hospital. On the road, he had passed through a village called Mungarpool, and having drank Ireely of the tank water of the village, was seized with diarrhoea. 'Ihe purging, however, stopped in the course of two days, and although weak, he felt otherwise when about 6 o clock pretty well, until the morning of the 30th, the disa.m. he was seized with violent vomiting and purging; his admission into of time the at at 12 and ceased a.m., charges hospital (2-30 p.m.) he was in a state of utter collapse. He had
one
stool at 3 o'clock which
was
alkaline, and contained
not
quantity of cylindrical epithelial cells, but numerous cells which, I believe, were cylindrical epithelial, having undergone transformation, and also given origin to some of. the round cells so abundant in the stools of cholera patients, which I shall subsequently describe more fully. The stools also contained cells which could not be distinguished from white blood corpuscles and intestinal gland cells, in addition to considerable quantity of flaky amorphous and granular matter. The temperature of the patient's body on admission was 101?; at 2-45, it was 101?6; at 3-14 (after death), it fell to 99?. The patient, on admission, weighed 90?lb; after death, 8Sglb. The post-mortem examination was made five minutes after death, the temperature of the dead-house at the time being 90?. There was no cadaveric rigidity. On opening the thorax, the lungs were not found to be collapsed, they were mottled and of a normal slate color: on section, they were of a red color; the cut surface bled freely; the lung tissue seemed healthy; the pulmonary artery contained fluid blood. Eight lung weighed 5oz. 2drs.; left, 5oz. On examining the heart, the right side was found full of dark blood; the left side of the heart was quite full of only
a
considerable
scarlet color than the blood contained in the The heart weighed 7oz. after its contents had been allowed to drain away. The liver was of a Gall bladder half full of bile. dark color, and weighed 21b. Spleen enlarged; weight5oz. 2drs. .Kidneys deeply congested.
blood, of
right
a
more
side of the heart.
The mesenteric veins looked
as if almost bursting, with dark The appearance of the whole of the intestinal canal was that of deep congestion of its veins. The vessels of the mucous membrane of the stomach were engorged with blood throughout its whole extent. The duodenum was also very much in the same state. The mucous mem-
viscid blood.
brane of the jejunum was infiltrated with fluid and greatly congested in patches, as was also that of the ileum ; but much of the walls of the small intestines was lined with a glutinous semi-opaque mucus-like matter (the nature of which I shall subsequently consider); patches of considerable extent in this
glutinous lining of the intestines had disappeared, leaving the deeply scarlet villous surface of the mucous membrane exposed. The vessels of the lower part of the ileum were engorged with blood, and large spots of ecchymosis were visible in this part of the intestinal canal; its epithelial lining was destroyed, and the denuded villi stood prominently forwards. On portions of the intestines being placed in water and gently moved about, the greater part of the glutinous-like covering above noticed floated off the surface of the intestinal canal, leaving its congested and denuded villi bare, so as much to resemble in appearance the lower part of the ileum. In places, however, the epithelial covering of the villi remained attached to the mucous membrane, in spite of the treatment above described. The walls of the large intestine were congested, especially near the ileo-ccecal valve.
A CASE OF ASIATIC CHOLERA, WITH
By
REMARKS.
C. Macnamara.
Dhoopnauta, aged 25, was admitted into the Chandnie Hospital on the 30th of March, 1872, at 2-30 p.m., suffering from Asiatic cholera. This man was a native of Hazareebaugh, and had
only arrived
in Calcutta four
days
before his admission into
The intestines contained a small quantity of fluid resembling in appearance the rice-water stools of cholera, but containing rather more flocculent matter than is usually present in the dejecta, and not by any means so much of the cylindrical cells as is commonly found in the intestines when
epithelial
the body is examined
a
few hours after death.
Remakks.?This case affords a very good illustration of several interesting points connected with the pathology of Asiatic cholera. In the first place it must be noticed that
THE INDIAN MEDICAL GAZETTE.
178 the
was one of a virulent type; the patient passed into within six hour3 of being seized with the disease, The post-mortem was made died speedily afterwards.
case
collapse and
five minutes after death, Jieither
so
prolonged collapse
safely conclude that changes could noticed in the body
that
we
nor
post-mortem
may
have influenced the appearances alter death. The left side of the heart was under these circumstances found to be full of blood ; and I have so frequently noticed this to be the case in cholera, when the pcst-mortem has been made instantly after death, that I do not hesitate to
possibly
mistake to suppose that the left side of the heart is found empty in those dying from cholera. This empty condition of the left side of the heart in cholera is, in by far the majority of instances, a post-mortem change ; immediately after
say it is
a
generally
death it is, without doubt, more common to find the left side of the heart distended with blood than otherwise ; but if the chest
be opened directly after death from cholera and the heart carefully watched for a few hours, or if cold water be dashed on it, its left ventricle may be seen gradually to contract, no doubt driving the blood it contained forward into the aorta. The same remark applies to the appearances noticed in the intestines : the mesenteric veins are usually greatly distended with blood immediately after death ; but if the body be left for a time, their appearance alters very considerably. Lastly, the condition of the walls of the intestinal canal vary greatly, as regards the condition of its blood vessels, directly after death, and some time subsequently : for instance, the denuded portions of the mucous membrane, which in this case were of a deep scarlet color at the time of death, after an hour became gradually paler, and in two hours' time were many shades lighter than when first examined. So marked was this alteration in their condition, that one would have described the patches of denuded mucous membrane as being deeply congested in the first instance; subsequently, as being pale, with punctiform spots of ecchymosis on its surface. (To be continued.)
