x, B, 6 Coulter: Gall Bladder and Biliary Passages in Cholera 387 
death, was admitted to the hospital with cholera with the usual 
symptoms as well as marked jaundice. Physical examination 
showed an enlarged liver. Vibrios were found in her stools at 
this time and for fifty-seven days: thereafter. Seven months 
later she was admitted to another hospital with enlarged and 
painful liver. At autopsy, four months later, cholera vibrios 
were recovered from the bile ducts, but not from the intestines. 
Kulescha quotes this case to explain the intermittent cholera car- 
riers. The liver showed a marked biliary stasis due to the 
cholangitis. Therefore the bile containing the vibrios only 
reached the intestines at intervals. 
Grieg (14) records the largest series of bacteriological exami- 
nations of the bile for cholera vibrios. He examined 271 cases 
and found the vibrio in 80. In 12 (4.4 per cent) of these there 
were distinct pathological changes. One of these cases was 
recorded in detail in 1912(15) and another in 1913.(14) In the 
latter case the gall bladder was shrunken and contained a small 
quantity of dirty, brown bile. The mucous membrane was con- 
gested. Histologically the sections stained for the vibrios 
showed their presence not only in the mucosa, but also deep in 
the submucosa. 
In another article(16) Grieg tabulated the results of 235 
cholera autopsies at the Medical College, Calcutta. Ten cases 
(4 per cent) showed to the naked eye some signs of inflamma- 
tion of the gall bladder. He notes that the macroscopic changes 
observed in the gall bladder were the following: Slight thicken- 
ing of the wall, mucosa congested, and on section the submucosa 
was red. The microscopic changes he noted were that the 
inner layer had almost entirely disappeared; in the submucosa 
there were polynuclear and mononuclear cell infiltration, new- 
formed vessels, and hemorrhages; in the middle and serous 
layer foci of round cells were seen. In sections specially stained 
he found the cholera vibrio in the mucosa and deep in the 
submucosa. 
In the cystic, hepatic, and common bile ducts, and in a lesser 
degree in the biliary passages in the liver, the same pathological 
changes were found, and a pure culture of the comma bacillus 
was obtained. 
Table I shows the condition of the gall bladder and biliary 
passages as taken from cholera autopsy records of the Bureau 
of Science on file at the College of Medicine and Surgery, Univer- 
sity of the Philippines. 
