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Show [Sneriox VI. DISEASES OF THE ORGAXS 0F DIHI‘IS'I‘ION. Txnrr. XI. FIG. l,.-]/r!'merr/IIq/r of "If .llm'uus .l/em/n'tme of HIP Stan/Hell.from .l/rc/mm'cu/ Obstruction to ill!" [Kr/urn off/M [Nor/(l. .sI/IIrIfM/ In f/N' llr-m'l. I (A) pyloric portion; (It) ct1111111cnee111ent of duodenum; (F) the mucous membrane thrown into folds of a uniform redness and presenting a granular appearance from cnlargement of its follicles. Flo. 2.-llwntm'r/nrye off/1c Sloan/('7) in Follicular I'l(Ierufirm. (A A) enlarged follicles. its bodies are pale. but have a red central orifice; (B) other enlarged follicles. but diti'ering from the above in their bodies being also red; (('i) follicles pale throughout. with a central depression; (It) petechiax ot' the mucous membrane accompanying this 1] l of the colon. from embolic occlusion of the superior mesenteric artery. The h:en1orrhagic patches (:1 a) present a uniform dull red color. with slight congestion onlv. the ef- fused blood being confined to the mucous 111c111bra'ne alone. At (b and c) the cxtravasation is more extensive. and oc- cupies the mucous as well as the sub-mucous tissue. and is associated with extensive venous stasis and varicose dilatations of those vessels. presenting also here and there deep red and black blood coagula. The infarct (1)) is situated between the mucous and sub-mucous layers. A portion of the first is thereby raised as a flat spherical elevation. Flo. 5.-[JUN/luff"ll.I/I-(‘ l'lemwtfon {/1 HM Dom/mum, The mucous and scrolls surface of the intestine is here shown. The valvnlzc conniventes of the duodenum ('I' 1)) form of hzemorrhage. are all covered with fibroid and puriform matter. with here Flo. 3.-[Itmnm'r/m‘r/r) of flu» Dumimuoa.from IVcPl‘f/tim) of its JDH'oHs .Ifc‘m/u'u/w. (A) duodenum; (B) pyloric portion ofthe stomach; (C) ragged ulcers of the membrane penetrating to the sub-unicous tissue and surrounded by elevated borders of the mucous structure. i The surfaces of the ulcers are covered with dark blood coagula. and the membrane presents a deep brownish red color from imbibition. (C) a small ulcer of the follicles; (E E) two small circular ulcers in the pyloric portion of the stomach. FIG. 4.-Ihemorrhagic [aft/ref. in the mucous 111embrane and there blaclv‘ gangrenous points between them. The mucous tissue is swollen and thickened. The serous surface tissue are enormously injected. and many small luemorrhages appear upon the surface and in the parenchyma. These haimor- rhages take place even in mitigated cases of the inflammation. as the subsequent pigmentations upon the structure readily prove. I11 21 case of a follicular ulcer confined to the colon (of a child described by 'l‘hiertclder). the intestine was much contracted: its mucous 111embrane covered with abundant mucus. colored with biliary pigment. and showed very 1111111erous 111iliary l12e1norrhages. The 111embrane was moderately swelled and much infiltrated with lymphoid cells into the inter-glandular tissue. The glands were not compressed. but seemed rather dilated and filled with mucus. The hyper2e111ia. which must have existed during life. had com» pletely disappeared. The sub-mucous tissue was itrdomatous.but otherwise slightly changed. The vessels were somewhat injected. and the muscular and serous tunics but little altered. 3. I11 the stomach and the duodc1111111 suppurative inflan‘unation is frequent; in the intestines it is very rare. Its clinical character is that of an idiopathic fever. very analogous. in its symptoms. to l'iltlegnionous and erysipelatous inflammation of the skin. The phlegmonous process may extend over the whole intestinal tract. in all its layers. and lead to exceedingly extensive ulceration. 111 the superficial layers there is but little alteration. except some collection of few pus-eorpuscles around the little dilated capillaries. In the mucous tissue proper7 and in the interstitial structures between the tubular glands, there is enormous infiltration of pus. which presents many haanorrhagic spots. some of great extent. Ilalmorrhagic ulceration and destruction of portions of the, serous membrane (II F). showing the denuded muscular coat (M). The borders of the ulcers are only slightly" raised (as is usual in perforation of the serous membrane by 11l- cerative destructions). in some places not at all. There is extensive infiltration of blood and pus in the tissue (ll) surrounding the ulcers. The serous 111embrane is also i111- pregnated with blood pigment in those localities. into the peritoneal spaces. and fatal peritonitis is the consequence. It happens sometimes that excremcnts are retained in the-appcir dicular cavity whilst its orifice in front is closed 11p bv neoplastic. matter. Abseesses are then formed which may perforate the walls and discharge either into an intestine or externally into the peri- toneum. Sometimes the whole cavity becomes thus tilled up with newly-formed hyperplastic material. or it may only become partiallyfilled. and the still open cavity will gradually fill more and more with secretion from still functioning mucus membrane and dilate to an enormous extent. L'nder other circumstances the appendix becomes atrophic and is almost obliterated. or becomes attached by adhesive inflammation to some portion or other of its adjacent tissue. Inflammation into the appendicular cavity is often extended from the ileum or the coecum. or from both. Especially in tuberculosis ot' the lung and tubercular infiltration in the mucus 111cmbrane of the coeeum is the appendieular organ highly deformed by extensive ulceration and sometimes almost obliterated. I11 (Sec. \VI. Table XVI) a case reported by [tic/Howl Brie/It. in his cele- brated Report of .llo/feu/ Cums (Fig. l). is given an excellent representation of ulceration of the coccum and almost total oblit- eration of the appendix found on post-mortem in a consumptive patient of Guy‘s Hospital. London. Inflammatory. typhoid. and tubercular intiltrations into the appendix are often very dangertuls. and sometimes even prove fatal complications in those diseases. f/{7f1o/Umlt/n/l 13f [/11 m/m/ is a very frequent disease ((91/17/29) Its several peculiar forms have been described above. Its causes are many and various. lmpaetion of faeccs. septic intiltrations. or compresses the glands. Extensive extravasates of blood are pressed between the tissues. and the epithelium loses its characteristic specific infections. and sometimes poisons are usually the inciting cylindrical form from this very pressure. causes of those diseases and lesions. 