DYSENTERY CHOLERA 87 



The disease is produced only by swallowing the germs 

 of cholera, and since the germs invariably come only from 

 the intestinal contents of man, it follows that sewage pollu- 

 tion of water, the contamination of milk and food through 

 handling by cholera patients, and food infection through 

 flies constitute the common avenues of infection. 



Unlike the typhoid bacillus, the cholera spirillum does 

 not penetrate deep into the wall of the intestine, but 

 produces an intense poison while multiplying in the intes- 

 tinal contents and in the superficial layers of the intestinal 

 mucous membrane. The absorption of the poison pro- 

 duces the clinical symptoms of the disease. These begin 

 with diarrhea and colicky pain in the abdomen. In a 

 short time the diarrhea becomes intense and profuse 

 and is accompanied by vomiting. Many of the pa- 

 tients die at this period in a state of collapse. The 

 stools are at first yellowish, but soon become grayish 

 white, and are then termed "rice- water stools." These 

 discharges often contain the cholera spirilla in practically 

 pure culture. When recovery takes place the stools 

 gradually resume their normal color and the cholera 

 spirilla disappear. 



The disease is spread chiefly by contaminated water 

 used for drinking, cooking, and washing. Vegetables 

 washed in infected water, particularly lettuce, cress, 

 and the like, may convey the disease. Wash- women 

 and others who are brought into very close contact with 

 the linen of cholera patients or their stools are prone to 

 contract the disease. Like in typhoid fever, it has 

 recently been found that some healthy persons may 

 carry cholera germs in their stools. These are spoken 



