414 The Philippine Journal of Science 1923 



tine, especially the duodenum and jejunum, seemed lax and 

 flaccid, often considerably distended by fluid, suggesting the 

 appearance in paralytic ileus. 



This condition of the intestine obviously makes more difficult 

 the problem of securing material suitable for histological study, 

 for the mucosa of a normal intestine rapidly undergoes post- 

 mortem changes, so that the ordinary necropsy specimen is 

 unsatisfactory for histological purposes. 



To this difficulty in securing suitable fresh material are due 

 undoubtedly our lack of an adequate description of the histo- 

 pathology of the intestine in cholera and the differences of 

 opinion on certain points such as whether desquamation of epi- 

 thelium occurs to any extent before death, as maintained by 

 Deyke,(2) or whether denuding of the mucosa, which everyone 

 describes, is a result of post-mortem maceration, a view ad- 

 vocated by Cohnheim and others. 



A complete knowledge of the histopathology of the intestine 

 in early stages would probably throw some light on the obscure 

 pathogenesis of cholera, which appears to be different in prin- 

 ciple from any other acute infectious disease. The nature of 

 the intoxicating substance is still in question, and it is yet to 

 be determined whether the intestinal manifestations are due 

 directly to injurious action of a poisonous substance on the 

 mucosa or whether the intestinal congestion, excretion, and 

 anatomical changes are manifestations of the general intoxica- 

 tion. Of special interest is the question of possible desquamation 

 or extensive injury of epithelium which may permit a rapid 

 absorption of toxic material from the intestinal contents. 



In a series of cases from San Lazaro Hospital, Manila, which 

 I recently had an opportunity to study, special care was taken 

 in examinations of the intestine. From twenty-five necropsies 

 performed after various intervals it was soon evident that no very 

 reliable information could be gained from material obtained as 

 long as two hours after death. In some instances it was possible 

 to remove the intestine and fix portions of it in less than one 

 hour after death. In one early case on opening the peritoneal 

 cavity slow contractions of the small intestine could be elicited 

 by mechanical stimulation. Such material was very well pre- 

 served and its histopathology is worthy of description. 



The earliest case was a female Filipino child that was admit- 

 ted to San Lazaro Hospital at 11.45 a. m., January 12, 1922, 

 and died at 2.10 p. m., January 13. Duration of illness on 

 admission three days. Condition on admission very weak and 



