22,4 Goodpasture: Histopathology of the Intestine 417 



In sections stained for bacteria no vibrios could be demon- 

 strated in the duodenum or the jejunum. No organisms of any- 

 kind were seen within glandular crypts or beneath the epithe- 

 lium. In the ileum, on the other hand, especially in the lower 

 portion, an abundant surface growth of various types of bacte- 

 ria was present and many of these organisms had penetrated 

 the mucosa to a certain extent beneath the elevated epithelium 

 and within denuded villi. They had, however, apparently caused 

 no injury or reaction. Glandular crypts were often filled with 

 bacilli of unrecognized type. In the abundant surface growth 

 of bacilli, cocci, and filamentous forms, no vibrios were identified. 

 Vibrios of unmistakable morphology were found only in gland- 

 ular crypts, where they lay in great numbers embedded in a film 

 secretion, and often apparently in pure culture. The epithelium 

 immediately around these organisms showed no indication of 

 injury as a result of their presence, and the vibrios exhibited 

 no tendency to invade the tissues. 



The most-striking change observable in these preparations in 

 well-preserved portions of the intestine was the subepithelial 

 oedema, which was undoubtedly responsible indirectly for the 

 widespread desquamation of epithelium. 



A second case, that of an adult male Japanese, autopsied within 

 two hours after death, shows early post-mortem changes in the 

 epithelial layer and in contrast to them the beginning of ante- 

 mortem ulceration. 



The patient, a man aged 45 years, was admitted to the hos- 

 pital on the second day of the disease complaining of cramps 

 in the lower extremities, chest oppression, hardly perceptible 

 pulse, and husky voice. Clinically he had cholera, and the bac- 

 teriological examination of his stool showed agglutinable vi- 

 brios. He developed uraemia and died on the ninth day of the 

 disease. 



At autopsy he was found to have very large congenital cystic 

 kidneys, which microscopically showed foci of necrosis involving 

 cortical parenchyma. The small intestine was congested, and 

 the mucosa showed in gross no evidence of ulceration. Pieces 

 were placed immediately in formol-Zenker. 



Microscopically, sections through the ileum show the usual 

 subepithelial cedema with as yet very little desquamation. The 

 epithelial layer is partially well preserved, but in many places, 

 especially at the crests of villi, post-mortem changes are very 

 evident, both in the epithelium and in the tips of villous projec- 



