of these distinctions, and to call in question the role of the comma-bacillus in the causation of cholera, was to place themselves outside the of
pale
civilisation,
and to reduce them to the
level of Matteists and other people whose opinSuch ions were not worthy of consideration. the state of
was
feeling
in
and
August last,
we
what curious results this narrow view of the pathology of cholera has led. The question of the relationship of cholera to
will
to
see
the comma-bacillus one
Here,
of definition.
tomed, as discovery
to resolve itself into
seems
in
India,
we are accus-
also the way in Europe before the of the comma-bacillus, to recognise
was
certain well-defined symptoms, which it was well-nigh impossible to confound with those of any other condition
(except perhaps
poisoning),
with
together
distinct and
The time has
now come
when
we
may profitably ask what additions have been made to our knowledge of cholera during the recent epidemic
clinical
A
complete Europe. year's epidemic has not yet
iu
the
history
been of
of lust
written,
and
remarks in have taken as another column the various references which are to be found scattered chiefly in the pages of the Centralblatt fur Bacteriologie and Parasitenhunde since the outbreak of the disease iu Hamwe
burg
in
with the
August
last.
source
A list of
our
these, together
of the
publication in which the articles appeared, when they were not original communications to that journal is also given, so that our readers will be able to amplify for themname
selves the observations we there made, and which it would be impossible to do within the compass of
our space. On the appearance of the epidemic in Europe, the medical journals of all countries teemed for a time with instructions for the diagnosis of cholera by the bacteriological method, and the was that which was procedure of Schottelius a sale as guide by which recommended giving would Koch be distinof the comma-bacillus and Prior,and other guished from that of Finkler similar micro-organisms which might be found in cholera nostras or other cholera-like cases. The British Medicul Journal had illustrations tube contrasting the appearance of a gelatine " with that culture of the " true comma-bacillus
of the Prior-Fiukler comma, and a writer warned all controversialists that to doubt the value
arsenical
group of
a
equally
well-defined post-mortem appear-
constituting grounds for the most unqualified diagnosis of cholera. "Cholera Nos-
ances,
as
tras" is
a
formerly
term
we
do not
confined to
use
in
India,
and
was
presenting exactly
cases
same symptoms and post-mortem appearances, but with little tendency to a fatal issue and occurring in lion-epidemic years. In India we call these cases "sporadic," and they are com-
the
enough, and we maintain that there is no essential difference between them and those which occur in epidemics of "Asiatic" cholera, whether in India or Europe. Since the discovery of the comma-bacillus, Indian bacteriologists have not altered their position, have continued to define cholera as a disease presenting certain well-marked and unmistakable
mon
symptoms
and
post-mortem
appearances,
and
have maintained further that there is uo essential bacteriological distinction, as far as the comma-bacillus is concerned, between "sporadic" "
epidemic" cholera, or what iu Europe are called "Cholera Nostras" and Asiatic cholera." and
"
It one
was
iu India first
unvarying
that bacilli in
pointed
comma uo "
in all
out
cases
way to be
that there is of true
no
cholera,
distinguished
from
Asiatic " cholera are found in other allied morbid conditions of the bowel, and that iu a considerable proportion of cases of cholera as defined above, especially at certain seasons of the year?no comuia-bacilli are to be discovered either in the stools during life or in the intestinal contents after deatii. The commabacillus has therefore been regarded iu India those found iu
May us
holding
place
MEDICAL NEWS.
1893.] :i
non-essential
or
at least
subordinate
in tho
which
picture of true cholera. The data now place before our readers, constiunimportant contribution to a right
we
tute a not
conception of the bacteriological relationship of the disease, while the frequent allusion to the absence of any comma in the reports of both Ge rman and French authors certainly seems to
support the Indian view. In
Europe the discovery of the comma-bacillus has led to an entirely different result. The definition of cholera as a very fatal epidemic
disease presenting certain well-defined and unO mistakeable symptoms and post-mortem appearances has been abandoned. The old meaning of the term " Cholera Nostras " has been lost. 1
Neitl ler in symptoms,
post-mortem
appearances,
fatality or epidemic tendency is it to be distinguished from true Asiatic cholera. The comma-bacillus of Koch is everything at least in
Germany.
made of
There
a
sort of fetish
special organism,
a
and
has been
unless
that
found, the disease is not cholera. organism The symptoms may be those of cholera in their severest form, the autopsy may reveal the most typical appearances of cholera ; curved bacilli is
may be may be
as
abundant
as
they like,
and the
cases
fatal as 82 per cent, as :n Carp's 62 per cent, of all, as and cases, may constitute in Berlin last year, but all this is of no account as
unless certain
organisms
are
present, grow in
a
particular way at a certain temperature and only likely otherwise to mislead to an erroneous are
diagnosis.
We give in our bacteriological section, for c the information of our readers, a summary or observations on this subject made by German and French writers, and leave them to judge which view of cholera is the more tenable in our present
state of
knowledge.
