704: ACUTE INFECTIOUS DISEASES. 



sometimes deep blue. The other parts of the body also have a more 

 or less marked cyanotic appearance. This is most apparent in the ter- 

 minal phalanges of the fingers and toes. The skin of the fingers is 

 often shrunken, and wrinkled like that on the fingers of a washer- 

 woman who has had her hands in the suds all day. On opening the 

 bodies we remark the hardness and dryness of the subcutaneous con- 

 nective tissue, and the dark-red color of the muscles. The blood is 

 thick, of the color of huckleberry-juice, and contains a small amount 

 of soft, black clots ; it is collected in the right heart and veins, while 

 the arteries and left heart are often perfectly empty. The cerebral 

 sinuses and veins of the meninges are distended with dark blood, while 

 the cerebral substance is dry and hard. The pericardium does not con- 

 tain a trace of serum, its inner surface feels pasty, and is often covered 

 with ecchymoses ; the muscular substance of the heart is contracted, 

 hard, and of a dirty-red color. The surfaces of the pleura, like those 

 of the pericardium and other serous membranes, are covered with an 

 adhesive layer. They also often contain small ecchymoses. On open- 

 ing the thorax, the lungs collapse very quickly and completely, appar- 

 ently because the empty, dry bronchi offer no opposition to the escape 

 of air from the alveoli. On cutting into the lungs, we find them re- 

 markably dry, and free from hypostasis and cedema. The relaxed, 

 baggy small intestine has a peculiar rosy appearance, even before it is 

 opened, while the large intestine preserves its natural color. On open- 

 ing the intestines, quantities of a colorless or faintly-colored fluid, con- 

 taining white flocculi, often escape ; this liquid exactly resembles the 

 "rice-water discharges" of cholera patients, which we shall more 

 minutely describe. I have found the greatest amounts of transuda- 

 tion in the intestines, in cases of so-called cholera sicca. The mucous 

 membrane of the small intestine is finely injected, especially near the 

 valve, and growing less so as we pass upward. The vascularity is 

 occasionally accompanied by greater or less escape of blood into the 

 tissue, and on the free surface of the mucous membrane. Then the 

 mucous coat shows numerous, often extensive, ecchymoses, and the con- 

 tents of the intestines appear reddened from the admixture of blood. 

 Sometimes the small intestine is pale, and neither vascularity nor ecchy- 

 moses can be found ; but since we find the intestines filled with watery 

 transudations even in such cases, and as these transudations come from 

 distended, not from empty vessels, it follows that the pale hue of the 

 mucous membrane is to be regarded as a post-mortem appearance. It 

 is a matter of daily experience for visible mucous membranes that have 

 been very hypereemic, and secreted abundantly during life, to become 

 pale after death. The mucous membrane and whole intestinal wall are 

 swollen and relaxed from opdematous infiltration. As a rule, also, the 



