EDITORIAL. 61 



fact that the cholera organism is either not present or no longer present 

 in sufficient numbers for us to be able to find it. I think it is a reflection 

 upon the bacteriologist to say that he is not able to make a bacteriologic 

 diagnosis of a case of cholera in which the examination is' made within a 

 short period of time after the onset of the symptoms. The methods 

 employed in the laboratory are very satisfactory and definite for the 

 bacteriologic diagnosis of cholera. We do not rely alone on the morphol- 

 ogy of the organism, for its identification, as one might suppose from 

 some of the remarks that have been made here, but we consider in addi- 

 tion its agglutinative and bacteriolytic reactions and to a certain extent 

 its general biologic properties in culture media and its pathogenic prop- 

 erties. By all these means taken together we are able to make just as 

 definite a bacteriologic diagnosis of Asiatic cholera as we are of typhoid 

 fever or plague. During the past year Dr. Marshall has tried in the 

 laboratory with definite strains of the cholera spirillum to produce a 

 change in the organisms so that they would not agglutinate with a cholera 

 serum, but he has not succeeded in accomplishing this, nor has anyone 

 else done so. The fact that one or two atypical organisms ("El Tor" 

 strains) which resemble the true cholera spirillum in all respects except in 

 the production of hsematoxins and which give the characteristic serum 

 reactions with cholera serum, have been reported, does not serve to inter- 

 fere with the bacteriologic diagnosis of cholera from a practical stand- 

 point. I feel that we may have great confidence in being able to make 

 bacteriologic diagnoses, providing the cases are seen early enough in the 

 disease and that the examination is performed with sufficient care. A 

 good deal has been said here about the cholera organism changing its 

 morphology, biological properties, and serum reactions so that we were 

 not able to recognize it in the laboratory, but I feel confident that we are 

 still able to diagnose the cholera organism without difficulty for all 

 practical purposes. 



Dr. Van R. Hoff: I understand that you mean unless you do find the 

 organism it is not cholera? 



Dr. E. P. Strong: I do not mean that it is always not cholera if we do 

 not find the organism in a specimen which had not been sent us until 

 say forty-eight or seventy-two hours after the subsidence of all symptoms 

 of the disease, or if the specimen is not delivered to us for several days, 

 or if the autopsy is not performed until several days after death, or if the 

 case has died of some late complication of cholera; but if we get the 

 specimen in time we can find the organism if it is there. The idea has 

 been expressed that before the actual epidemic or toward its close, the 

 organism changes its morphology and its biologic properties to such a 

 degree that we are not able to make a definite, bacteriologic diagnosis. 

 There is no evidence whatever to support this theory, so far it is entirely 

 theoretical. 



