Medical Officers of the Army of India. 11
blood. The condition of the serous surfaces of the peritoneal cavity was also
so far similar to that present in cholera in that they were covered with a thin
layer of peculiar adhesive secretion.
On the other hand, this secretion is sharply defined from that normal to cases
of cholera owing to the presence of abundance of commas in it. The results of
cultivations of the cardiac blood, moreover, differ from those in cholera, as, al-
though no commas were ever recognisable in the fresh blood, cultivations always
gave pure crops of such bodies. In regard to this point, however, it is just
possible that the commas were really derived from the serous surface of the peri-
cardium and not from the interior of the heart. The materials for cultivation were
always obtained by passing the end of a freshly drawn and hermetically sealed
capillary pipetti through the walls of the auricle and subsequently breaking off
the closed lip within the cardiac cavity. Now, as the external surface of the
heart was in no case disinfected previously, it remains possible that the results
of the cultivation were due to commas derived from the pericardium and
adhering to the exterior of the pipette. The extensive subcutaneous effusion
of sanguineous material full of commas which formed such a characteristic feature
in all three cases is unlike any phenomenon normal to cases of cholera. The
condition of the spleen, too, is, if anything, rather adverse to the acceptation
of the choleraic nature of the affection, as there appeared to be a decided tend-
ency to splenic enlargement in two of the cases, at all events, and such a con-
dition is suggestive rather of septicæmia than of cholera.
Taking everything into, consideration, however, there yet appears to be a
considerable probability that the disease in these cases was in many ways closely
related to cholera. The points of agreement between the two morbid conditions
seem to me to be very noteworthy, and the deviations may possibly be as-
cribable to the nature of the animals experimented with, the quantity of the
pathogenic medium introduced, and the site of its introduction.
One thing is very clearly demonstrated by the results of these experiments,
and that is that the sites in an organism in which pathogenic schizomycetes are
ultimately to be encountered in greatest abundance by no means necessarily
correspond with those of primary invasion of the system. In all these cases
comma-bacilli of identical nature with those originally introduced were ultimately
present in great, and in one case in excessive abundance, within the cavity of the
intestinal tube, whilst in all cases alike the site of primary invasion was the
subcutaneous tissue.
It must, I think, be granted that the commas present within the intestinal
cavity were the descendants of those which were introduced into the subcutane-
ous tissue, and, from the abundance of similar bodies present in the peritoneal
secretion, it would appear that the path which they followed in their systemic
diffusion was from the subcutaneous lymphatic spaces to the great peritoneal one,
and thence by direct penetration of the walls of the intestinal tube to its cavity.