422 The Philippine Journal of Science 



The habitat of vibrios in most cases of cholera is within the 

 intestinal lumen; and, while a few organisms may survive 

 entrance into the blood stream, most of them are no doubt 

 rapidly destroyed. Judging from post-mortem appearances of 

 the intestine, where evidences of their pathogenic nature should 

 be most prominent, the symptoms of cholera are induced by the 

 production, within the lumen of the small bowel, of material 

 which is absorbed through a non-ulcerated mucosa, manifesting 

 its poisonous character by a general intoxication. The oedema 

 of the intestinal wall seems to be a part of the systemic reac- 

 tion, with splanchnic dilatation, and excretion of quantities of 

 fluid. Finally, there is no indubitable anatomical evidence that 

 in cholera there are changes in the intestinal mucous membrane 

 which would render it more permeable than the normal intestine. 



1. There is a constant subepithelial oedema in the small intes- 

 tine of cholera subjects, which may be due to splanchnic conges- 

 tion associated with general intoxication rather than to direct 

 injury of toxic material within the lumen. 



2. Desquamation of epithelium in the small intestine as seen 

 at necropsy is an agonal or post-mortem effect due to the action 

 of bacteria and, possibly, of enzymes of intestinal fluid upon 

 the epithelial layer displaced during life by oedema. 



3. Ante-mortem desquamation may occur but can be recog- 

 nized at necropsy by the presence of ulcers with acute inflam- 

 matory exudate. 



4. The vibrios of cholera may invade the mucosa and be 

 directly responsible for an acute ulcerative enteritis, but they 

 are not always the cause of intestinal ulcers complicating the 



I evidence indicates that the great mass of vib- 

 rios is confined to the intestinal lumen and, if toxic substances 

 are formed there directly or indirectly as a result of their 

 growth, they are absorbed early in the disease through an ana- 

 tomically intact mucosa. 



Crowell, B. C. Philip. Journ. Sci. § B 9 (1914) 361. 

 Deyke. Deutsche med. Wochenschr. No. 46 18 (1892) 1048. 

 Goodpasture, E. W. U. S. Naval Med. Bull. 13 (1919) 177. 

 Koch, R. Arbt. Kaiserl. Ges. 3 (1887) 156. 

 MacCallum. Textbook of Pathology ed. 2. W. B. Saunders Co. 



