li.] DISTRIBUTION OF COMMA-BACILLI. 25 



duodenum, is of a rosy tint ; here and there the colour is in 

 patches and more pronounced, the intestine is distended, 

 and on opening it a large amount of watery fluid escapes in 

 which are suspended very numerous flakes of various sizes. 

 The internal or mucous surface is pale, and the epithelial 

 layer is in many places loose or separating in larger or 

 smaller flakes. Placing a piece of the intestine under water 

 this loosened or detached condition of the epithelium 

 becomes very conspicuous. In the lower ileum rarely and 



FIG. 2. PREPARATION OF MUCUS-FLAKES FROM THE ILEUM OF AN ACUTE 

 CASE OF CHOLERA. 



1. Masses of single comma-bacilli. 



2. Circular forms. 



3. Semicircular forms. 

 Magnifying power about 1,400. 



then only in a few places are present small particles of faecal 

 matter adhering to the mucous membrane, but as a rule only 

 watery fluid and mucus-flakes are present. Such cases 

 correspond to Koch's " pure " cases ; the symptoms during 

 life are always vehement and well pronounced, and death 

 ensues generally during the first twenty-four hours. There 

 is much purging with rice-water stools. In such cases, 

 according to Koch, the lower ileum is almost a pure cultiva- 

 tion of comma-bacilli. But I cannot confirm this statement. 