147
pale
civilisation,
and to reduce them to the
level of Matteists and other people whose opinSuch ions were not worthy of consideration. the state of
was
feeling
in
and
August last,
we
what curious results this narrow view of the pathology of cholera has led. The question of the relationship of cholera to
will
to
see
the comma-bacillus one
Here,
of definition.
tomed, as discovery
to resolve itself into
seems
in
India,
we are accus-
also the way in Europe before the of the comma-bacillus, to recognise
was
certain well-defined symptoms, which it was well-nigh impossible to confound with those of any other condition
(except perhaps
poisoning),
with
together
distinct and
The time has
now come
when
we
may profitably ask what additions have been made to our knowledge of cholera during the recent epidemic
clinical
A
complete Europe. year's epidemic has not yet
iu
the
history
been of
of lust
written,
and
remarks in have taken as another column the various references which are to be found scattered chiefly in the pages of the Centralblatt fur Bacteriologie and Parasitenhunde since the outbreak of the disease iu Hamwe
burg
in
with the
August
last.
source
A list of
our
these, together
of the
publication in which the articles appeared, when they were not original communications to that journal is also given, so that our readers will be able to amplify for themname
selves the observations we there made, and which it would be impossible to do within the compass of
our space. On the appearance of the epidemic in Europe, the medical journals of all countries teemed for a time with instructions for the diagnosis of cholera by the bacteriological method, and the was that which was procedure of Schottelius a sale as guide by which recommended giving would Koch be distinof the comma-bacillus and Prior,and other guished from that of Finkler similar micro-organisms which might be found in cholera nostras or other cholera-like cases. The British Medicul Journal had illustrations tube contrasting the appearance of a gelatine " with that culture of the " true comma-bacillus
of the Prior-Fiukler comma, and a writer warned all controversialists that to doubt the value
arsenical
group of
a
equally
well-defined post-mortem appear-
constituting grounds for the most unqualified diagnosis of cholera. "Cholera Nos-
ances,
as
tras" is
a
formerly
term
we
do not
confined to
use
in
India,
and
was
presenting exactly
cases
same symptoms and post-mortem appearances, but with little tendency to a fatal issue and occurring in lion-epidemic years. In India we call these cases "sporadic," and they are com-
the
enough, and we maintain that there is no essential difference between them and those which occur in epidemics of "Asiatic" cholera, whether in India or Europe. Since the discovery of the comma-bacillus, Indian bacteriologists have not altered their position, have continued to define cholera as a disease presenting certain well-marked and unmistakable
mon
symptoms
and
post-mortem
appearances,
and
have maintained further that there is uo essential bacteriological distinction, as far as the comma-bacillus is concerned, between "sporadic" "
epidemic" cholera, or what iu Europe are called "Cholera Nostras" and Asiatic cholera." and
"
It one
was
iu India first
unvarying
that bacilli in
pointed
comma uo "
in all
out
cases
way to be
that there is of true
no
cholera,
distinguished
from
Asiatic " cholera are found in other allied morbid conditions of the bowel, and that iu a considerable proportion of cases of cholera as defined above, especially at certain seasons of the year?no comuia-bacilli are to be discovered either in the stools during life or in the intestinal contents after deatii. The commabacillus has therefore been regarded iu India those found iu
May us
holding
place
MEDICAL NEWS.
1893.] :i
non-essential
or
at least
subordinate
in tho
which
picture of true cholera. The data now place before our readers, constiunimportant contribution to a right
we
tute a not
conception of the bacteriological relationship of the disease, while the frequent allusion to the absence of any comma in the reports of both Ge rman and French authors certainly seems to
support the Indian view. In
Europe the discovery of the comma-bacillus has led to an entirely different result. The definition of cholera as a very fatal epidemic
disease presenting certain well-defined and unO mistakeable symptoms and post-mortem appearances has been abandoned. The old meaning of the term " Cholera Nostras " has been lost. 1
Neitl ler in symptoms,
post-mortem
appearances,
fatality or epidemic tendency is it to be distinguished from true Asiatic cholera. The comma-bacillus of Koch is everything at least in
Germany.
made of
There
a
sort of fetish
special organism,
a
and
has been
unless
that
found, the disease is not cholera. organism The symptoms may be those of cholera in their severest form, the autopsy may reveal the most typical appearances of cholera ; curved bacilli is
may be may be
as
abundant
as
they like,
and the
cases
fatal as 82 per cent, as :n Carp's 62 per cent, of all, as and cases, may constitute in Berlin last year, but all this is of no account as
unless certain
organisms
are
present, grow in
a
particular way at a certain temperature and only likely otherwise to mislead to an erroneous are
diagnosis.
We give in our bacteriological section, for c the information of our readers, a summary or observations on this subject made by German and French writers, and leave them to judge which view of cholera is the more tenable in our present
state of
knowledge.
147
