OF CHOLERA AND COMMAS. 307 
sarily follow that these bacilli must, as a conditio sine qua 
non, be the actual cause of the disorder. 
“ Now, our observations are in direct opposition to these 
statements of Koch. It is difficult to explain how such a 
statement could have been made. Several cases of acute 
typical cholera were subjects of post-mortem examination. 
Death had followed in some within from sixteen to twenty-eight, 
in others from eight to twelve hours; the post-mortem was 
made in some within one, in others within half or a quarter of 
an hour. The ileum, and, as a matter of fact, the whole of 
the small intestine, was either slightly and uniformly injected 
and its mucous membrane slightly tumefied, the cavity both of 
the jejunum and ileum being filled with clear watery fluid in 
which were suspended large numbers of the typical flakes ; 
there was no difference noticeable in this respect between the 
lower part of the ileum and the rest of the small intestine. In 
a few cases in the lower portion of the ileum the solitary 
follicles and Peyer’s glands were distinct, and presented either 
a slight redness or only redness at the margin. Koch’s state- 
ment that in acute typical cases of cholera the Peyer’s glands 
and solitary glands of the ileum are enlarged, and on naked- 
eye inspection already visible by a slight injection of their 
marginal portion, is not confirmed by our observations, since 
several acute typical cases came under our observation in 
which such a condition was not noticeable, that is to say, cases 
coming under the category of the pure typical cases of Koch 
in which the mucous membrane ought to be almost ‘a pure 
culture of comma-bacilli’ ” (pp. 7, 8). 
“That the comma-bacilli should in some cases of cholera, 
particularly those with typical rice-water stools, with or with- 
out many mucous flakes, be very abundant may simply mean 
that here the comma-hacillus finds the most suitable conditions 
for growth, more suitable than any other bacillus, although, 
as a matter of fact, we have not found that, except in a few 
cases, it always predominates over other bacilli, particularly 
very short, thin, straight bacilli, to be mentioned below. The 
statement of Koch that, in acute typical cases, the comma- 
