OCR Text |
Show Sice'riox V1,] DISEASES ()F Tlll‘] ()RGANS ()l" I)I(i‘rliS'l'I()N. T.\iti.n I. Fig. I.-(,'Nlurr/I(Il (Ii/(l ,I/wmorr/JrIg/e lufltlinmull/m of Hit- N/InI/IH‘II. i i (‘.\si-1.-(l. I... a l'our-year-old hov. Ills/or" om/ i\"//i///;/I;iiis.--()n Jiiiie Ttli. lS-. lie swallowed a portion ot' a ll-per-eent. solution of eoiieentrated lye; dropped the vessel eoiitaiiiiiig it and hegan to sereain. aiid immediately to vomit bloody and mueous masses; was seized with very violent pain in the pharynx. (esophagus. aml stomaeli. wliieh soon spread over the whole ahdomen. It'epeated retehiiig and vomiting; no stools; all applied remedies did not help. l)ied al'ter 'tit‘teen liours extreme sutl'ering. I'ost mortein al'tei' l'oi'ty- eight hours. On the eliin some eorrosioii: the lips purple. externally; within. the mouth denuded ol' its epithelium, and without. spotted reddish hrown and greenish. The gums partly spotted and partly opaque white. The tongue. mostly denuded of its mueoiis eoveriiig. intensely red and swollen; the soft. palate and pharynx of similar 1 strongly ei'iiiti'asted in eoloi' and density against the hal- anee ot' the mueoiis tissue. Those lormed a tiiangiilar ele\ation ahove the level ol‘ the general siirt'aee. distinctly outlined and of brown reddish eolor. and ol‘ eonsisteiiee (it' leather. The surrounding siirt'aee is red. passing into yellow. with a greenish shade. It is in eatai'rlial eonditioii. .\ numher ol' dark red spots are pei'eeptihle here and there. A seetioii through the dark red tissue of the triangle shows the whole thielx'ness ol' the mucous men - hrane to he involved. the siih-iiiiieoiis and iiiuseular layeis similarly all'eeted. In the lighter portion only the inueoiis tissue is inueli atl'eeted. with infiltration ot' serum and lymphoid hodies. The smaller dark spots are injured only siipi,-rlieially. The deeper layers ot'tlie stomaeh eontained but very little blood. The greenish diseoloratioii of some portions of the surface was due to post-iiiorteni ehaiige ot' the tissue. Fig. 2-]71‘01'1/1‘1/ (:‘r/s/r/ffs. A, 'ase ol' very severe gastro-entei'ie ‘Ellill‘l'll. with "avity ol‘ the stomaeli, a dark viseid mass. tinged with bile. and, ot' an acid reaetioii. On its inner siii'liiee the eardia. the lesser eiirvatiire. and a great part ol‘the adjaeent tissue (‘littlt‘l‘tl-lilx't‘ diarrhti-a. vomiting. and exeessive pain in the whole intestinal traet. l)ies shortly alter attaek. .\ii- topsy very soon at'ter death: Stoiiiaeli of normal size; innumerahle spots ol‘ deep red eolor are spread over the whole inner siirl'aee. They eonstitute miliary liieiiior- rliages. The eolor ol' the memhrane proper was yellow, and laid in many longitudinal folds. ("(I‘I) tesophagiis. (I') pylorus. (1)) duodenum. (It () great eurvatiire. til l) lizemorrliagie iiililtratioii. ])(////o/o.r//eu/ 7"I/tl/hII/l‘l/_ thrombosis and eniholisins ot' the vessels. and eei'taiii aerid and appearanee. The swelling. eorrosion. and (edematoiis infiltration extended into the upper oriliee ot' larynx and the sinus pyrot'orniis. The «esophagus partly eorroded. partly indiirated. diseolored. and iiililtrated. The peritoneal eoveriiig ol'tlie stomaeli pale. and the sub-serous veins very turgid. with hlaelt' liquid hlood. \Vithiii the poisonous siihstanees are otten eaiises ot' llzt‘llltil‘l'llll‘fl‘t‘fli the same The niiieoiis membranes eover all the inner snrt'aees ot' those internal organs whieli eoinmiinieate with the exterior ot' the body. Their struetures. although essentially identieal with those ot' the skin, are so l'ar modified in their arrangements as to tit them for the peculiar t'iinetions to he earried on in those organs. The siih- mucous tissue is tar more loosely eonstrueted than the iniieoiis membrane. and eontains far more eells than the other. In some loealities it is elianged iiitoa lynipli-adeiniid