Medical Officers of the Army of India.
47
is clear that this can only serve to give rise to a certain number of cases
of opium -poisoning ; if he also introduce a supply of the seed, the possible
outcome of introduction will depend on whether the new locality does or does
not present conditions favourable to their germination and to the growth of
the resultant plants. If conditions for the growth of the plants be absent,
no amount of introduction of the seed will be capable of leading to any local
development of opium, and therefore cases of poisoning must cease with the ex-
penditure of whatever amount of the already elaborated poison was introduced ;
but if conditions favouring growth be present, no such limitation exists, and there
is a possibility of the occurrence of an indefinite number of cases as the result of
the importation. In cases like those which occurred in Stuttgart and Koblenz,
we may not be in a position to determine whether the limitation of the disease
to those, who directly or indirectly came in contact with the individuals who
had come from an infected locality, were due to an entire absence of any impor-
tation of the factors which elaborate the poison, or merely to an absence of the
local conditions allowing of their exercising their activities, but the fact remains
that the phenomena are totally inexplicable on the theory that the specific poi-
son is manufactured and multiplied within the bodies of those upon whom it
acts, and are readily explicable on that which regards the environment as the
essential site of manufacture.
The acceptation of the view that the specific cause that determines the
initial symptoms of cholera is manufactured in the locality and not within the
bodies of the sick does not involve a refusal to allow that during the course of
the disease certain toxic products may be developed within the organism and
affect the ultimate outcome of the attack. It has practically been assumed that
all the symptoms occurring in cases of cholera must invariably be directly due
to the action of a single specific cause, but there is really great reason to doubt
whether this assumption is a well-founded one, and to suspect that in many
cases of the disease we are dealing with phenomena which are due to the action
of two entirely distinct factors. The initial symptoms of cholera are those of
acute ptomaine poisoning, and in a certain number of instances these alone
present themselves, death or recovery taking place without there being anything
to indicate the intervention of any influence beyond that of the primary poison.
But in a large number of instances the latter portion of the course of the disease
is characterised by the presence of symptoms of septicæmia, and there is good
reason to doubt whether these can be ascribed to the direct acton of the
primary toxic agent. On the assumption that they are due to it, it is almost
impossible to account for the fact that they certainly bear no definite relation to
the severity or mildness of the initial symptoms of disease. Neither the presence
nor the absence of secondary symptoms can be in any way definitely connected
with the primary character of the attack. The disease at the outset may be
exceptionally severe, and, where recovery occurs, secondary symptoms may be
very slight or practically entirely absent, or it may be relatively mild and