﻿IX, B. 4 Crowell: Diagnosis of Asiatic Cholera 363 



true also of the blood in all parts of the body, and its total volume 

 may be very much diminished. In a fair percentage of the cases, 

 however, a mixed coagulum is present in the right side of the 

 heart. No acute endocardial lesions have been encountered. 

 Subendocardial haemorrhages sometimes occur, while epicardial 

 ecchymoses are the most frequent hjemorrhages found in the 

 body; these are, however, not present in a large proportion of 

 the cases. 



The spleen. — The spleen is usually much diminished in size 

 and is flabby, with wrinkled capsule. The cut surface is dry, 

 smooth, and dark red in color. 



The kidneys. — The kidneys present either the evidences of an 

 acute parenchymatous degeneration or haemorrhagic nephritis. 

 In the former case, they are pale and dry and the cortex appears 

 pale, yellowish gray, compact, opaque, and relatively rather wide ; 

 the vascular markings in the cortex are not usually readily visible. 

 In the kidneys of the haemorrhagic type, the organ is more 

 swollen, much darker in color, and the vessels are more promi- 

 nent, both on the surface and within the organ. 



The urinary bladder. — The condition of the urinary bladder 

 is a matter of some interest. In 60 of our cases it was firmly 

 contracted and empty, and 11.6 per cent of these cases had been 

 treated. In 18 cases there was a small amount of urine in the 

 bladder, often only 2 or 3 cubic centimeters, and 77 per cent of 

 these cases had been treated. In the remaining 14 cases no 

 record was kept of the condition of the bladder. I know of no 

 other epidemic disease in which a firmly contracted empty 

 bladder is so constant a finding. The explanation probably lies 

 in (1) the lack of urine, due to (a) loss of fluid through the 

 intestine and (6) specific toxic action on the renal epithelium, 

 and (2) strong cadaveric rigor of the bladder muscle. 



The liver. — The liver is diminished in size as a rule, from loss 

 of fluid. It frequently appears dark and congested, probably 

 from concentration of the blood, and presents evidences of acute 

 parenchymatous degeneration from the action of the toxins of 

 the cholera vibrio. 



The gall bladder. — The gall bladder may present the condition 

 of hydrops or acute inflammation. This has been very infrequent 

 in our series, only 3 cases of marked inflammation having been 

 recognized. 



The stomach. — The stomach frequently contains a moderate 

 amount of brownish fluid ; a catarrhal or haemorrhagic inflamma- 

 tion may be present. In one case a pseudomembranous or 

 gangrenous gastritis was present. 



