The mucous membrane was often rather pulpy and thickened (edematous), but much less so than in the jejunum or ileum. In one instance, where the acute symptoms had lasted 63 hours, and the patient died in asphyxia with partial reaction, there was, in the descending colon and rectum, extensive and irregular superficial ulceration with vascular injection of the edges, probably the result of diphthe ritic exudation. In a second case, fatal in collapse at the beginning of the fourth day, there was slight granular exudation and patches of punctate injection in the transverse and descending colon; and superficial ulceration to a limited extent near the sigmoid flexure, leaving the solitary glands unaffected and spreading around them. In two others there were a few minute ulcers in the rectum.

The solitary In only 4 out of 34 cases were the solitary glands glands. prominent throughout the whole extent of the large intestine; in 11 others they were slightly enlarged about the cœcum and ascending colon. They were often translucent from distension of their cavities with serous fluid; sometimes this distension had been followed by rupture, producing an appearance of small rounded ulcerations.

After recording the morbid appearances in the small intestine, Reinhardt and Leubuscher* continue thus:-"The veins of the large intestine were commonly congested, not, however, equally so over the whole surface as in the ileum, but rather in isolated patches. The cœcum and rectum were the parts more particularly affected." They add (page 485), "In the majority of cases we found the solitary glands enlarged, but not so constantly, nor to so marked a degree as in the small intestine. They were round, more or less strongly prominent elevations, from the size of a millet seed to that of a hemp seed, sometimes surrounded by a circle of injected vessels, and very commonly marked at a point corresponding to their orifice, with a dark spot, which depended upon extravasated and altered blood. In certain cases the superficial layer of mucous membrane on the prominent part of the glands had exfoliated, producing a cup-shaped or lenticular de

pression, but entire destruction of them in this stage was never observed."

Briquet and Mignot* report as follows: "The large intestine was the seat of general venous congestion in 9 cases (out of 32 examined), in only half of these was it very intense. In 4 it was limited to some points of the mucous membrane, and had the characters of inflammation. For the most part the mucous membrane was pale and very coarsely congested.

"In half the cases there was an abnormal prominence of the crypts (solitary glands). In 3 the mucous membrane was obviously softened.

"In no instance was there gangrene, or any appearance which in the least resembled such a change, although certain authors, and especially M. Bouillaud, mention that they have sometimes met with it in their dissections."

M. Leudet writes as follows: "The lesions of the large intestine were less frequent than those of the small intestine. The mucous membrane was generally pale, or, when reddened, it was in patches. The follicles were enlarged in 11 cases out of 38, and sometimes ulcerated."

The following table exhibits the general results of his examinations. Color of the mucous membrane of the large intestine.

Pirogoff mentions "a peculiar affection of the mucous membrane of the large intestine, principally of the descending colon, sigmoid flexure, and rectum;" illustrations of which are given in his fifth plate. It consists in a large extravasation of blood into the mucous membrane and submucous tissue, leading to gangrene. As the eschars separate during the period of reaction, the muscular coat is exposed, leaving irregular ulcerations. The morbid changes in these cases were remarkably rapid, and more frequent where diarrhoea of some days' standing had preceded the development of the algide stage.

Evacuations.

The general appearance of the evacuations in cholera

is well known.

Their reaction was alkaline or neutral.

The specific gravity of the clear fluid left after the subsidence of the flocculi was from 1006 to 1010; rarely higher than this.

No change, or only a slight opalescence, was produced by boiling. The mean of six observations, the details of which are given by Dr. Parkes *, is as follows:

Water
Solids

987.95

12.05

1000.

The solids consisted of

Organic matter and insoluble salts (earthy phosphates)
Soluble salts (chlorides, phosphates, and sulphates of

soda and potash)

3.9

8.1

12.

The amount of organic matter varied with the stage of the disease, being at a minimum in the large effusions of the algide stage, and greatest as the symptoms of reaction set in.

Dr. Dundas Thomson + gives a table of three analyses of cholera evacuations, in which the quantity of the organic matter was much beyond the mean amount stated above, viz.—

In case D the supernatant fluid, when exposed to a temperature of 212°, "coagulated into a mass in a manner corresponding with the serum of the blood, and yielded a similar odour; thus exhibiting the presence of a large amount of albumen." It was, however, very rare that the effused fluids carried off so large an amount of organic matter. The alkalinity of the fluid, and probably also the physical condition of the albumen, allied more to albuminose, prevented its ready recognition by heat; yet that the principal part of the organic • On the Intestinal Discharges in Cholera, London Journal of Medicine, 1849. + Medico-Chir. Transact., vol. xxxiii. p. 83.

matters thrown out was albumen, or allied to it, is shown by the fact stated by Dr. Thomson that, " on evaporation in vacuo, a yellow residue was obtained, which, on being treated with water, yielded a solution coagulating on boiling, and by the addition of acids; and usually," he adds, "the fluids as evacuated, when allowed to settle, yielded by boiling, or, on the addition of an acid, distinct evidence of the presence of albumen."

Dr. Parkes particularly noted the small amount of the so-called extractives, or incoagulable organic substances thrown out in cholera, a circumstance which seems to indicate a suspension of the proper excreting function of the mucous membrane during the algide stage. This observation is important as bearing upon the pathology of the disease. The following table, given by him, exhibits the amount of extractive matter, albumen, and salts in the cholera fluid.

He further adds, "As in the algide stage, the excretion of the extractives is arrested, so also in great measure is that of the earthy phosphates which are thrown out so largely by the healthy intestinal surface. In some cases there has been hardly a trace of the phosphate of lime; in others it has existed in diminished quantity. In no case has it nearly equalled the healthy standard or approached to the excessive increase which occurs in the stools of typhoid fever."

• On Intestinal Discharges, &c., London Journal of Medicine, p. 134.

Occasionally the cholera dejections became of a pink or rose tin when nitric acid was added in small quantity (Schmidt, Parkes), a result probably due to the presence of biliary matter.

Both Schmidt and Garrod agree upon the absence of urca from cholera fluid. According to the former, this is owing to its rapid decomposition into carbonate of ammonia, the presence of which often produces slight effervescence when nitric acid is added.

In one analysis very faint traces of uric acid were observed by Garrod, but in general no indication of its presence could be made

out.

Three complete analyses of the soluble salts, taken from Dr. Parkes's paper, give the following results :—

For comparison, we subjoin the following table of the proportions. in which these soluble salts normally exist in the blood itself:

Microscopical

The membranous shreds and loose flocculi examined

appearances. by the microscope, presented the following appearances. They were homogeneous, translucent, and indistinctly striated, and contained :

1st. Amorphous granular matter and larger granules (fibrinous) often very abundant.

2nd. Minute bodies having the general characters of nuclei. 3rd. Finely-granular cells (exudation cells?) Some of these were large.

4th. Occasionally a few scattered blood corpuscles, generally not in sufficient numbers to produce any tinge of colour, but when the cold