306 OFFICIAL REFUTATION OF DR. KOCH’S THEORY 
Klein and Gibbes. Stated shortly, Dr. Koch appears to main- 
tain-—first, that the number of comma-shaped organisms in 
the, intestinal tissues and contents is in proportion to the 
acuteness of the attack, and that these organisms generate 
within the body a ferment by which the system is poisoned : 
second, that they are not found under any conditions other 
than in connection with cholera; and, third, that their presence 
in a tank which supplied certain cholera-affected villages in 
Calcutta with water was, practically, a proof of the causal 
connection between the organisms and the disease. 
7. With regard to the first cited of these propositions, Drs. 
Klein and Gibbes write as follows : 
“ Comma-bacilli are present in the rice-water stools of 
cholera patients, but their number is subject to very great 
variations ; while in some they are easily found, in others it is 
difficult to meet with one” (p. 6). . . “ In order to explain the 
causation of the disease by the comma-bacillus, Koch assumes 
that, it being absent from the blood and present only in the 
small intestine, a chemical ferment, which is the actual poison, 
is secreted by it, and on the amount of this the severity and 
rapidity of the illness depend; in the typical acute cases a 
large amount of this chemical ferment is being produced, 
absorbed by the system, and therefore death rapidly ensues. 
And this, Koch states, is in accordance with the observation 
made by him that in these instances the comma-bacilli are so 
numerously found in the mucous membrane itself, particularly 
in the lower part of the ileum, that this appears almost like a 
pure cultivation of the bacilli. If this were really the case— 
viz. if it could be shown that in acute typical cases of cholera 
not only the flakes composed of the detached epithelium and 
mucus, found in the cavity of the intestine and on the surface 
of the mucous membrane, but also, as Koch states, the super- 
ficial layers of the mucous membrane of the congested ileum, 
are loaded with comma-bacilli and nothing else, this would be 
a remarkable fact, and there would be strong grounds for 
believing that the comma-bacilli must in some way or another 
be related to the morbid process, although it would not neces- 
