XII, B, 2 Crowell and Johnston: Cholera Cases 87 



of an epidemic may be of value to public-health officials in serv- 

 ing to localize an infected focus and allow intensive sanitary- 

 measures to be applied to the place. 



There are several possibilities concerning the route by which 

 the vibrio reaches the bile from the intestine. In 1913 Greig(l2) 

 claimed to have recovered the comma bacillus from the urine of 

 8 out of 55 cholera cases examined. From this finding he argued 

 that in these cases the disease was a septicsemia. In 1914(14) 

 he adduced further evidence to show that the disease is at times a 

 septicaemia by isolating the organism from almost all the organs 

 in different cases after death. In a later article (15) he refers to 

 the probable dissemination of the vibrio in the tissues in cholera 

 through the lymph stream rather than through the blood stream. 

 Kulescha(29) also believed that the bile infection was of hsemo- 

 togenous origin. In 5 cases Schobl(42) failed to confirm Lief- 

 schiitz-Jakowleff's finding of vibrios in the tissues of a stillborn 

 child whose mother had suffered from cholera. In 1910 Ku- 

 lescha(29) investigated the urine of numerous cholera cases and 

 failed to find the vibrio. In the same way Schobl failed to find 

 the vibrio in the urine in 41 examinations of 27 patients and 

 convalescents. While the evidence is conflicting, it must be ad- 

 milted that occasionally the disease may be a septicsemia, but that 

 under ordinary conditions the gall bladder is more probably 

 infected through the bile ducts from the duodenum. A few 

 attempts on our part to isolate the cholera vibrio from parts 

 of the body outside the intestine and bile passages have failed. 



Kiister and Gunzler(30) note that Goldman had pointed out 

 that charcoal fed by mouth could be recovered through a cho- 

 lecystectomy wound. Kiister and Gunzler fed charcoal every two 

 hours for a day before operation and after cholecystectomy re- 

 covered the charcoal from the bile. 



Kulescha(29) recovered the vibrio from the bile in one case 

 one year after the acute attack. The International Sanitary 

 Conference at Paris (22) in 1911 reported that the duration of 

 the excretion of cholera vibrios by cholera carriers is as a rule 

 short (two to three weeks), but exceptionally it lasts to twelve 

 months. It was also reported that the excretion is also inter- 

 mittent and irregular and that there occur vibrio-free intervals 

 up to twenty-one days. The occurrence of these vibrio-free 

 periods in cholera carriers is probably accounted for by the re- 

 tention of the vibrios in the gall bladder and their irregular 

 release. At times they may be too few in the faeces to be re- 

 covered, as they are overgrown by other organisms. This irreg- 



