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Show 10 DISEASES 01" THE () KG A N S ()l" DIGICS'I‘ION. TABLE X. 11.7/lmrplusffc vbrunt/ions. la/i/frrrf/oas Fibroid. lit/M"!!lllr (Im/ .l/cm/H'm/mus Atop/(Ismr/M,‘ .[llll/H'I'fI'U/l/Ill/ (ll/(l Atrophy of HM sec/rm! Tim/cs of [1/43 slur/[l latest/ms. Flo‘s. 1.2.*7.\ small pyiiform polypus attached by a peduncle to the wall of the abdomen and covered by a. serous membrane derived from the peritoneum. (A) tumor. (B l; B) small vessels ramifying under the peritoneum and passing into the tumor. Fm. 2.- Section of the neoplasm showing its interior nucleus (C) to be 'at'her orange color, whilst externally it is ol'a bright red (B). Flo. 3,-Neoplastic membranes and newly-lbrmed vessels in those adhesions uniting the intestines with each other and with the paricties of the abdomen, (A ,A) portion of the intestine, (B B) portion of the abdominal wall, (0 C) adhesions, in which the blood vessels are seen. Fm. 4.-- Ci 'atrizations ofuleersoftheagminated glands, greater number of veins, although smaller-sized, than the former viscus, etc., performs su}>plemeut‘ary digestion; its digestive liquid is mum/y alkaline, does not require the great quantity ofblood serum to neutralize it as the stomach; its arteries are very munerous but far smaller, and supply oxygen to itstissues. The biliary substances, necessarily more or less absorbed in the wall of this intestine, cause a slowertiow of its bloodanda greater stagnation in its vessels, which, by their being enveloped inthe mesenterie folds, are already hemmed very much in their circulatory function. Yet this slow ci1‘<.-ulation permits a great quantity of serum to enter the 'avity and dissolve its digesting contents, preparatory to thei ‘absorption by the chylif- erous vessels. The arterial pressure is usually low, but is subject to nice regulation by the very numerous vasomotor fibers derived from many sources of the sympathetic plexuses. After digestion has taken place in its several eavitics the intestine is only supplied with sufficient blood for its own nutrition, and is in this condition usually of a pale or very light pink color (at «Volta/s). Ian'unmmt/nu, III/prr/rm/u of (/«c fates/mes. The line of demarcation between the physiological and patholog- ical hype *azmia is very hard to draw in the intestine. l'ostanort‘em appearances are. the most deceptive in regard to the color or the quantity of the blood in the organ. The most intense state of hyper:emia during life may show the intestine of nearly pale color after death. ()n the other hand, imbibition of its tissues with blood takes place so easily after death, and even during prolonged death agony, that intense redness and great. injection of the intestinal structure *an be found after death, where, during life, it was per- fectly normal. Still, hyperannia, during life, seldom fails to leave some traces behind, if it has existed for any length oftime, and has caused the vessels to undergo such changes which can be revealed by the microscope. Sometimes statie congestion even impresses upon the endothelial stratum of the vessels, and upon the epithelial layer of the mucous membrane such distinct marks that. notwithstanding the. paleness of the tissue, they am he recognized without great difficulty. ()f the dittcrcut forms of infiammatimr affecting the intestines the catarrhal is the most frequent («whom/ml r/Itt‘rt'f/s). The inflam- matory process furnishes sometinn-s mucous, sometimes serous, sometimes puritin'm, and often mixed secretions. In the colon the quantity of mucus produced by the inflamed epithelium is some~ times enormous, and is carried off as very copious mucus discharges. By far the greatest number of catarral int'lammatitms of the tract are of a transient character, and as a rule terminate favorably, yet sometimes leave behind quite noticeable anatomical alterations. Even in moderate intestinal catarrh the connective tissue betw'cen Lieberkulins Krypts become infiltrated with plasma and lymphoid corpuscles. A portion of the hyltersecreting epithelial cells are thereby loosened from their sub-stratum, and are gradually de- stroyed. \Vhen the inllannnatory process reaches a high degree, andhpersists for any length of time, there occurs extensive epithelial exfoliation without any retormation of new structures in their places, and the intestine becomes atrophic. Light grades of atro- phy are not readily recognizable by the naked eye. (l'ossibly the very thin and glossy appearance might indicate it.) lint. even a low magnifying poWer will show its atrophic condition by the glandular layer being much thinner than normal, sometimes re- duced to one-half, or even a third, of its usual thickness. The Same alte‘ation is found in the villous stratum of the smaller intes- tine. Uleerative processes oause still higher degrees of atrophy of the intestinal wall, for not only is the epithelium obliterated but the other structures are gradually destroyed in succession. (Nrc. l'I. "ii/is, V, VI, VII, show the various degrees of successive destruc- tion of the intestinal walls by inflammatory and ulcerat'ive processes.) The mucous membrane presents, under such diseased circumstances, its surface covered either with mucus, pus, or whit- ish or yellowish fiakes, consisting of granules, or shreds of the mortified portions of the infiltrated upper portions of the glandular stratum. (Son VI, 'I‘a/i. XIV/f, Fly/s. l, :2, 3.) l'lccrative in fiammation can, in a very short time, produce not only a loss of the upper layer ofthe mucous membrane but also of the whole glandular stratum, leaving upon the muscular surfact only a, very thin pellicle of highly nuclear connective tissue. (Sic, V1,. Ill/i. All , Sicc'riox VL] in follicular catarrh. (A b c) agminated glands. (l) c) cica- trices consisting of simple mucous tissue. ( l" (at) two small ulcers incompletely ci 'atrich, their edges still sharp, (ll) an ulcer undergoing the process of rctirganization. Fin. 5. 