striietiii'e; eoiitains innumerahle lymphoid eells. and is eovered by a very delieate eover of epithelial tissue. In others the iiiueoiis tissue eoiisists ot' one or more layers ot' prot'oplastie eylindrieal or eoliininar eells. and is devoid ot‘ any eovering ot' any proteetive pavement eell layers. All mueoiis ineinhraiies eontain abundant quantities ot‘ hlood and talx'es plaee in very aeiite states ot' inflammation ot‘ the ineiiihiaiies. (Set-tioii \'I. Table l.I*‘igs. 1.2.) Slight ha‘morrhages are. as a rule, soon absorbed. but leave behind them grayish or hliiish-hlaek dis- eolorations upon the surtaee. Illeeration and inortitieation are not so seldom eaused by extensive lia~iiiorrliages. l‘lxtensive destriietion ot‘ the tissues, with total loss of t‘iinetioii, otteii follows sueh litiiiiorrliages. [hf/1 [it rill/Ion, At/‘op/o/ (ll/(l [It/[it‘I‘li't'tp/ij/ q/i J]l./['/lt(.\' Ill: )u/u'rlm s, Itet'rogressive iiietaniorplioses may all find plaee in the intestinal nineous iiiemhraiies. In eonseqiienee ot' iiieeliaiiieal. elieinieal. or From the underlying tissue they are separated by a loosely-eon- strueted eoiineetive tissue, wliieli also is pleiitit'iilly supplied with blood and lymph vessels. In siieh organs as the stomaeli and intestines, whieli are suhjeet to very sudden alternate eontraetion and dilatation, the iiiueous membrane is alternately stretehed and thrown into t'olds. and the sub-iiiiieous tissue is very tliiek and yielding. The epithelium eoveriiig the iiiiieous memhrane ot' the intestinal eanal is very periiieahle. allowing liquids and small solid partieles to pass t‘rom without inwardly and reversely than the blood upon the tree siirtaee ot' the membranes. .\|l miieoiis nienihrain-s prodiiee seeretions. made up partly ot' liquid ainl partly ot' inueiis, wliieli are termed within the epithelial eells and exudated externally. Grreat. quantities of lymphoid elements also pass than the eelliilar eoiiiieetive tissue. between the epithelial eells, upon the miieous surtiiees. and eonstitute the spheroid iiiueoiis eorpuseles. Aeeoi'ding to Stolir they are most abundant where the miieous tissue eoiitains lyiii]iii-adenoid struetiires. The seeretion ot' niiieiis is most. ini- portant to the membrane, not only in physiologieal eonditioiis, but, inflammatory irritations and derangements ot' eireulation. the memhrane may undergo a number ot‘ eliaiiges in all its struetiii'es, ehanges ditlering in quality. quantity. and eoiiseqiienees. Alterations in the epithelium are tar easier and inueh sooner iiotieeable than those ol' the siih-iniieous striietiires. (‘atari‘hal intlanimations show an enormous inerease ot' seeretion t'roni the all'eeted epithelial In deep and extensive inllaiiimatory eoiiditions ot‘ the eells. iiiueoiis memhrane extensive exloliation ot' the epithelial eells are readily notieeahle. Fatty degeneration of that tissue goes on far slower. and never heroines so extensive as the other alterations. The siih-iiiiieoiis tissue is very otten the seat of aiiiyloid elianges. The vessels are most frequently thus atleeted. Atrophy ot' the inueoiis tissue and permanent loss ot' the epithelial eovering are very ol'ten the result of severe eatarrhal atl'eetions ot‘tlie intestinal eanal. \Vhen the eoniieetive tissue hetweeii the krypts ot' Lieberlx'uhii lieeonie deeayed from the pressure produeed by enormous eellular infiltration. and the epithelial lining of those krypts loosen and extoliate, the glandular layer ol' the membrane heeoines atrophie and its glands obliterated. This atrophy superiiidiiees atrophy of the siih-miieoiis museular tissue. However, when the lesion is not also, and espeeially, iii pathologieal, for it eonstitutes in the latter too deep and the epithelial loss is not too extensive, the whole lymph vessels. \vllieli are ill elose eoiitaet with the epithelium. states a pi'oteetion