4. Amyloid degeneration in the intestinal vessels is as frequent as in those of other viscera ot'the abdomen. only here they are not [adamant/[on of t/«r [Britt/m-]'roetff/N. so prominent as in the others. The walls of the smallest arteries and In many respects. both in regard to symptoms and etiology. capillaries are usually first affected: the muscles and the epithelium the afl'ections ot‘ the rectum resemble those of the vermifortn appen- become subsequently involved. The altered tissues have a glassy. dix. l'resence of 11.11‘eig11 bodies is the most frequent cause of its translucent appearance. and turn purplish or brownish-red when several lesions and derangcmcnts. \Venons stasis is usually the. treated with iodine and some sulphuric acid. The affected parts immediate cause of inflammatory processes therein. [Vlcct‘ations‘ lose their elasticity; they close up the vascular cavity. and thereby fibroid hyperplasia. thiekeningof the intestinal mucous 111e111brane, produce local anaemia of the tissues and their subsequent death. and vegetations upon its surface are the most frequent results of The inflammations of the different portions of the intestine have, I those inflammations. Its surface readily becomes covered with been denominated according to the name of the affected part viz: purif'orm mucus. \Vhen the inflammation or ulceration penetrates D/l«)r/,1'1I«'/1's.-lnfiammatiou of the duodenum usually occurs ‘i1n» into the deeper strata of the rectal wall the adjacent soft connecultaneously with that of the stomach. llyperplastic formations in tive tissue becomes infiltrated and byperplastic; or there are formed that eavitv often close 11p the orifice and portion of the common perireetal abscesses and suppurating gangrenous pockets, (I'm-«'- choledie duet: especially the inflammation extends upward into the prm-titis.) Sinuses and canals are then formed from the mucous bile ducts. By this closure. although even temporary. there is and sub-mucous structures into the adjoining tissue; so-called produced eatarrhal ieterus, which stunetimes assumes a very grave [lmmiplt/r dist/1hr. When the sinus aml abseess open externally form of blood-pt>isoning. As in the stomach so may also be found they form comp/Mr 11/1 r/m/ .fis/u/Ir. \Vhen the external orifice circular ulcers in the duodenum. communicates with the rectum by a canal. romp/rte ru-tn/ fish/hr is I/m'f/s.-Inflammation in this portion of the tract is generally then produced. Thesinus may then be either lined with a layerot' characteriZed by swelling of the solitary glamls and aggregated secreting epithelium or with a pyogenic 111embranc. Itecto-vcsicular follicles. (lib/licu/«o' willow/1.) The solitary follicles appear as aml recto-vaginal tistuhe are also thus formed. Syphilis. tubercureddish or grayish-white prominent nodules; the aggregated as losis. dysentery. and other infections matters. carcinoma or ulceragrayish or reddish-gray patches or flat ridges. with many small tions. are all very liable to produce pcriproctitis. l'uerpcral sepsis, depressions or pits on top of these. Destruction of the follicles py2en1ia. typhoid. and rheumatic infections very often produce produces follicular ulcers. pcriproctitis without preceding ulcerations. YII/p/«lo‘is and I'll-ltr/p/d/tfs are names given to inflammation ofthe Inn's/full, l/IIHIIIIIHHI/I'UHN lu'm/Hc/‘r/ ll'f/ ,\'/)lt'l:fil' Ill-ffl'il'u/lR. vermifi'a‘m appendix and its adjacent tissues. This portion of the I‘ipidelnic. endemic. and sporadic dysentery constitute an inflam- intestine is. from the nature of its position and structural arrangematorv atlcctioli of the colon. The "pccitic infectious substance or ment. much subject to retention ofmany substances passi11gtl1rm1gl1 agency has not yet been detinitely ascertained. It is undoubtedly the intestine. Some of these cause very great irritation in the one or another of the many forms of sehixomycetes found in many cul de sac. The inflamed tissue and the substances causing the localities in the ground and in water. The character of anatom» inflammation often become incrustated with earthy phosphates and ical alterations in dysentery is very similar to those found in the carbonates. (Iv'o/n'n/ir/m.) These deposits may extend upon all the intestinal afli-ctions by a non-specific agency. This is the reason surrounding tissues and thereby produce ulceration. followed by wbv its morbid anatomy has as yet not furnished any peculiar mortitication and perforation of the intestine. \th11 these for» diagnostic pheno111e11a of dysentery. The intensity of the dysen- eign substances produce inflammation confined only to the cavity of teric process and its extent differ very mueh under various circum- the appendix. and the exudate is not very extensive. the cavity may stances: the whole colon or only a small part may become involved. close 1111 by neoplastic tissue. lint when pertoration of its wall from the rectum. the signoid flexure. ilio-eoecal valve. or even takes place before the cavity can close up. its contents are emptied |
