28 Objects Seen in Cholera Evacuations. [part i. 



great stress on the fact of the shedding of the epithelium in cholera about 1832, since 

 which period it has been the general opinion in G-ermany, with the exception of 

 Virchow and a few others. In the well-known Bavarian report of 1857 I find great 

 prominence given to this view, modified, however, by the remark that, as a rule, only 

 the broken down epithelium, or rather freed nuclei of such, are seen. Dr. Beale also 

 lays great stress on the diseased condition of the epithelium, and the latest authority on 

 the subject, Dr. Macnamara, follows Dr. Beale; indeed, it is evident that Dr. Macnamara's 

 explanation of many of the phenomena observed in this disease is based upon a 

 conviction of the correctness of the views advanced by these writers. It is of the 

 utmost importance in matters of this kind, as was pointed out by Professor Parkes in 

 1848, not to confound the microscopical appearance of the rice-water stools passed 

 during life with that of the contents of the intestine obtained after death. In a 

 brochure which was published by him on this subject at the time I find stated : — 

 " With regard even to the separation of the epithelium, although from the facility with 

 which this structure is shed, even during ordinary healthy processes, it does appear 

 probable, a priori, that it would be largely thrown off in cholera, there is absolutely 

 no proof that it is so thrown off until after the death of the patient. The stools 

 contain none, or a quantity not more considerable than is present in common 

 diarrhoea"* Judging from the cholera stools which have come under my observation 

 in Calcutta, — several hundred specimens, — I believe that not more than two out of 

 twenty slides will contain distinct traces of columnar epithelium. 



That these corpuscles are the remains of diseased epithelium may, I think, be 

 disproved without any reference to post-mortem^ appearances, which I wish at present 

 to avoid ; first, by the fact that, under favourable circumstances, they exhibit movements 

 exactly analogous to those seen in the blood, pits, lymph, chyle, and the so-called 

 " mucus " corpuscles. Secondly, cell formations and minute flocculi, microscopically 

 identical with these, may frequently be observed under other conditions, and from sources 

 where it would be difficult to account for their presence were they epithelium fragments, 

 such as in the fluid obtained by pricking a blistered surface. Thirdly, that even where 

 portions of columnar epithelium are seen they will, I believe, almost invariably exhibit, no 

 matter how much broken down the cell appears, the delicate rim or basement membrane 

 lining the free end of the cell, believed by some to be pores communicating with the cells. 

 The presence of epithelial fragments, when not excessive, may be readily accounted for by 

 the process of renewal which takes place in all cells. Dr. Sharpey writes : — " The particles 

 of columnar epithelium are undoubtedly subject to shedding and renovation. According to 

 Donders and Kolliker, the columnar cells on the villi appear occasionally to cast off parts 

 from their upper ends, with subsequent reparation of the loss ; that is, a cell enlarging, and 

 a second nucleus appearing ; the upper and broader part with its nucleus and much of the 

 cell contents separates, and the lower remaining portion with its nucleus grows again to 

 the natural size." And, fourthly, the epithelium thus discovered in the dejecta will 



* The italics are mine. 



