xB, 1 Schobl: Concerning Cholera Carriers 13 
per cent of cases in 1909 (50 examinations). His is the unique 
case of a patient who took sick with cholera in November, 1908, , 
and became a carrier (feces positive for cholera vibrios for 
fifty-seven days). Death occurred in September, 1909. Cholera 
vibrios were found in the bile passages, but not in the feeces. 
The close relation between the infection of the gall bladder 
and the condition in convalescents known as cholera carriers 
was early recognized. Nevertheless the emphasis of the fact 
and its importance in regard to the dissemination of the disease 
is justified, because assertions to the contrary are to be found 
in the literature as evident from the statement attributed to 
Roger by Greig:§ 
The absence of the infection of the gall bladder and bile ducts by the 
comma bacillus places the disease in quite a different position from that 
of typhoid fever in this respect. 
Considering the lengthy period of infectiveness as found in 
certain instances of cholera carriers and the periodical reoccur- 
rence of cholera vibrios in the stools of convalescents, theo- 
retically it would be difficult to believe that the cholera vibrio 
would live for such a length of time free in the intestinal tract 
where the competition with the normal inhabitants of the in- 
testine and other factors render the conditions unfavorable to 
its vitality. 
The tidal occurrence of the cholera vibrio in the stools of con- 
valescents who become carriers seems to indicate a focus con- 
nected with the alimentary canal, where the vibrios multiply 
and are being discharged into the digestive tract. At times 
and under certain conditions they appear in the excreted feces 
in numbers large enough to be detected by the usual methods. 
As to the genesis of the infection of the bladder and the bile 
ducts two ways come under consideration. Does the invasion of 
the bile passages take place directly from the small intestine 
or is the infection of hematogenous origin? The facts that 
the bile passages show marked pathological changes while the 
liver tissue proper exhibits, as a rule, only signs of toxic effect, 
the high percentage of infected gail bladders, and the rarely 
encountered evidence of a bacteremic stage of cholera infection 
speak in favor of the first-mentioned mode of infection. 
It was found that bile is not only a fairly good medium for 
the growth of the cholera vibrio, but also that it inhibits the 
growth of many other intestinal bacteria. As a matter of fact, 
* See footnote 2. 
