CHOLERA ASIATICA. 705 



solitary and Peyer's glands are swollen and distended* The individual 

 follicles may attain the size of a hemp-seed. In consequence of this 

 swelling of the intestinal glands, the inner surface of the bowel looks 

 as if sprinkled with isolated and conglomerated granulations. Occa- 

 sionally certain follicles of the patches burst, and then the surface has 

 a sieve or net like appearance (plaques d surface reticulee). The most 

 important appearance in the intestine is the great loss of epithelium 

 The intestinal villi are stripped of their protecting envelope ; occa 

 sionally, at certain spots, the epithelial covering is only elevated by a 

 serous effusion, and is still loosely adherent to the villi ; but in most 

 places it is already detached, and lies on the intestinal wall as shreds 

 of mucus, or forms the whitish flocculi already spoken of as floating in 

 the transudation. The comparison of the intestine in cholera to a por- 

 tion of the skin from which the epidermis has been removed by a blis- 

 ter, or by boiling water, is very correct; and, if it be remembered thai 

 the denuded portion of intestine is quite extensive, it will be difficuli 

 to understand why some observers speak of a " disproportion " be- 

 tween the anatomical changes in the intestinal canal and the severe 

 symptoms observed during life. The large intestine does not show 

 any constant changes, and there is but little alteration in the jejunum, 

 The gastric mucous membrane is more or less reddened by hyperaemia 

 and ecchymosis ; its tissue is swollen and relaxed from serous infiltra- 

 tion. The liver is of normal consistence and pale ; on being incised, 

 only a small amount of thick, huckleberry-colored blood flows out 

 slowly from the large vessels. The gall-bladder is almost always dis- 

 tended with thin, brownish or greenish bile. The spleen has no con- 

 stant change. In the first stages of cholera the kidneys are appar- 

 ently normal, except an excessive venous hyperaemia ; in other cases, 

 even at this time, certain places, especially in the pyramids, are whit- 

 ish ; and at these points, on microscopical examination, we find the 

 uriniferous tubules filled with cloudy, swollen epithelium and fibrous 

 exudation. The mucous membrane of the urinary passages is covered 

 with mucous and epithelial masses, the bladder is contracted, and 

 almost always entirely empty. Hence we see, when death occurs at 

 the height of the disease, the characteristic changes consist chiefly in 

 extensive catarrh of the intestines, accompanied by detachment of the 

 epithelium and copious transudation, in decided thickening of the 

 blood and excessive venous hyperwmiq of the Jcidney. 



When death occurs during the stage of reaction, or so-called cholera 

 typhoid, the anatomical appearances differ in some respects from the 

 above. Then the limbs are less constantly contracted, rigor mortis is 

 less marked ; the teeth and gums are often covered with a dirty coat- 

 ing, the cyanosis has disappeared or is slight. The subcutaneous con- 



