144 



CHOLERA. 



In no case were these parasites absent from 

 the intestines after death, as shown by a large 

 number of post-mortem examinations, and they 

 were constantly found in the choleraic stools, 

 diminishing in number and finally disappear- 

 ing as the patient recovered. The parasites 

 were easily cultivated outside the body in such 

 fluids as gelatine and meat-broth, but Koch 

 never succeeded in producing cholera in ani- 

 mals by the injection of fluid containing bacilli. 

 He proved that the organisms were quickly 

 destroyed by drying, as shown by numerous 

 experiments with soiled linen. This fact is 

 of great practical importance, as it is a strong 

 argument against the theory that the germs of 

 cholera are permanent, and may be transported 

 to a great distance. The question may be asked, 

 "Why is it assumed that these parasites are the 

 cause of cholera? They confine themselves to 

 the bowel, which is the seat of cholera. In 

 the early stage of the disease but few are found 

 in the stools ; but, as the dejections assume the 

 characteristic rice-water appearance, they be- 

 come more numerous. Moreover, they are not 

 found in either the bodies or dejections of pa- 

 tients affected with other intestinal troubles 

 (as dysentery). It has been noticed that the 

 bacilli thrive best in an alkaline fluid, and in 

 this way an attempt has been made to explain 

 the fact that patients who are suffering from 

 indigestion succumb more readily to cholera, 

 since the germs, when introduced into the 

 stomach, are rendered less active on account 

 of the diminshed acidity of the g.-istric juice. 

 As to the question of how the presence of 

 these minute organisms in tha intestines can 

 cause cholera, all that can be affirmed at present 

 is, that they exercise some destructive influence 

 upon the blood, and doubtless also upon the cell. 

 They seem ^ to generate some peculiar poison 

 within the intestine. Koch's deductions con- 

 cerning the origin of cholera are as follow : 



If the origin of the separate epidemics be carefully 

 looked into, it will be found that cholera has never 

 reached us except through human beings themselves. 

 We must not think that there are exceptions because 

 the infected individuals can not always be found. So 

 far as we know, no cholera epidemics have broken out 

 spontaneously outside of India ; hence, in this point, 

 experience agrees with the presumption that cholera 

 is caused by a specific organism having its habitat in 

 India ? where the circumstances are especially favor- 

 able for its development. 



Koch regards the delta of the Ganges as the 

 true home of the disease, since the luxuriant 

 vegetation, crowded population, and poor sani- 

 tary arrangements especially favor its perma- 

 nence. In other countries epidemics soon die 

 out of themselves. 



The reader may ask, What is the practical 

 nse of the parasitic theory of cholera, aside 

 from its interest as a brilliant scientific dis- 

 covery ? It will undoubtedly exercise a great 

 influence upon the future treatment of the dis- 

 ease, though at present, it must be confessed, 

 no way has been devised of introducing into 

 the intestines of cholera-patients (with safety) 



solutions strong enough to destroy the bacilli. 

 In doubtful cases, where cholera is suspected, 

 it will be possible to establish a diagnosis by 

 finding the characteristic organisms in the 

 stools. The principle will be most important 

 when applied to public hygiene. Not only will 

 quarantine regulations be more intelligently en- 

 forced, but the process of disinfection will be 

 conducted in a more rational manner. Since 

 it is certain that the bacilli perish as soon as* 

 they are thoroughly dried, the public will lost 

 something of their fear of the disease, as it will 

 be robbed of its mystery. As water is regard- 

 ed as the principal source of infection, renewed 

 care will be taken to see that this is free from 

 impure germs. 



Since the publication of Koch's views, his 

 experiments have been repeated, and numer- 

 ous attempts have been made to furnish the 

 missing link in the chain of evidence by com- 

 municating cholera to the lower animals by 

 introducing the parasites into their systems. 

 Success has been claimed, but the results are 

 still too imperfect to warrant any positive con- 

 clusions. Eecent investigations have seemed 

 to prove that the " comma-bacillus " is only 

 a temporary form of another organism, which 

 probably exists in a permanent state within 

 the intestine. This complicates greatly the 

 original question, and casts some doubt upon 

 the specific character of the cholera- parasite. 

 The latest news from Germany is, that Koch 

 has at length succeeded in inoculating rabbits 

 with the cholera-microbe, so as to produce a 

 disease similar to that in man. 



Drs. Klein and Gibbes, of the English Cholera 

 Commission, who are still engaged in carrying 

 on elaborate investigations in Bombay and Cal- 

 cutta, have just issued a preliminary report, 

 which is quite adverse to Koch. They claim 

 to have established the following points : 1. 

 The comma - bacilli are not characteristic of 

 cholera, since they are found in the evacua- 

 tions of diarrhoea and dysentery. 2. Certain 

 straight bacilli are more constantly present in 

 choleraic discharges than are the common va- 

 riety. 3. Numerous experiments have demon- 

 strated the impossibility of artificially com- 

 municating the disease to animals. 



The Epidemic of 1884. Cholera appeared as 

 an epidemic in those portions of southern 

 Europe bordering upon the Mediterranean, 

 mainly in France and Italy. The earliest of- 

 ficial mention of it was at Toulon, France, 

 June 4; but subsequent inquiry showed that 

 there had been cases at Toulon since April, 

 and that the disease had been introduced by 

 a vessel that had arrived at that port from 

 Tonquin, in Asia. Toulon had a population 

 of about 75,000, including Italian laborers, 

 mostly employed in the harbor, who, with 

 their families, numbered 10,000, living under 

 circumstances every way favorable for the 

 propagation of the cholera when once intro- 

 duced. It spread steadily, and within two 

 weeks was prevalent all through the city. A 