7 Imperfect ci 'atrixation of an ulcer of the small intestine, which has destroyed the muscular coat around the whole eireumterence of the tube. It has been replaced by the cont 'actile fibrous tissue (A). which has here a stellated arrangement, and has, by its contraction, narrowed the intestinal cavity (1% B) considc 'ably. Flo. (5.-A remarkable example of stricture ofthe small intestine from the presence ofthe same tissue in a ci *atrix occupying the entire 'aliber ofthe intestine. (A a) upper extremity ofthe ileum ; (B 1)) lower extremity. (C c) fibrous tissue stretching across the intestine in the form of bands, leaving small openings (1) 1)) between them, aml through which but, small quantities of liquid l'zeces could pass. 7 Fit}. 7.-A portion of the ileum with a croupous deposit upon its mucous membrane, in croupous enteritis. altered, but in ulceration of the mucous coat it is often strongly infiltratcd with lymphoid cells, and sous-what thickened and iudnratcd. The folliclesinordinarycatarrhal llll‘ltlllllllilfltlll:ll't',\\'lfllfilt‘t‘Xt't‘llleIl of a slight enlargement, but little altered; but in the ulcerative form they are usually most involved. and very soon destroyed by sup~ purative process. (Sm VI, Tali. X1 V, Fig/s. 3, 4. 5,:r/r.) ‘ (Fol- (I'm/[or CHIN/7‘11.) Upon the membrane there are formed ulcerating depressions of greater or lesser extent in the place of the follicles (jb/l/z-«l/m‘ chrrs). Atrophies following catarrhal intlammations are mostly found in the colon, and especially in and around the coecum. Nothnagel found eighty per cent. of enteric atrophy of adults to be only: in the coccum. Next to this, in frequency of this affection, is the ascending colon. The higher above these the rarer is thisattcction found in them. In small children enteric atrophy is found in ally portion of the intestine after acute and chronic catarrh. The muscular tissue suffers but little change in catarrhal trouble (lchpt when associated with static liypeiamia, and then it is ratherhypertrophiedthan atrophic. (.Yot/im/f/rl.) Although littleinclinedtomuch alteration, the muscular tissue undergoes fatty dcgeuc ‘ation in consumptive diseases. (Wily/arr.) ()ccasioually there is found congenital atrophy of the intestinal muscular tunic. (Ne/loulyrh) In chronic catarrh there may be found atrophy and hypertrophy side by side in this tissue, hyperplastic formations, either in the shape of mere indurations of the sub-mucous and muscular structitres, or in the form of excrescences or polypi upon the mucous sue face. They resemble, in form and structure, those described among the diseases of the stomach, as, civil mronc/wouc, or {/as/r/cpoly/mos. Diphtheritic lesions are often found in the lower portions of the smalle' and upper portions of the larger intestines, especially asso- ciated with nice ‘ative 'atarrh, in the form of minute furfuric scales upon the very red aml exceedingly swollen surfaces of the mucous tissue. Sometimes in larger plaques. Thisniost frequently exists in specific infiammations and infettious diseases. Extensive tibrinous exudatcs are very rare.yct it sometimes happens that a large portion of the intestine is enormously swollen, intensely red, and hypera‘mic, and covered with a fibroid membrane. Fibrinous exu- dations of small dimensions are very often found in catarrhal ulceration by the side of diphthcritic patches. ( ll'r/f/Iu'r, [film/rill, (Hr/Howl], libel/ward, Douwsr/o'lm, Kass/mud, Illa/('1', and iSc/twccl'k.) I]/.<fo/o///m//, (Via/Wis «5/. HM [MIMI/[ml i\'(,'/Ic/m't's. They are as follows: 1. hrs/Ir!!!Holt/1w ('u/i/rr/z.-ln sudden diarrhma of even a healthy person. in which there are very copious, watery discharges from the bowels, mixed with jelly-like or opaque mucous masses, in the form of shreds or membranes. the microscope shows a vast number of epithelial cells in the serous and saline liquids of the stools. llccasionally the cells form cohesive membranes. These are the exfoliated epithelium of the mucous membrane. Most of the cells are bloated and enlarged. their nuclei are dimly outlined, a little more refractive than their protoplasm, which is changed into a finely granular mass. (lccasionally the whole lining of a krypt is found among the cells, forming a coherent m-rm of cells in radiary ar- rangement. in chronic catarrh. the cells are purplish or deep red, unusually granular, with very indistinct nuclci. and contain many fat molecules not derived from the intestine but from degeneration of its own protoplasm. 2 In light follicular 'atarrh neither the microscope nor the naked eve is able to discover much change in the mucous membrane: but in graver forms of this inflammation. the alterations in the solitary glands aml I'm/(rs patches are very characteristic. According to the intensity or duration of the inflammatory process. the follicles pro- ject more or less above the surface of the mucous membrane, and are usually thus recognized by the naked eye. The redness of the otherwisc‘ normal mucous membrane remains. even after death. The follicular enlargement is at first produced by excessive hypera-mia. Sllllfitulllt‘llfl‘VrltA' cellular infiltration. In the more advanced stages of the disease, the intcrlbllicular connective tissue becomes similarly iuliltratcd to such an extent that it will destroy the follicular .walls and produce communication between the several follicles, giving rise to formation olebsccsscs in the ctmnnunicating sinuses. and ultimately ulceration within the plaques. The outer Ordinarily the muscular tissue is but little altered surface will thereby assume a reticulated alqu-arance; orcxtcnsive in'eatarrhal int‘lammatious. its fibers are very seldom atroplncd, or fatty degenerated. The sub-mucous is usually also but very little portions of the mucous surface will exfoliate in a body by the undermining abscesses. The capillaries in these portions of the ‘h/s. 1. 12,3, 4.) |