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947 CHOLERA IN FRANCE. into Paris from Lille and Amiens, the night refuge in the latter town especially having been discovered to be a centre of the disease. Apropos of M. Haffkine’s expedition to India and of his exposition in this country of his method for conferring immunity from cholera by the I vaccination " procedure, it does not seem to find much favour with medical authorities in India, if we may take the Indian Medical Gazette as the exponent of their views. At any rate, our contem- porary subjects the theory on which the procedure is assumedly based to a searching and critical examination, and asks whether "cholera bacillus" and ’’ comma bacillus" are convertible terms, and whether, amongst the many diverse micro- organisms to be found in the evacuations of cholera patients, the final selection of the comma bacillus as a true contagi1tm vivum of cholera is so justified by what we know of it as to place its acceptance beyond all question. Whatever hold this view may have taken of the professional mind in Europe generally, there can be no doubt that in current German literature the comma bacillus is regarded as the cholera bacillus and the expressions are consequently used in- differently. The Indian Medical Gazette does not by any means, however, accept this view as having been proved or demonstrated up to the present time. On the contrary, the difficulties in accepting it are, it alleges, not far to seek, and they are considerable. In the first place, the first of these organisms selected by Koch himself in Egypt as the cause of cholera was a straight bacillus, which he subsequently abandoned, without a word of explanation, in favour of the comma bacillus he discovered in Calcutta. That the last-named bacillus is not invariably present in the stools of cholera patients is admitted. In certain seasons of the year cases of cholera appear in India in which a daily search for comma bacilli fails to find them. On the other hand, those found in cholera stools do not invariably present characters by which they can be distinguished from similar organisms found in other re- lated pathological conditions of the bowel. There are apparently endless varieties of these bacilli, some of which do not, and some of which do, conform in their behaviour to tests like typical comma bacilli, although, as in the case of the outbreak of epidemic diarrhoea caused by putrid meat on board the ship Crofton ffall, the comma bacilli differed less from those found in true cholera than these do amongst themselves. Moreover, the inability of the comma bacillus to produce the disease as tested by various experi- menters and (with our knowledge of the destructive effect of acids and the gastric juice on the comma bacillus) requiring the assumption that there must not only be a general diffusion of the bacillus, but a coincident epidemic of alkaline dyspepsia, to give rise to an epidemic of cholera are opposed to the view that this micro-organism is the really essential factor. The natural history of cholera also implies that if its cause be indeed a micro-organism it must be one of strong, and not feeble vitality like that of the comma bacillus. We have only attempted briefly, and, in a cursory manner, to give the drift of the article in our contemporary, but it cannot fail to be of interest to readers in this country to know what members of the profession in the so-called "home of cholera " think of the present bacteriological position. They do not regard the comma bacillus and the cholera bacillus as convertible terms, and consequently consider the experiments of M. Haffkine as being interesting, no doubt, but as having little real bearing on the cholera question. CHOLERA IN FRANCE. (FROM OUR SPECIAL CORRESPONDENT.) Tlte Eight C7iolera Epidemics of Paris. MUCH that has been said in the course of these articles may tend to create alarm and anxiety. The existence of cholera in a great number of places, and especially in the ports nearest to England and with which we carry on a con- tinuous and brisk trade, has been forcibly illustrated and described. Cholera is so dangerous and spreads so rapidly that there is every need to realise in good time and to the fullest extent all the dangers of the situation. This, however, nowise justifies any excessive and exaggerated alarm. On the contrary, everything indicates that cholera is becoming less and less dangerous. Certainly, localities have been visited and described which, by reason of bad sanitation, seem to invite cholera epidemics, and, though the mortality from cholera has not been high in such places if one takes towns or districts as a whole, it has been very high in certain particular villages, localities or streets. Thus if cholera does not seem so dangerous to this as it was to the previous generation the lesson taught by that disease is none the less important; and now, as then, good sanitation is the best and probably the only true preservative. But if there is still a deplorable absence of good sanitation in many towns and districts, especially on the Continent, there is nevertheless a general and widespread improvement. Thus it is that in many places the epidemics succeeding each other show a marked decrease in gravity. Nowhere is this improve- ment more evident than at Paris, and this is all the more important as Paris was the centre of the present epidemic. The cholera broke out in Paris long before what appeared to be another and totally different cholera epidemic reached the south-eastern frontiers of Russia. Nothing can be more encouraging than the study of the cholera epidemics in Paris. Cholera, it will be remembered, first came to France in 1832. It was brought over from England to Calais, and the first case was recorded on March 15th of that year. There were no railways at that date, yet the cholera took only eleven days
