376 CHOLERA. 



main, confirmation from the investigations of others, though 

 some criticism arose, especially as regards the uniformity of 

 the characters of the comma bacillus. 



Within recent years, and especially during the epidemic 

 in Europe in 1892-93, spirilla have been cultivated from 

 cases of cholera in a great many different localities, and 

 though this extensive investigation has revealed the invari- 

 able presence in true cholera of organisms resembling 

 more or less closely Koch's spirillum, certain difficulties 

 have arisen. For it has been found that the cultures obtained 

 from different places have shown considerable variations in 

 their characters, and, further, spirilla which closely resemble 

 Koch's cholera spirillum have been cultivated from sources 

 other than cases of true cholera. There has therefore 

 been much controversy, on the one hand as to the significa- 

 tion of these variations whether they constitute different 

 species, or whether they are to be regarded merely as in- 

 dicating varieties of the same species, and on the other 

 hand as to the means of distinguishing the cholera spirillum 

 from other species which resemble it. 



We shall first give an account of the characters of the 

 cholera spirillum, with the evidence for its causal relationship 

 to the disease, and afterwards discuss some of the questions 

 just referred to. It may, however, be stated here that no 

 other organism of any kind has been discovered which has 

 even the faintest claim to be the cause of the disease. 



In considering the bacteriology of cholera it is to be 

 borne in mind that in this disease, in addition to the evi- 

 dence of great intestinal irritation, accompanied by profuse 

 watery discharge, and often by vomiting, there are also 

 symptoms of general systemic disturbance which cannot be 

 accounted for merely by the withdrawal of water and certain 

 substances from the system. Such symptoms include the 

 profound general prostration, cramps in the muscles, extreme 

 cardiac depression, the cold and clammy condition of the 

 surface, the subnormal temperature, suppression of urine, 

 etc. These taken in their entirety are indications of a 

 general poisoning in which the circulatory and thermo- 



