22,4 Goodpasture: Histopathology of the Intestine 415 



drowsy, with abdominal pain and loose bowel movements. Ill- 

 ness began suddenly with loose black discharge. Much vomiting 

 since onset and patient refused to take anything by mouth. 

 Even water could not be tolerated. Child was quiet but 

 apparently conscious. Eyes slightly sunken, face pale, tongue 

 coated, pulse rapid, feeble, thready, and barely perceptible. 

 Extremities cold but not cyanotic. Urinated only twice since 

 onset. Temperature on admission, 36.9° C; twelve hours later, 

 36°. Pulse, 85 ; twelve hours later, 144. Respiration, 23 ; twelve 

 hours later, 31. Although treatment was immediately instituted 

 the child did not respond well and died twenty-six hours after 

 admission, or four days after the onset. 



At autopsy the small intestine was faintly pink. It contained 

 about 100 cubic centimeters of fluid with much mucus stained 

 green with bile. The mucosa appeared velvety and pale. Por- 

 tions of stomach, duodenum, jejunum, ileum, and colon were 

 immediately placed in formol-Zenker. There was infection with 

 ascaris and with trichuris. Clinically and pathologically it was 

 a typical case of cholera, and cultures from intestinal contents 

 showed the presence of agglutinable vibrios. 



Blocks from the gastrointestinal tract were embedded in 

 paraffin and sections stained with hematoxylin and eosin and 

 by the fuchsin method for bacteria. (3) 



Mucous membrane of the stomach appears normal. Fixation 

 is excellent and there is no evidence of degenerative change 

 even of the superficial cells. The mucosa of the colon shows no 

 lesions except those due to the threading of trichuris through 

 superficial layers in the caecum. There is, however, a definite 

 pathological change throughout the small intestine, increasing 

 in severity from the duodenum downward. 



The mucosa of the duodenum is intact and well preserved, 

 although there is a great subepithelial oedema which has lifted 

 up the epithelial layer, completely separating it from the mucosa 

 except for a delicate honeycomb of lines which seem to represent 

 a continuation of the outline of each cell. The basement mem- 

 brane remains attached to the mucosa, the fluid apparently 

 accumulating just beneath the cellular body pushing it upward 

 from its basal attachment. The effect of this oedema has been to 

 increase the length of villi by about one-half and the width of 

 the mucosa about one-third. The epithelial layer is intact every- 

 where except on the crests of valvulae conniventes where it is 

 broken in places, evidently in the process of preparation, for 

 often the detached layer of cells remains close by. The epi- 



