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Scientific Memoirs by
a change, and at the same time find it providing them with a favourable medium,
it is surely only rational to conclude that the frequency with which their preva-
lence attends the choleraic condition is in any case an effect, and not a cause of
the latter. When we find that comma-bacilli multiply freely in choleraic fluids,
that numerous instances have been recorded in which choleraic materials are
devoid of any recognisable comma-bacilli, or contain only very small numbers of
such organisms, and, at the same time, that cases of disease occur in which any
primary causative action of comma-bacilli appears to be entirely excluded, and
which are yet attended by the presence of innumerable multitudes of comma-
bacilli in the intestinal fluids, we can hardly be expected to accept any theory
which regards them as the essential cause of cholera. There is really just as
much ground for affirming that the normal condition of the intestinal contents is
essentially due to the presence of those species of schizomycete organisms which
occur most abundantly in them, as for affirming that their choleraic condition
is essentially due to comma-bacilli because the latter occur with special fre-
quence and in special abundance in them under such circumstances. Every one
will at once allow that the excessive prevalence of certain forms of schizomy-
cetes in the normal intestinal contents is the result of peculiarities in the latter
re-acting upon the organisms which gain access to them. The elements of
many distinct species of schizomycetes must constantly be gaining access to the
interior of the intestinal tract, but the extent to which they will increase and
multiply there must depend on the degree to which they find a congenial environ-
ment in it ; it is the nature of the environment which determines the prevalence,
and not the prevalence that determines the nature of the environment. Even
Koch seems to allow this in regard to cholera when he admits that in order to
allow of his comma-bacilli multiplying sufficiently to give rise to the disease an
abnormal condition of the digestive tract must be present. But if this be so, it
can no longer be affirmed that the multiplication of the bacilli is the primary
essential cause of the disease, as it is a consequence of an antecedent abnormal
state, and therefore may have no causal relation to the disease whatever. We
are first called on to suppose the existence of an abnormal condition to allow of
their multiplication, and next to assume that in course of multiplication they
secure the continued presence of such a condition. The data which are at present
available certainly furnish no evidence that the presence of any special form of
comma-bacillus, or, indeed, that the presence of any comma-bacilli whatever is
an essential concomitant of the choleraic condition, and they render it at all
events highly probable that the abnormal nature of the schizomycete population
of the intestinal tract in cases of cholera holds a consequential, and not a
causal relation to the initial phenomena of the disease. But if this be so, to what
are we to ascribe the latter ?
The earliest symptons of cholera are those of acute ptomaine-poisoning, and
it has been ordinarily assumed that the toxic materials must have been elaborated