[August
1, 1872-
one
stool at 3 o'clock which
was
alkaline, and contained
not
quantity of cylindrical epithelial cells, but numerous cells which, I believe, were cylindrical epithelial, having undergone transformation, and also given origin to some of. the round cells so abundant in the stools of cholera patients, which I shall subsequently describe more fully. The stools also contained cells which could not be distinguished from white blood corpuscles and intestinal gland cells, in addition to considerable quantity of flaky amorphous and granular matter. The temperature of the patient's body on admission was 101?; at 2-45, it was 101?6; at 3-14 (after death), it fell to 99?. The patient, on admission, weighed 90?lb; after death, 8Sglb. The post-mortem examination was made five minutes after death, the temperature of the dead-house at the time being 90?. There was no cadaveric rigidity. On opening the thorax, the lungs were not found to be collapsed, they were mottled and of a normal slate color: on section, they were of a red color; the cut surface bled freely; the lung tissue seemed healthy; the pulmonary artery contained fluid blood. Eight lung weighed 5oz. 2drs.; left, 5oz. On examining the heart, the right side was found full of dark blood; the left side of the heart was quite full of only
a
considerable
scarlet color than the blood contained in the The heart weighed 7oz. after its contents had been allowed to drain away. The liver was of a Gall bladder half full of bile. dark color, and weighed 21b. Spleen enlarged; weight5oz. 2drs. .Kidneys deeply congested.
blood, of
right
a
more
side of the heart.
The mesenteric veins looked
as if almost bursting, with dark The appearance of the whole of the intestinal canal was that of deep congestion of its veins. The vessels of the mucous membrane of the stomach were engorged with blood throughout its whole extent. The duodenum was also very much in the same state. The mucous mem-
viscid blood.
brane of the jejunum was infiltrated with fluid and greatly congested in patches, as was also that of the ileum ; but much of the walls of the small intestines was lined with a glutinous semi-opaque mucus-like matter (the nature of which I shall subsequently consider); patches of considerable extent in this
glutinous lining of the intestines had disappeared, leaving the deeply scarlet villous surface of the mucous membrane exposed. The vessels of the lower part of the ileum were engorged with blood, and large spots of ecchymosis were visible in this part of the intestinal canal; its epithelial lining was destroyed, and the denuded villi stood prominently forwards. On portions of the intestines being placed in water and gently moved about, the greater part of the glutinous-like covering above noticed floated off the surface of the intestinal canal, leaving its congested and denuded villi bare, so as much to resemble in appearance the lower part of the ileum. In places, however, the epithelial covering of the villi remained attached to the mucous membrane, in spite of the treatment above described. The walls of the large intestine were congested, especially near the ileo-ccecal valve.
A CASE OF ASIATIC CHOLERA, WITH
By
REMARKS.
C. Macnamara.
Dhoopnauta, aged 25, was admitted into the Chandnie Hospital on the 30th of March, 1872, at 2-30 p.m., suffering from Asiatic cholera. This man was a native of Hazareebaugh, and had
only arrived
in Calcutta four
days
before his admission into
The intestines contained a small quantity of fluid resembling in appearance the rice-water stools of cholera, but containing rather more flocculent matter than is usually present in the dejecta, and not by any means so much of the cylindrical cells as is commonly found in the intestines when
epithelial
the body is examined
a
few hours after death.
Remakks.?This case affords a very good illustration of several interesting points connected with the pathology of Asiatic cholera. In the first place it must be noticed that
THE INDIAN MEDICAL GAZETTE.
178 the
was one of a virulent type; the patient passed into within six hour3 of being seized with the disease, The post-mortem was made died speedily afterwards.
case
collapse and
five minutes after death, Jieither
so
prolonged collapse
safely conclude that changes could noticed in the body
that
we
nor
post-mortem
may
have influenced the appearances alter death. The left side of the heart was under these circumstances found to be full of blood ; and I have so frequently noticed this to be the case in cholera, when the pcst-mortem has been made instantly after death, that I do not hesitate to
possibly
mistake to suppose that the left side of the heart is found empty in those dying from cholera. This empty condition of the left side of the heart in cholera is, in by far the majority of instances, a post-mortem change ; immediately after
say it is
a
generally
death it is, without doubt, more common to find the left side of the heart distended with blood than otherwise ; but if the chest
be opened directly after death from cholera and the heart carefully watched for a few hours, or if cold water be dashed on it, its left ventricle may be seen gradually to contract, no doubt driving the blood it contained forward into the aorta. The same remark applies to the appearances noticed in the intestines : the mesenteric veins are usually greatly distended with blood immediately after death ; but if the body be left for a time, their appearance alters very considerably. Lastly, the condition of the walls of the intestinal canal vary greatly, as regards the condition of its blood vessels, directly after death, and some time subsequently : for instance, the denuded portions of the mucous membrane, which in this case were of a deep scarlet color at the time of death, after an hour became gradually paler, and in two hours' time were many shades lighter than when first examined. So marked was this alteration in their condition, that one would have described the patches of denuded mucous membrane as being deeply congested in the first instance; subsequently, as being pale, with punctiform spots of ecchymosis on its surface. (To be continued.)
[August
1, 1872-
