22,4 Goodpasture: Histopathology of the Intestine 419 



fluid. The duodenum and jejunum measured 6 centimeters in 

 diameter. There was no free fluid in the peritoneal cavity. 

 Loops of jejunum and upper ileum were bound together by thin 

 fibrinous adhesions. In the wall of the jejunum and extending 

 about halfway down the ileum were several large areas of 

 opaque yellowish and greenish necrosis which tended to extend 

 circularly around the gut. The necrosis was most marked op- 

 posite the mesenteric attachment. No perforation had occurred, 

 but fibrino-purulent exudate was abundant in the regions of 

 necrosis. The intestinal wall was cedematous, injected, and 

 contained numerous small haemorrhages. The lower end of the 

 ileum was about normal in size. There was no evidence of 

 mechanical obstruction. The stomach was considerably dilated, 

 especially by gas. No necroses were observed in its wall. 



Anatomical diagnosis : Acute enteritis (cholera) ; dynamic 

 ileus; necrosis of jejunal and iliac walls; acute peritonitis; 

 parenchymatous degeneration of kidneys, liver, and heart. 



Microscopically, sections from the upper part of the small 

 intestine show necrosis of the wall and ulceration of mucosa. 

 The submucosa generally is extremely cedematous, and rugae 

 and villi are flattened because of excessive dilatation. Beyond 

 areas of ulceration the epithelium is well preserved and shows 

 no post-mortem change or desquamation. There is an abundant 

 coating of mucus and there are fragments of necrotic mucosa 

 over the surface, especially between folds. Over the peritoneal 

 surface is a thin fibrinous membrane. In areas of ulceration 

 there is superficial necrosis, polymorphonuclear leucocytic exu- 

 date, intercellular fibrin, thrombosis of some small vessels, and 

 congestion of others. In stained sections enormous numbers of 

 bacteria of various types are found in the mucous coat and on 

 the surface of ulcerated areas. The majority of these are 

 short, easily stained bacilli, and thin filamentous forms. In 

 some places, however, masses of smaller, less intensely staining, 

 curved rods are present, morphologically identical with cholera 

 vibrios. The various organisms occur in dense groups so that 

 one type may be easily distinguished from another. No bac- 

 teria are found in glandular crypts or invading the mucosa 

 except at the site of ulceration. On the surface of ulcers and 

 for a certain distance within the inflammatory exudate are 

 small curved vibrios, apparently in pure culture. The morphol- 

 ogy of these organisms is so distinct that there can be little 

 doubt they are vibrios of cholera. 