against. manyinjurious suhstanees by preventing their immediate eoiitaet with the inemhraiieoiis wall ot' the organs. ()eeasit'iiially the lymphoid elements take the plaee ot the niueous in preventing injurious etleets upon the organs. \Vlieii hotli means of protection prove insutlieient or inadequate, then injurious efieets upon the membranes will produee more or less eliaiige in their structures as Well as in their t‘iinetion siirt'aee is very liable to he speedily regenerated. At. other times there are pi'odueed granulations and liyperplasia, with more or less eieatrieial eoiitraetions ot' the membrane. Should neither take plaee there will remain a permanent siih-aeute uleeratioii. Ilyperilastie toriiiations are not uneomnion iii the intestinal tract. and may assume a variety of forms to he deseribed hereafter. IIi/[irr/rm/«t Hit/l Ilirmm'r/iuli/e. The intestinal miieoiis nieniln'anes are siihjeet to periodical hyperieiiiia iieeessary to a perti'irmanee of their t'uiietion ot' digestion and ahsorption. The liypt'Irieniia is brought about by the speeitie aetioii ol" the vaso-niotor nerves, wliieli permits :1 gr ‘atei' influx of blood into the tissue than usual. Analogous to physiologieal hy- perteinia are those eoiigestive eonditions ot' the nuieous membranes iii morbid eireunistaiiees. siieli as paralysis of the vasti-eontraetors or irritation of the vasosdilators. wliieli may happen either in the center of those nerves or within the organs. In the liyperzemie state the membrane beeoiiies intensely red. and on elose inspeetion small vessels are found exeeedingly turgid. \Vlien eongestioii takes plaee even the naked eye ean diseover the by]iei'seeretion wliieli then takes plaee upon its surtaee. Statie hyperaania is eliaraeterized by a. livid eolor ot‘ the membrane. t‘ontiniied stag- nation ol' the blood usually leads to permanent dilatation of the veins and formation of variees‘. \Vlieii (edema follows stagnation the loose suh-iiiiieous tissue can beeome enormously intiltrated and bloated. lla‘inorrliages may take place in the i'iiiieoiis memhrane either to a very limited extent. wliieli will then he manifested by a slight admixture of blood to the steeretion or as massive hlood infiltration within the tissue and on its free surface. Mechanical injuries, The stomach is that part ot' the intestinal ii‘m‘t where the process of digestion and absorption begins. Aeeordiiigly it is provided with great numbers of blood. lymph vessels, and very numerous T/ic Molnar/i. glands, wliieli seerete gastrie jiiiee and .Illllt‘l'lis‘. As digestion requires a long stay of the t'ood in the eiivity ot the organ, and at the same time an inerease ot‘ the quantum ol' hlood in its walls is prodiieed, wliieli eauses prodiietion of its seeretions far beyond that found in an empty stomaeli. its epithelial tissue undergoes a eel'» tain amount of disintegration. liotli eonditions. although physio- logical, are Verv mueli akin to those morbid proeesses wliieli are iisiiallv observed in inflammation. The massive proportion of the silltsin‘uettlls struetui'es. its great quantity ot‘ iiiuseiilar tissue and large amount of labor all its tissues have to pertiii‘iii during stoiiiaeli digestion, expose this organ to a greater nuniherrot' easualties than aiiv other organ of the body. exeept the skin. ()ii the other hand, the sitilllzlcllilfi provided with enormous power of resistanee to inju- ries and an equally great power of regeneration and reconstruction of its injured or destroyed tissues. Maiiv suhstanees. wliieli, in their passage through the mouth, pliaryiix, and (esophagus, into the stomaeh. atl'eet Very seriously the walls ot'tliose passages. zit‘leet but little those ()I-lllt‘ stoinaeli. This is due to the power of this organ to p_l‘(')t'eel"lts'ell against many injurious. effects by secreting large quantities ot mucus, which, in a |