Attention called to the inhibiting ac tion of lactic acid upon the cultures of the spirillum. Ferrani (Revista de Cien cias MOlicas, Sept., '02).
The cholera spirillum secretes a sub stance which is inhibitory to the growth of the bacillus eoli, bacillus typhosus, bacillus anthracis, and bacillus pyocya netts. Gabritschewsky and Maljutin (Centralb. f. Pact. u. Parasitenk., June 15, '93).
There are not different species of the true cholera vibrio, but the changes which occur when it is grown under dif ferent circumstances are not constant and arc unessential, the typical forms being obtained again from the changed ones.
Friedrich (Centralb. f. Bakt. ti.. Para sitenk., May 19, '94).
Pathology.—The characteristic lesions of cholera are found in the small intes tine. whose inner surface is covered by a whitish, creamy lining, extending from the pylorus to the ileo-cmcal valve. Its contents are generally made up of the well-known rice-water material; this has a neutral or slightly-alkaline reaction, and contains only 1 to 2 per cent. of solid matter (chloride of sodium, carbo nate of ammonium, a little urea, and traces of salts of potash); it is devoid of albumin, coloring substances, and biliary salts. The mucous membrane, after the lining has been removed, shows a red coloration, more or less marked, accord ing to the period of the disease, and a number of small, round prominences, made by swelled folliculi: "psorentery." In a later stage the lesions are more pro nounced: the intestinal contents are bloody, the folliculi are ulcerated, and the mucous membrane shows a more or less extended gangrene. The large in testine is also extremely- hypermnic, studded with luemorrhagic patches and ulcerations, and is filled with black, bloody, fcetid, fcal matter. Deepening of the ulcerations may give rise to per foration, with all its dire sequehn. Mi croscopical examination shows a vari able degree of swelling and clouding of the epithelium, and extensive desquama tion of the small intestine. The ade noid tissue of the mucons membrane and of the villi is filled with embryonic cells, and this cellular infiltration is also found in the follicles and in Peyerls patches. The muscular layer is unaffected; the subserous connective tissue is infiltrated with leucocytes, while the epithelial layer of the peritoneum has disappeared.
Anatomically, therefore, the intestinal lesion may be regarded as an acute des quamative enteritis.
The fluids, especially blood and urine, may be very toxic and reproduce typical symptoms of mortal cholera in animals. Bose (Ann. de l'Inst. Pasteur, June 25, .95).
There is always a more or less severe glomerular nephritis. in the algid stage. Perniec and Scaglioni (Iliforma Mediea, Oct. 19, '94).
In the kidneys the pathological changes are those of a more or less severe glomerular nephritis, or, according to Leyden, of a coagulation necrosis of the epithelium without any inflammatory action. In the former case the morbid changes would be explained by the elim ination of toxins passing from the intes tine into the blood; in the second by alterations in the circulation due to the profuse loss of water. An epithelial des quamation is observed on the mucous membrane of the bladder, ureters, and the pelvis of the kidneys. The spleen is hard and rather small; the liver is con gested and its cells have undergone ffranular deaeneration.
As for the cerebral changes, both in the algid stage and in the period of re action, they- are likewise of the nature of acute deog,eneration and necrosis.
Cerebral changes in Asiatic cholera in algid state, as well as in reaction period, of the nature of an acute degeneration and necrosis, and not of a perivascular inflammation. Tschistowitsch (St. Pe tersburg med. Woch., Aug. 17, '95).
Prognosis.—Cholera Asiatica is always a serions disease, even when its symp toms do not apparently show a specially grave character. Considering its insidi ous tendency and the probability, never lacking, of lethal accidents in every period of its course, the slightest forms of diarrlacea may be regarded, during an epidemic, as the onset of a fatal affection. In the algid stage, of course, the prog nosis is still more unfavorable, and such symptoms as anxiety, agitation, collapse, weakness; quickness and, moreover, dis appearance of the radial pulse; anuria, coma, delirinm, and convulsions are ahnost without exception of very ill omen. As for the period of reaction. the prognosis becomes bad when cerebral or pulmonary complications occur, or if its course is irregular.