476 



On the Anatomy of Asiatic Cholera. [June 16, 



villi, especially, to the presence of an excessive nnmber of leucocytes 

 in the meshes of the mucosa and submucosa, and to evident engorge- 

 ment of the portal venules. The comma-shaped bacilli lie in the fundi 

 of the tubular glands of, especially, the ileum, and in the tissue in 

 which those glands are imbedded in the immediate vicinity of the 

 glands. Their distribution is not uniform, but is patchy. They occur 

 with various other forms of bacteria in the same situation. Generally 

 of these other forms some have penetrated more deeply into the tissue 

 than have the comma-bacilli ; especially is this true of certain fine, 

 straight bacilli resembling morphologically the bacterium coli com- 

 mune of Escherich. 



In the other cases in which comma-bacilli are found, the signs of 

 acute severe inflammation are more obvious, many of the denuded 

 villi are in part necrotic. Shallow sloughs occupy the surface of the 

 mucous membrane, together with small extravasations and patches of 

 " coagulation-necrosis." Here the comma-shaped bacilli are within 

 the mucosa, and with them occur a multitude of micrococci and 

 bacilli of various shape and size. Although in two of these cases 

 bacilli are to be seen in the distended venules, I have in no instance 

 found comma-bacilli within any blood-vessel. 



Of those cases in which comma-bacilli have not been found, the 

 impression left upon me is that in some of them it is possible that 

 still further examination of a still more extended series of prepara- 

 tions from them might have revealed comma-bacilli in the wall of the 

 intestine in some of them. They are all cases that, although of 

 rapidly fatal issue, had passed into a stage of febrile reaction. 



In them often the surface of the ileum and large intestine was 

 thickly set with little patches of superficial sloughing, and micro- 

 scopical preparations made through these areas forcibly recall prepara- 

 tions of a mucous membrane diphtheritically inflamed. The attached 

 face of the slough is occupied frequently by an almost continuous 

 sheet of bacteria, and bacteria infiltrate the inflamed submucosa, and 

 often the superficial regions of the muscularis. In three of these 

 cases micro-organisms are present in the blood-vessels, more especially 

 numerously in the venules of the portal system. 



With regard to the preparations made from freshly evacuated 

 dejecta and vomit from living cases, the six cases examined reveal 

 comma-bacilli in the stools in five. There is no evidence of blood in 

 these five stools, but blood is mixed with the intestinal fluid in the 

 case in which no comma-bacilli are seen. The vomit also in three of 

 the cases shows a small number of comma-bacilli. In none of the 

 preparations do the comma-bacilli make up more than a small fraction 

 of all the bacterial forms present. 



With regard to the statement by Cohnheim that the shedding of 

 the intestinal epithelium is purely and merely a process setting in 



