On the Pathology of Cholera Asiatica. 



177 



change in the mucosa. The experiments of Moreau, who found well- 

 marked hypersecretion of the mucous membrane of the small intes- 

 tine, resulting from section of its nerves, seems to us to have a very 

 important bearing on the pathology of the disease in question. The 

 chemical characters of the fluid so abundantly secreted during the few 

 first hours following section of the nerves of the isolated loop of in- 

 testine are, as shown by Kuhne, practically identical with those of the 

 dejecta of cholera cases. That the hypersecretion from the intestine 

 in cholera, with the more or less complete arrest of the power of ab- 

 sorption by the mucosa, is the cause of the thickening of the blood 

 and the drying of the tissues there can be little doubt. Everything 

 seems to point towards the assumption that the chief symptoms and 

 signs of cholera, as well as the frequent fatal termination of that 

 disease, is due to the escape of fluid from the vessels into the intes- 

 tine. The pathology of cholera is therefore centred in the question 

 as to what is the cause of this intestinal secretion and diminished 

 power of absorption. We have repeated Moreau's experiments more 

 than once with the view of observing for ourselves how far the fluid 

 contained in the isolated loop of the intestine resembles the intestinal 

 contents of fatal cholera cases. The results of these experiments are 

 such as to impress us strongly with the conviction that the characters 

 of the paralytic secretion following section of the nerves to the intes- 

 tine are practically identical with those of the contents of the intestine 

 in cases of cholera. With regard to the question whether or not the 

 epithelium covering the free surface of the mucosa is simply less 

 firmly attached than in the normal intestine, or whether it be actually 

 detached before death, our observations tend on the whole towards 

 the first-named of the two possibilities. 



The pathology of cholera, we are of opinion, can be best explained 

 by some cause acting on the glands or nerves of the intestine, and 

 producing effects similar to those which result from paralysis of the 

 intestinal nerves. This conclusion makes it probable that the cause of 

 the disease, if discoverable by the microscope, is to be found either 

 in the mucosa itself, in the nerves running in the mesentery, or in 

 the ganglia from which those nerves proceed. 



Soon after our return from Spain our inability to confirm Koch's 

 views as to the causal relation of the comma bacillus to cholera in- 

 duced us to look with care for any other parasite, the presence of 

 which might be supposed capable of causing the disease in question. 

 In the course of this work, which occupied many months, we observed 

 in sections of the intestinal wall, prepared and stained in the different 

 ways which we thought best fitted to make evident any micro- 

 organisms present in the tissue, granules the characters of which 

 arrested our attention. These granules, which vary much in size, 

 were for the most part smaller than the nuclei of the surrounding 



