CHOLERA 71 



discussed in typhoid is equally applicable to cholera. The 

 cholera vibrio is very proteolytic. It will destroy itself in 

 its own culture. It is unable to penetrate alive into the 

 blood and the products of its bacteriolysis find in the blood 

 precipitating antibodies already preformed in combination 

 with which they produce all the known disturbances. They 

 act like the arsenobenzenes which have been insufficiently 

 alkalhiized. In the case of fulminating cholera, the crisis is 

 caused by the rapid passage into the blood of a great quan- 

 tity of products of bacteriolysis and in fact here we find none 

 or very few living bacteria in the intestines (at autopsy) . 



It is impossible to know today whether the subjects over- 

 whelmed in this way have been more or less immunized by 

 spontaneous immunizing infections but it is very probable 

 that if they had been immunized, we should find that the 

 reaction would be here exclusively intravascular. 



When the crisis lasts for several hours it begins with 

 intravascular reactions which cause disturbances of the 

 circulation: embolism, dilatation of capillaries, congestion 

 of mucous membranes and, in consequence, gastro-intestinal 

 disturbances and fall in temperature: sometimes dyspnea, 

 convulsions, and syncope which may result fatally. When 

 the crisis is prolonged, there are very probably intracellular 

 reactions which are expressed by fever and may in turn lead 

 to death. But in the latter case, the pathologic state may 

 result, not from the direct action of the cholera antigen but 

 from lesions more or less severe and numerous or from com- 

 plications produced by the reactions. 



To sum up: the total of our knowledge concerning the 

 pathogenicity and evolution of gastro-intestinal infections 

 produced by the bacteria of the typhoid-colon and cholera 

 group permits us to conclude: 



1. Only the animal species or individuals which are incap- 

 able of completely digesting, that is to say, of transforming 

 into non-specific amino-acids the albumins of certain bac- 

 teria can be spontaneously infected by those bacteria. 



2. The severity of the disease is determined on the one 

 hand by the dose of bacteria injected as well as by the inten- 

 sity and rapidity of bacteriolysis; on the other hand, by the 



