144 THE BACTERIA IN ASIATIC CHOLERA. [CH. 



insignificant. But there are not less important difficulties of 

 another kind to be settled. Supposing the comma-bacilli 

 in the intestine of a cholera patient produce this chemical 

 poison, say some kind of ptomaine, does that mean that 

 before the disease has set in the comma-bacilli have been 

 already so numerous in the intestine as to produce this 

 poison in sufficient quantity to set up the disease ? There 

 exists no proof that because in a person already ill with 

 cholera the stools and the contents of the ileum contain 

 numerous comma-bacilli, they were present there in large 

 numbers before the disease set in, and there is no proof 

 that when in a well-pronounced acute case the comma-bacilli 

 are very numerous, their chemical products are being 

 absorbed and thereby produce the symptoms. This would 

 be tantamount to placing the cart before the horse. In 

 some, not by any means in all, cases of acute typical cholera 

 that are brought into the post-mortem room, the mucus- 

 flakes of the lower ileum contain large numbers of the 

 comma-bacilli. Does any one mean to say that this state 

 of things existed before the disease set in, or that such an 

 intestine filled with watery fluid is capable of absorbing 

 anything from its cavity ? And how about those cases of 

 acute and typical cholera that are brought into the post- 

 mortem room, in which nothing of the sort obtains, i.e. 

 where the intestine, amongst crowds of other bacteria, 

 contains only a few comma-bacilli ? If it were true, as was 

 first maintained by Koch, that the invasion of the super- 

 ficial strata of the mucous-membrane of the ileum and its 

 Peyer's glands is the beginning of the disease, and that here 

 the poison is elaborated by the rapidly-multiplying organisms 

 and absorbed, this aspect of the argument would unquestion- 

 ably lend considerable support to Koch's view, but this I 

 have clearly shown is not the actual case ; an invasion of 



