386 The Philippine Journal of Science 1915 
Kulescha, (1) in the cholera epidemic at St. Petersburg in 1908— 
1909, performed 480 autopsies. He found cholecystitis in 42 
cases, or nearly 10 per cent; 21 of these were in the first 
week of the disease, and 19 were in the second week. 
In these cases the gall bladder was brown or yellowish gray, 
distended, and greatly congested. The mucous membrane was 
covered with a thick, turbid mucus often mixed with pus. 
When this was removed, the mucous membrane was seen to be 
swollen and bright red. In one case he found a great number 
of small, scattered areas covered by diphtherialike membranes. 
In eight cases the gall bladder contained a thick, colorless 
fluid. 
Microscopically his cases showed the mucous membrane of 
the gall bladder denuded of its epithelium and infiltrated with 
round cells. The submucosa shows a marked round-cell infil- 
tration, dilatation and congestion of the blood vessels, and some 
blood extravasations. In more severe forms there is a necrosis 
of the mucosa extending to the submucosa. Kulescha charac- 
terizes this as a catarrhal hemorrhagic inflammation, the same 
as is seen in the intestines. 
Bacteriological examination of the bile showed the vibrio in 
40 cases. 
In regard to the bile ducts Kulescha found only four cases in 
the above series in which cholangitis could be recognized 
grossly. Microscopically these cases showed the bile ducts 
denuded of their epithelial layer and the wall infiltrated with 
round cells. The lumen was filled with granular débris, com- 
posed of leucocytes, bile pigment, and cells of cylindrical epithe- 
lium. Some cases showed necrosis extending to Glisson’s 
capsule and even to the liver cells. This inflammation was more 
severe in the larger ducts. 
Of the four cases, Kulescha(1) describes three as purulent 
biliary hepatitis and one as hepatic biliary cirrhosis. Bacterio- 
logically cholera vibrios were found in all four, but in only two 
in pure culture. By appropriate staining methods vibrios were 
demonstrated in sections from one of these cases. The vibrios 
found in the tissues were not identical with the ordinary vibrio, 
but resembled involution forms of the cholera vibrio when grown 
on agar or potato—that is, thick and swollen. 
In this connection Kulescha records an interesting case illus- 
trating the importance of this infection in regard to chronic and 
intermittent carriers. A woman, aged 36, one year before her 
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