1887.] 



On the Anatomy of Asiatic Cholera, 



475 



One of the main objects of the renewed inquiry was to ascertain 

 the presence in, or the absence from, the anatomy of cases of cholera 

 from another epidemic than the Spanish of certain appearances that 

 the microscopical preparations from the Spanish epidemic of 1885 had 

 presented. The appearances referred to were described in a Report 

 made to the Society in June of last year, and printed in the Proceed- 

 ings of the Society for that year, so that it is unnecessary for me to 

 repeat them here. The more so since in this year's work I have com- 

 pletely failed after minute, long and repeated search, with the use of 

 good lenses (new apochromatic system of Zeiss), and after employ- 

 ment of various methods of staining including that by which the 

 Spanish preparations were coloured, to find any trace of the above- 

 mentioned appearances in any of the material obtained in Italy. 

 Neither in the specimens of the tissues nor of the intestinal fluid 

 post mortem, nor of the vomit or dejecta during life is any trace of 

 them to be found. Any view that suggested itself of a causal con- 

 nexion of them with cholera must therefore meet the difficulty that 

 they form no constant anatomical feature of the disease. 



With regard to the presence of comma-shaped bacilli in my 

 material, such forms have been found in altogether thirteen of the 

 cases from Puglia, although always with difficulty, and seven times 

 only after extremely patient and rigorous search. The method found 

 most satisfactory for their detection has been that of Loffler with a 

 methylene-blue solution made according to the receipt given by him. 

 The chief difficulties of the investigation have lain in the facts, that 

 the comma-bacilli are among the bacilli which are earliest decolorised 

 by the solutions for removing the excess of stain, that the morpho- 

 logical characters of the comma-bacilli are not so distinctive as to 

 make their recognition from bacilli of some other species always 

 certain, and that in none of my specimens have I found them free 

 from admixture with other micro-organisms, and in none in very great 

 abundance. Having only the morphological characters of the bacilli 

 for criterion, I have compared them always with specimens from pure 

 cultivations of Koch's comma-bacillus freshly prepared for the purpose, 

 and I have only accepted them as such when they have agreed with 

 the latter standard form. 



Of the cases in which the comma-bacilli have been found, in three 

 they may be called " fairly numerous," in five " sparse," and in five 

 " very scanty." The bacilli have never been found in any other situa- 

 tion than in the wall of the alimentary canal, and in the wall only in 

 the most superficial portion of the tissue, in the mucosa. 



The three cases in which they are fairly numerous are characterised 

 clinically by the fatal ending having supervened without any stage of 

 febrile reaction, and anatomically by the changes in the wall of the 

 intestine being confined to partial denudation from epithelium of the 



