464 SPIRILLUM CHOLERA ASIATICS. 



accidental conditions we not uncommonly find in the 

 smaller towns in Mid and North Germany that the 

 relatively pure water flows through the streets of the 

 town in open gutters, and that this water is not only 

 employed for household purposes but also per nefas, 

 but nevertheless very frequently for carrying away the 

 refuse from houses. If a case of cholera occurs in the 

 higher portion of such a town, and if dejecta or water em- 

 ployed for washing the linen gain entrance to this run- 

 ning water a sudden extensive spread, a sort of explosive 

 epidemic, may be the result, whatever be the state of 

 matters as regards the other factors which are of im- 

 portance in the production of an epidemic. Koch 

 observed another example in Marseilles ; in that town the 

 market women who offered vegetables for sale were wont 

 to sprinkle their wares from time to time with water in 

 order to keep them fresh, this water being taken by 

 means of a broom from a gutter which ran past the 

 market. The comma bacilli could very readily enter 

 this gutter water ; and hence, by means of the infected 

 vegetables and fruit, the germs might be distributed to 

 such an extent that a violent epidemic could result. A 

 similar occurrence can take place when one of the first 

 cholera cases occurs in a dairy, and when comma bacilli, 

 though only in very small numbers, enter the milk by 

 one of the modes described, for milk is a very excellent 

 soil for the growth of the cholera bacilli. 



Such accidents may now and then exert an important in- 

 fluence on the course of the epidemic, and as it maybe very 

 difficult to trace them subsequently, we may have the oc- 

 currence of a number of so-called "inexplicable" cases. 



If we review the whole series of factors which are 

 here mentioned, and which can influence, both as regards 

 place and season, the commencement and the course of 

 a cholera epidemic, we must admit that a local and 

 seasonal distribution of cholera, varying much at 

 different places and times, undoubtedly exists. 



