THE INFECTIOUS DISEASES. 239 



irritation or lesioii may on absorption incite those systemic disturbances 

 which characterize profound toxaemia. 



LESIONS OF ASIATIC CHOLERA. 



In some cases of cholera there are no marked changes to be found 

 after death, and in no case are the lesions distinctive of this disease. 



If death occur during the invasion of the disease or in the stage of 

 collapse, the appearances in the more marked cases may be summarized 

 as follows: 



The bodies may remain warm for some time, and the temperature 

 may rise for a short time after death. The rigor mortis usually begins 

 early and lasts for an exceptionally long time. The muscles sometimes 

 exhibit a peculiar spasmodic twitching before the rigor mortis sets in, 

 especially the muscles of the hand and arm. 



The Skin is of a dusky gray color ; the lips, eyelids, fingers, and toes 

 are of a livid purple. The ends of the fingers are shrivelled, and the 

 cheeks and eyes sunken. 



The Brain. The sinuses of the dura mater are filled with dark, thick 

 blood. The pia mater may be normal, or oedematous, or ecchymotic, 

 or infiltrated with fibrin. The brain is usually normal, but may be dry 

 and firmer than usual. 



The Lungs are retracted and anaemic, the pleura may be dry or coated 

 with fibrin. The Heart is normal. The Peritoneum may be dry or coated 

 with a layer of fibrin. - 



The Stomach is usually unchanged, but may be the seat of catarrhal 

 inflammation. The Small Intestine. There may be ecchymoses in the 

 mucous membrane ; the mucous membrane may be soft and oedematous ; 

 there may be general congestion, or the congestion may be confined to 

 the peripheries of the solitary and agmiuated nodules, and these nodules 

 may be swollen ; or there may be croupous inflammation and superficial 

 necrosis. All these changes are usually most marked at the lower end 

 of the small intestine. There is apt to be post-mortem desquamation of 

 the epithelium. The characteristic rice-water fluid may be found in the 

 intestines after death, or instead of this dark-colored, bloody fluid. The 

 Large Intestine is usually normal, but in some epidemics croupous inflam- 

 mation occurs in a considerable number of cases. 



The Spleen may be soft. The Liver may show small areas of granular 

 or fatty or hyalin degeneration. 



The Kidneys are often increased in size, with white and thickened cor- 

 tex and congested pyramids. The epithelium of the cortical tubes may 

 contain coarse granules and fat globules, or be necrotic. The tubes 

 may contain casts and disintegrated epithelium. The Uterus and Ovaries 

 may be congested and contain extravasated blood. 



If the patient do not die until the stage of reaction, the body does not 

 present the same collapsed appearance, and there are often inflammatory 

 changes in different parts of the body, especially in the larynx, the lungs, 

 the stomach, and the intestines. 



