anid call for the exhibition of a vaceine.A recent pape1' oni the use of r csi(llal vaccinies in a wide variety of coniditionis may be quoted as repr-eselntative of imiany othe'rs whlichl lhave beeni *p-ublished, advocatinig the use of autogenous vaccinies of intestinal organismis.The authlor regards the occurrence of B. lactis aerogenes, Friedliinider's bacillus, anid Morgan's bacillus in the stool as of patlhogenic significance, and such conmmoni coliform organiisms as B. acidi lafctici anid 1B. coli roin mutiis aie looked upon with sulspicion.Whatever nmay be the therapeutic results obtained with vaccinies, it is niot justifiable to associate these commoni inhabitants of the intestinal tract as stanidinlg in causal irelation-slhip to the patient's pathological condition.-An increase in the numbers of streptococci in the stool,