510 THE CHOLERA GROUP 



5. Complement Fixation. Besche and Kon, 1 Neufeld and Haendel, 2 

 and others have been successful in diagnosing cholera and identifying 

 cholera vibrios by means of the complement-fixation test. This method 

 has not been generally used, however. 



6. Agglutination by Serum of Patient. The agglutination reaction 

 is not of much value for an early diagnosis of Asiatic cholera. Agglu- 

 tinins occasionally appear in the blood serum of cholera patients 

 as early as the third or fourth day; usually, however, they are not 

 demonstrable until later. A dilution of at least 1 to 50 should be 

 obtained with the patient's serum to warrant a positive diagnosis. 

 Even in chronic cases and in cholera carriers this reaction is too 

 inconstant to serve practical needs. 



Dissemination. Cholera vibrios are found in the fecal discharges 

 of cholera patients, but practically never in the urine, so far as is 

 known. The disease is spread through contaminated water and 

 sewage, occasionally by uncooked vegetables and by fomites, rarely 

 by milk. Dissemination by flies is probably fairly common, par- 

 ticularly in those countries, as India, where the dejecta are not 

 properly disposed of. Those in contact with the dejecta of cholera 

 patients, particularly doctors, nurses, and especially laundresses, are 

 quite likely to contract the disease. The sacred rivers of India, the 

 Ganges and the Jumna, are regarded by many as the home of the 

 cholera vibrio, and it has been accepted in the past that drinking 

 the water of these rivers by pilgrims who visited them in large numbers 

 yearly has been responsible to a large degree for the spreading of the 

 disease, particularly in India. Hankin 3 has made the astonishing 

 statement that the waters of these rivers kill cholera vibrios in two 

 to four hours, it being surmised that some soluble acid substance 

 is the bactericidal agent. This observation, if corroborated, would 

 discredit the spreading of cholera by pilgrims who bathe in the sacred 

 rivers. 



Cholera Carriers. The observations of Greig, who found cholera 

 vibrios in the gall-bladders of 81 out of 271 cholera cadavers, and of 

 Kulescha, 4 who described pathological changes in the gall-bladder 

 and biliary passages caused by cholera vibrios, have attracted atten- 

 tion to the importance of cholera carriers in the spreading of the 

 disease. Zeidler 5 found cholera organisms in the feces of a patient 



1 Ztschr. f. Hyg., 1909, Ixii, 161. 



2 Arb. a. d. kais. Gesundamte., 1907, xxvi. 



3 Ann. Inst. Past., 1896, 175, 511. 



4 Centralbl. f. Bakt., 1909, 1, 417. Med. Klinik., 1907, Nos. 48 and 49. 



