A STUDY OF THE PATHOLOGY OF THE GALL BLADDER AND 
BILIARY PASSAGES IN CHOLERA ?* 
By J. S. CoULTER 
(Captain, Medical Corps, United States Army) 
In most of the literature dealing with cholera little or no 
mention is made of the pathology of the biliary passages and the 
gall bladder in this disease. Recently several papers have been 
published on this subject, calling special attention to its im- 
portance in relation to chronic and intermittent cholera carriers. 
This study was undertaken to determine the pathological condi- 
tion of the gall bladder and the bile ducts of the cholera autopsies 
in the cholera outbreak in Manila in 1913-14. 
Kulescha(1) first emphasized the importance of this subject 
in relation to the carrier question. In his review of the litera- 
ture he notes that Pirogoff(2) in 1848 observed two cases of. 
diphtheritic cholecystitis in cholera autopsies, one of which 
showed perforation of the fundus of the gall bladder and general 
peritonitis. Netschaeff(8) records a similar case in 1892, also 
one with acute cholecystitis without perforation, and two that 
showed catarrhal inflammation in sections of the gall bladder. 
There were a number of early observations on the presence 
of the cholera vibrio in the bile. Nicati and Rietsch,(4) in 1884, 
examined the bile in three cases of cholera and found the vibrio 
in two, and later in two of five cases. Similar observations were 
made by Doyen,(5) Kelsch and Vaillard,(6) Tizzoni and Cat- 
tani,(7) Raptschevsky, (8) Rekovsky,(9) and Defressine and Caze- 
neuve.(10) Sawtschenko,(11) in 1892, found cholecystitis twice 
among 30 cholera autopsies. In a series of 28 cases recorded by 
Girode, (12) vibrios were found in 14.. One case showed marked 
symptoms of cholangitis and cholecystitis with vibrios present 
on bacteriological examination. Brulloff(13) found vibrios in 
76 per cent of his cases. 
* Received for publication September 28, 1915. 
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