124 THE ACUTE SELF-LIMITED INFECTIONS 



certain whether or not this is a wholly extracellular toxin or 

 combined closely with the bacterial bodies. It is probably 

 mostly of the latter character, an endotoxin separated upon 

 the disintegration of the germ cells. 



Cholera is a disease transmitted almost exclusively by 

 polluted water, although food infected with bacteria may, 

 of course, transmit it. Water is contaminated by dejecta of 

 cholera patients, and the vibrio leaves the patient in no way 

 but with feces and vomitus. Large numbers of vibrios are 

 present in the feces early in the attack. Later they rapidly 

 decrease, but do not disappear from the gut and feces, and 

 may continue to come away in small numbers for many 

 months (the carrier state). In such cases they naturally 

 pollute anything with which the dejecta come in contact. 

 They do not live long in nature, however, and regulations 

 can be made to kill them. Flies having soiled themselves 

 upon cholera excreta may carry the germs. Vegetables may 

 be soiled from water. Personal contact and handling of 

 clothes from patients have the same value in transmission of 

 cholera as for typhoid fever. As the organisms leave the body 

 only with the feces, measures should be taken to disinfect 

 them, and anything likely to be soiled with them. The feces 

 should be received into 5 per cent, carbolic acid solution. 

 The buttocks and anus should be wiped with 1 to 1000 bichlor- 

 ide solution. Clothes or bedding, glasses, utensils, and other 

 objects should be soaked in these solutions. Boiling when 

 possible is advisable. A disinfecting hand lotion should be 

 constantly used by the attendants. It is necessary to con- 

 tinue disinfection of stools for varying periods after an attack, 

 since bacteria lurk in the depths of the intestinal mucosa, and 

 are excreted long after the acute symptoms have disappeared. 

 As in typhoid fever it has been found that contacts to cholera 

 patients may carry the germs without having the disease; 

 such persons may transfer the disease to other localities. 

 Feces should be disinfected until declared bacteriologically 

 free from the vibrios. 



