ASIATIC CHOLERA. 189 



The inhaled bacilli must also be restrained in the mouth, as 

 infection does not take place through the lungs. From the 

 mouth the vibrios gain entrance into the stomach. If the 

 hydrochloric-acid content of the stomach is normal, the 

 vibrios succumb to it. If infection takes place, it may be 

 assumed that either large amounts of the infected water 

 have been drunk, so that some of the bacteria escape 

 the action of the hydrochloric acid, in consequence of the 

 marked dilution of the gastric contents, or that the function 

 of the stomach was impaired from some cause, and the 

 hydrochloric-acid content was subnormal. Having gained 

 entrance into the intestine, the bacteria multiply and give 

 rise to the production of toxins. Mere multiplication of 

 the bacteria in the intestine does not constitute cholera. 

 Such an effect was observed in the well-known' experiments 

 of Pettenkofer, without the development of actual cholera. 

 Only when sufficient toxin has been produced to cause 

 injury of -the intestinal mucous membrane and when the 

 toxin is absorbed does the disease develop. While the tis- 

 sues and the blood become impoverished in water, the pro- 

 fuse rice-water stools take place, and with them innumer- 

 able bacilli are evacuated. 



The toxic action is manifested especially in the constitu- 

 tional symptoms (feebleness of heart, decline of temperature, 

 etc.). Cholera-typhoid also is now generally looked upon 

 as an intoxication, and the renal disease complicating 

 cholera likewise depends in part upon the toxic activity of 

 the comma-bacilli, being caused in part by the ischemia re- 

 sulting in consequence of the withdrawal of water. 



Brieger and Frankel have demonstrated the presence of 

 a toxalbumin in cholera-cultures, but greater significance in 

 experiments on animals has been attached to the poison 

 contained within the bodies of the bacilli themselves, and 

 whose effects have been studied, especially by R. Pfeiffer. 

 If a young agar streak-culture, from twenty to twenty-four 

 hours old, is destroyed by exposure for ten minutes to the 

 action of chloroform, and ten milligrams of the bodies of 

 the vibrios thus destroyed are injected into the peritoneal 

 cavity of a guinea-pig, the animal will die. After the lapse 

 of two hours it becomes relaxed, its temperature falls below 

 30 C. (86 F.), and death takes place in the course of 

 eight or ten hours, usually amid violent clonic convul- 

 sions. The poison that thus adheres to the bodies of the 



