460 CHOLERA 



systemic disturbance which cannot be accounted for merely by 

 the withdrawal of water and certain substances from the 

 system. Such symptoms include the profound general prostra- 

 tion, cramps in the muscles, extreme cardiac depression, the 

 cold and clammy condition of the surface, the subnormal 

 temperature, suppression of urine, etc. These, taken in their 

 entirety, are indications of a general poisoning in which the 

 circulatory and thermo-regulatory mechanisms are specially 

 involved. In some, though rare, cases known as cholera sicca, 

 general collapse occurs with remarkable suddenness, and is 



rapidly followed by a 

 fatal result, whilst there 

 is little or no evacuation 

 from the bowel, though 

 P? st mortem tne intes- 

 tine is distended with 

 fluid contents. As the 

 characteristic organisms 

 in cholera are as a rule 

 present only in the 

 intestine, the general 

 disturbances are to be 

 regarded as the result 

 of toxic substances 

 absorbed from the 

 bowel. It is also to be 



FIG. 135.-Cholera spirilla, from a culture on ted that r ch } & is n a 



agar of twenty-four hours' growth. disease OI which the 



Stained with weak carbol-fuchsin. x 1000. onset and course are 



much more rapid than 



is the case in most infective diseases, such as typhoid and 

 diphtheria ; and also that recovery, when it takes place, does so 

 more quickly. The two factors to be correlated to these facts 

 are : (a) a rapid multiplication of organisms, (b) the production 

 of rapidly acting toxins. 



The Cholera Spirillum. Microscopical Characters. The 

 cholera spirilla, as found in the intestines in cholera, are small 

 organisms measuring about 1 '5 to 2 yu, in length, and rather less 

 than *5 in thickness. They are distinctly curved in one direction, 

 hence the appearance of a comma (Fig. 135) ; most occur 

 singly, but some are attached in pairs and curved in opposite 

 directions, so that an S-shape results. Longer forms are rarely 

 seen in the intestine, but in cultures in fluids, as may be 

 well seen in hanging-drop preparations, they may grow into 



