442 SPIRILLUM CHOLERA ASIATICS. 



properties of these comma bacilli can be artificially 

 attenuated, a thing which is by no means improbable, 

 when we take into consideration the results obtained in 

 the case of other pathogenic bacteria. According to a 

 preliminary communication by Nicati and Kietsch, the 

 virulence of cultivations of comma bacilli is diminished 

 to a certain extent when the cultivation is carried on for 

 a long time in meat infusion or nutrient jelly kept at 20 

 to 25 C. The protective inoculations which were made 

 in Spain by Ferran with supposed attenuated cholera 

 bacilli are so entirely wanting in the necessary experi- 

 mental and statistical support (as is evident from the 

 description given by Ferran himself, as well as from the 

 reports of others,) that they require no serious discus- 

 sion. As regards the bacilli found by Emmerich in the 

 bodies of patients who died of cholera, see page 335. 



Mode in which In accordance with the facts made out by Koch as to 

 Infection* 51 *ke biological characters of the infective agents of 

 occurs. cholera, we may suppose that the infection takes place 



somewhat in the following manner : 



Distribution The cholera process arises when living bacteria gain 

 of the cholera admission to the small intestine, remain there for a 



bacilli in the . . . 



patient. considerable time, and multiply actively. As the result 



of their growth toxic materials are formed, which in 

 the first place cause the death of the epithelium, and 

 ultimately of the superficial layers of the intestinal 

 mucous membrane. If they multiply rapidly, and if 

 large quantities of toxic materials are produced, the 

 latter are absorbed in large amount and set up general 

 symptoms, and ultimately paralysis of the organs of 

 circulation. If in this way death occurs at an early 

 period there are no deep alterations of the intestinal 

 mucous membrane, and the appearances on post-mortem 

 examination correspond to what has been described 

 above in typical cases, viz., there is a pure cultivation 

 of comma bacilli in the intestinal contents but no other 



