CH.IL] DISTRIBUTION OF COMMA-BACILLI. 23 



cholera, the more numerous are the comma-bacilli found in 

 the lower ileum, so much so that in the very acute cases, 

 marked by the whole chain of symptoms characteristic of a 

 typical case of cholera, the lower ileum contains the comma- 

 bacilli "almost in pure cultivation": (e) no comma-bacilli 

 occur in the blood of the general circulation, in the mesenteric 

 glands, or any other organ. 



The observations which I have made with regard to the 

 general distribution of the comma-bacilli enable me to say 

 this, that while agreeing with Koch in some, I differ from 

 him in other very essential, points. We shall take the above 

 statements seriatim. 



(a) There can be no question about this important fact, 

 that in every case of acute cholera during the first days, i.e. 

 while the patient suffers from severe purging, the intestinal 

 discharges contain the comma-bacilli ; but there does not 

 exist, according to my experience, extending over a consider- 

 able number of cases, any definite relation between the 

 number of comma-bacilli present in the stools and the 

 severity of the disease. I have examined a good many stools 

 of patients during the first day or first two days of illness, all 

 the symptoms characteristic of typical cholera being present 

 severe vomiting and purging of watery fluid containing 

 mucus-flakes, great fall of temperature, voice and face that 

 of cholera, suppression of urine, respiration very irregular 

 and oppressed and yet the most careful examination of 

 fresh preparations and of preparations stained in the usual 

 manner revealed a few comma-bacilli only. In one instance 

 only have I come across a stool containing very numerous 

 bacilli. This stool was almost clear watery fluid in which 

 were suspended minute greyish flakes ; under the microscope 

 a great many comma-bacilli were found, and but few other 

 bacteria, the small mucus-flakes being almost like a pure 



