676 



SCIENCE. 



[Vol. II., No. 42. 



tions in suitable localities in tliat country. We'were 

 able to carry out the first part of our plan in accord- 

 ance with our wishes; for the commission found 

 abundant opportunity, during its stay in Alexandi-ia, 

 to collect the material necessary for its preliminary 

 researches. This was mainly due to the active co- 

 operation of the physicians of the Greek hospital, who 

 furnished us working-rooms, permitted us to study 

 the cholera cases in the hospital, and placed the bod- 

 ies of those who died of the disease at our disposal. 



At first the commission had two rooms of the hos- 

 pital, adjoining each other on the ground-floor, and 

 well lighted. In one room tlie microscope work was 

 carried on, and in the other the culture experiments. 

 The animals experimented on were at first brought 

 into both rooms. But when their number had been 

 increased, it was thought too dangerous to manipu- 

 late the material for infection in the same rooms in 

 which we had to spend nearly the entire day, and 

 they were accordingly removed to another room in 

 the old hospital ; and there the experiments on infec- 

 tion were made. 



The material for experiment was obtained from 

 twelve cholera patients, and ten bodies of individuals 

 who had died of the disease. The cases of nine of 

 the patients were studied in the Greek hospital, two 

 in the German, and one in the Arabian. The symp- 

 toms corresponded in all cases with those of true 

 Asiatic cholera. Specimens of the blood, of the vom- 

 lUed matter, and of the dejections of these patients, 

 ■were taken, and submitted to examination. It was 

 ■soon apparent that the blood was free from micro- 

 ■■organisms, that the vomited matters were compara- 

 'tively poor in them, but that the dejections contained 

 ■a, considerable quantity; and the latter material was 

 therefore mainly used in the infection experiments 

 with animals. 



Although the number of bodies used for dissection 

 was small, the material they afforded was of the great- 

 est service in localizing the disease. They represented 

 the most varied nationalities (three Nubians, two Ger- 

 man-Austrians, four Greeks, and one Tnrk), were 

 of different ages (two were children, two over sixty 

 years of age, and the others between twenty and 

 thirty-five years), and the duration of the disease va- 

 ried in the different cases. The most important fact, 

 however, is that dissection could be begun imme- 

 diately or in a few hours after death. The changes 

 produced in the^ organs, and especially in the intes- 

 tines, by putrefactive decomposition shortly after 

 death, which render microscopical examination difli- 

 cult, and its results generally entirely deceptive, were 

 thus effectively guarded against. I wish to lay par- 

 ticular stress on this circumstance, because it is 

 hardly probable that such excellent material for 

 microscopic examination as we obtained could be 

 found in other places. 



The appearances of the bodies, as well as the symp- 

 toms of the sick, left no room for doubt that we had 

 to deal ■n'ith true cholera, and not, as at first supposed, 

 with diseases resembling cholera, — the so-called 

 ' choleriform ' and 'choleroid' diseases. 



We were unable to detect any organized infectious 



matter in the blood, or in the organs which are 

 usually the seat of micro-paraiites in other infectious 

 diseases; viz., the lungs, spleen, kidneys, and liver. 

 Occasionally bacteria were found in the lungs; but it 

 was clear from their forms and position that they had 

 nothing to do with the processes of the disease, but 

 had entered the lungs from the vomited matter by 

 aspiration. In the contents of the intestines, just as 

 in the choleraic dejections, there was an extraordi- 

 narily large number of micro-organisms of different 

 kinds, no one of which was present in excessive pro- 

 portion. There ■n'cre also no special indications 

 which could enable us to dra'w any conclusions as to 

 their connection with the disease. On the other 

 hand, the examination of the intestine itself gave a 

 very important result. In all cases but one, a specific 

 form of bacteria was found in the walls of the intes- 

 tine. The exception was in the case of a patient who 

 had died of a sequela several weeks after the cholera 

 had subsided. These bacteria -n-ere rod-shaped, and 

 therefore belong to the bacilli. In size aftd shape 

 they most nearly resemble the bacilli of glanders. 

 In cases where the intestine showed the sliglitest evi- 

 dence of change, the bacilli had penetrated into the 

 tubular glands of the mucous coat, and had set up a 

 considerable irritation thei'e, as was shown by the 

 distension of the glands, and the accumulation of 

 jnany-nucleated round cells in their interior. In many 

 cases, top, the bacilli had worked their way beneath 

 the epithelium, and had penetrated between it and 

 the gland membrane. Moreover, they had planted 

 themselves in large quantities over tlie surface of the 

 villous coat of the intestine, and had penetrated its 

 tissue. In severe cases of the disease, where there 

 was a bloody Infiltration of the raucotis coat of the 

 intestine, the bacilli were present in great numbers, 

 and had not confined themselves to the invasion of 

 the tubular glands, but had entered the surrounding 

 tissue in the deeper layer? of tbe mucous coat, an(} 

 sometimes had penetrated to the muscular Coat. 

 The villous coat was also thickly covered with them 

 in such cases. The principal seat of all these changes 

 was found to be the lower part of the small intestine. 

 In investigations like the present, the examination 

 ought to be made on perfectly fresh bodies, because 

 putrefactive decomposition can induce similar growths 

 of bacteria in the intestine. From this consideration 

 I was unable last year to attach any value to the dis- 

 covery of the same bacilli in the same position in the 

 intestines of cholera patients which I had obtained 

 directly from India, because I was afraid of compli- 

 cations with post-mortem changes. This former dis- 

 covery, which was made in the intestines from four 

 bodies of persons who had died of cholera in India, is 

 now confirmed, because there can be no error in the 

 present case due to decomposition in the Egyptian 

 bodies. The inference, too, that the correspondence 

 in the conditions of the intestine in the Indian and 

 Egyptian cholera may be taken as a further indica- 

 tion of the identity of the diseases, is not without 

 weight. 



The number of bodies of cholera patients used by 

 the commission for examination, it is true, was small. 



