SPIRILLUM CHOLERA ASIATICS. 443 



noticeable morbid appearances. If, however, the forma- 

 tion and absorption of the toxic products of the comma 

 bacilli do not take place so rapidly, and if the patient 

 survives this stage, the results of the local poisoning, the 

 necrosis of the mucous membrane, become more marked ; 

 bleeding occurs, there is enormous multiplication of 

 putrefactive organisms which grow to the exclusion of 

 any comma bacilli not yet expelled ; the absorption of 

 putrefactive poisons sets up typhoid symptoms which 

 are not a necessary part of the cholera process itself, 

 and post-mortem examinations made at this stage show 

 those deep alterations of the mucous membrane which 

 have been often erroneously looked upon as characteristic 

 of cholera. As can be readily demonstrated, the comma 

 bacilli do not spread into the organs of the body, nor 

 are they excreted in the secretions at any stage of the 

 process. Further, direct experiments on animals show 

 most distinctly that comma bacilli, when they enter the 

 blood stream, unless when they are in enormous 

 numbers, and unless toxic materials are injected at the 

 same time, die very rapidly and do not pass from the 

 blood in a living state into any organ, or into the 

 intestinal canal or the urine.* 



From these facts, as well as from what has been Sources 

 previously pointed out as to the vital properties of the iri 

 comma bacilli, we may draw some important conclusions 

 as to the mode in which cholera is transmitted. In the 

 first place the comma bacilli leave the body of the patient 

 evidently only in the dejecta of the first few days of the 

 disease (quite exceptionally in the material vomited, see 

 page 419), and hence it is only these dejecta, and the 

 objects infected by them, as for example the bed and 

 body linen, vessels, soil, water-closets, earth on which 

 these dejecta are deposited, well-water into which the 

 dejecta may pass, &c., that can serve as sources of 

 infection. The greater the number of things contami- 

 nated the more numerous will be the sources of infection, 

 and the greater the danger of contagion. These sources 



* Wyssokowitsch, Zeitschr.f. Ifyy., vol. i. See chapter on the pro- 

 duction of disease. 



