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Scientific Memoirs by
choleraic nature can hardly be expected to see that immunity from them implies
immunity from cholera. The symptoms following the inoculation of virulent
comma-bacilli are certainly not unequivocally choleraic ; they can be induced by
the inoculation of other forms of schizomycetes, and there is a great mass of
evidence tending to show that the comma-bacilli which occur in the intestinal
tract in cases of cholera are not essentially concerned in the manufacture of
the poison which induces the primary choleraic condition, so that there are no
scientific grounds for regarding the procedure as calculated, in any way to affect
the prevalence of the latter.
At the same time it by no means necessarily follows that it should be abso-
lutely valueless. If, as has been suggested in the previous pages, we have in most
cases of cholera to deal with two distinct morbid conditions, one corresponding
with the initial choleraic symptoms, and due to the action of a poison of extrinsic
origin, and the other due to the action of one developed within the intestinal
tract in consequence of the concurrence of certain organisms, such as some forms
of comma-bacilli with the presence of conditions favouring their multiplication,
then it is evident that any procedure which confers an immunity from the effects
of the products of their activity is not to be regarded as valueless. It will not in
any way prevent the occurrence of cases of the disease, but it will modify their
character in a fashion similar to that which, as it has already been pointed
out, hygienic improvements in a locality may do. The products of the activity
of certain comma-bacilli unequivocally give rise to morbid results when intro-
duced into the system, and the primary choleraic condition equally unequivocally
provides facilities for their presence within the intestinal tract. So long as
absorption is in abeyance this will produce no effect, but when it has once
been re-established, the possibility of their access to the interior of the
organism must necessarily at once arise, and with this the liability to the
development of the secondary morbid symptoms dependent on their action. Any
procedure which provides immunity against the latter will render the presence
of the noxious products within the intestinal tract, and their absorption from it
matters of no importance. There will be no possibility of the development of
any ill effects from their action ; in other words, there will, be no possibility of the
development of secondary symptoms, and the termination of the attack will
depend solely on the action of the primary poison on the system. But there is
every reason to believe that this would imply a very great reduction in the fatality
of the disease. A certain number of cases certainly do occur in which, whether
as the result of the access of excessive doses of the primary poison, or of
idiosyncratic reactions of the organism to minor doses, death occurs independently
of the appearance of any appreciable secondary symptoms, but there can be no
question that in very many instances cases, which, in so far as the primary
symptoms are concerned, are of no special gravity, terminate fatally in connec-
tion with the subsequent development of secondary ones. But if the latter be