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IN a paper on Bacillus coli infections of the urinary tract, Dudgeon, Wordley and Bawtree (1922) refer to two cases of acute pyelo-cystitis, one of which terminated fatally, due to slow lactose fermenting bacilli which were strongly haemolytic. The diagnosis of paratyphoid fever was considered probable on clinical evidence, chiefly because of the severity of the illness and the prolonged pyrexia which was infinitely longer than occurs in typical cases of acute coli fever. An organism was isolated from each case with identical cultural, serological, and haemolytic properties. On cultural evidence both strains were distinct from true colon bacilli, as they formed blue colonies on litmuslactose-agar which were similar in appearance to typhoid-paratyphoid colonies, and slowly fermented lactose-broth. Since this paper was published, I have met with 49 cases of infection of the urinary tract due to this group of bacilli, all of which have run an acute course, in some instances with prolonged fever, and the clinical diagnosis of "enterica" was made in some of the cases. Owing to the appearance of the colonies on litmus-lactose-agar the clinical diagnosis may receive support at the outset, but detailed investigation of the organisms renders the bacteriological diagnosis relatively simple. Some of these cases have occurred in women recently confined, and the same organism has been recovered from the urine and lochia. The urinary symptoms may be masked by the severity of the general reaction which as already stated has led to the clinical diagnosis of "enterica." Two temperature charts are figured to illustrate the types of fever which may occur. Chart I is from a medical man whose illness ran an acute course for three weeks, while convalescence lasted for about one month. The chief symptoms were pain on passing water, pain in the lumbar region with tenderness on both sides on deep pressure, and severe malaise. There was no doubt that the malaise and general weakness were infinitely greater manifestations of the illness than the urinary symptoms. This patient had suffered from malaria in the Struma Valley during the Great War, but no malarial parasites were 1 Dudgeon, L. S., Wordley, B., Bawtree, F. (7. xn. 1922). On Bacillus eofc infection of the urinary tract especially in relation to haemolytic organisms. Joum. Hygiene, xxi. 168. (2nd communication.)

Acute Infection of the Urinary Tract Due to a Special Group of Haemolytic Bacilli