400 . CHOLERA 



often by vomiting, there are also symptoms of general systemic 

 disturbance which cannot be accounted for merely by the with- 

 drawal of water and certain substances from the system. Such 

 symptoms include the profound general prostration, 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 post mortem the 



intestine is distended 



^-Ai* \ with fluid contents. As 



*$*'& *"^ > *ke characteristic organ- 



^ " ^J **j *L+. isms in cholera are found 



/ " * c ^Vt ^ xf *4L.> ' 1*""* on ^ * n ^ e ifltestine, the 



* * f S^Q..C'O' C general disturbances are 



f> -v j3^H to be regarded as the 

 -*.cf~(X_^ -V,^ 1A . _ f __, , 



r ^ ; ^ ^ ? ' 



."t - * absorbed from the bowel . 



r ^ yf^T^- It is also to be noted 



v.'^'V ^^ r ~; f - a r^r 5^ that cholera is a disease 



^"**'> j ^ ^f. ""** of which the onset and 



. i5 x* l*vf| ^ ' ' ^ -r r- course are much more 



^' ( --w^ $3 j*f~ < rapid than is the case in 



^J**,"* most infective diseases, 



* *r ," such as typhoid and 



FIG. 134.-Cholera spirilla, from a culture on diphtheria : and that 



agar of twenty-four hours' growth. recovery also, when it 



Stained with weak carbol-fuchsin. x 1000. 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 JJL in length, and rather less 

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

 hence the appearance of a comma (Fig. 134) ; 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 is especially well seen in 

 hanging-drop preparations, they may grow into longer spiral 

 filaments, showing a large number of turns. In film preparations 



