The lower portion of the small intestines is the favorite location for the action of the endotoxin of cholera. Early and marked postmortem rigidity is a striking characteristic of the cholera cadaver. Muscular contractions, causing odd positions of the limbs, have at times given a basis for the idea that the victim had been buried alive.
Besides marked rigor mortis the emaciation, leaden hue of skin and shrivelled hands are noteworthy.
In opening up the body there is a striking dryness of all the structures. The dry and dark-red muscles stand out prominently. The lungs are dry and shrunken. The right heart is full of a dark, jelly-like, viscid blood. The leading changes are found in the abdomen. The omentum is dry, sticky and shrivelled looking. The intestines have a ground glass appearance with a lilac-pink color of the small intestines which is in contrast with the normal color of the large intestines.
There is congestion of the affected intestinal mucosa and the lumen is filled with the alkaline rice-water material. If the case is of some days standing we have a rather brownish, foul-smelling bowel content. There is usually a parenchymatous nephritis and on section the medullary portion is much congested.
Crowell gives the following points as indicating cholera upon autopsy: (1) Cyanotic finger nails, (2) dry tissues, (3) dry and sticky peritoneum with pink serosa of ileum, (4) contracted and empty urinary bladder, (5) shrunken dry spleen and liver, (6) rice-water intestinal contents and (7) prominence of lymphoid tissues in the ileum.
In his studies of the pathology of cholera Greig drew attention to the frequency of the involvement of the gall-bladder. He also noted the presence of small areas of consolidation in the lungs of those developing pneumonia during the early days of convalescence. In the exudates of such areas cholera vibrios could be seen thus showing their penetration of the lung. Although rare instances of recovery of the cholera spirillum from the blood have been reported Greig was unable to accomplish this in any instance. In his opinion the spirilla travel by way of the lymphatic system. In eight cases out of fifty-five cases he recovered the spirilla from the urine.
Symptomatology
A Typical Case of Cholera.—The so-called prodromal or premonitory diarrhoea is not a feature of the onset of cholera gravis, the type of the disease which characterizes the cholera epidemic.
The period of incubation is usually from one to five days. Longer periods are possibly explained by some exciting intestinal disorder in a cholera carrier. The course of the disease is conveniently divided into a stage of evacuation, an algid one and a stage of reaction.
The Stage of Evacuation.—A profuse and frequent diarrhoea comes on without colic or tenesmus. In fact the stools are voided with a sense of relief as when an enema is gotten rid of.