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Show 12 DISEASES OF THE ORGANS OF DIGESTIOX. TABLE XII. Ari/ff um] Clown/e I'lrrrtrf/on of fllf' Intestines. std/sequent (filmy/vine t/m/ .I'm'fm‘ulions. lei/II Flo. '1 presents a portion ofthe ileum laid open. the solitary and agminated follieles of whieh were the seat of inflammation. uleerated or in a state of sphaeelus. Several of the solitary follicles (a a) are seen surrounded by an inflamed elevated border. inelosing a yellowish gray slough. formed of the sub-mucous in sotne. from this and the muscular tissue in others. Several of the aggregated were in a similar state. and one of these had entirely sl<uighed and disappeared, together with the mnseular and peritoneal strata. thus giving rise to perforation of the intestine (B) to the extent of an ineh and a half in length and half an ineh in breadth. ((') sharp edges of the perforation. (1)) solitary follieles enlarged. Fm. 2.-I'erforation of the ileum. from sloughing of Peg/(Iris 1)](lillll‘. in ehronie follicular inflammation. (A) portion of the sphaeelus still adhering to the edge of the perforation. (B) raised border of pink eolor. ((' D) ag- minated follicles in a state of eln'onie inflannnation. Flo. 3.-Very extensive perforation sueeeeding ehrouie follicular eatarrh. (A) sharp edge ofthe perforated struetitres. (B) portion of the plaque still left on the mucous surface. (C) a plaque in a state of inflammatory ulceration. FIG. 4.- [hemorrhage and perforation from ehronie beyond it. into the smaller intestine, the inflammation may spread with different intensity in ditferent loealities. In reeent eases the mueous membrane is intensely eongested and swollen. often filled with lnemorrhages. its surfaee eovered with albuminous liquid usually mixed with bloody strings. The seeretion assumes. very early in the disease. a mueus eharaeter. or one almost totally bloody. The sealy furfurie deposits (TH/1. A'. See. VLF/1LT) denote partial death of some of its surfaee tissue. (See also Ne. V]. T('//. XIII. Fig/s. 1. 2.) Denudation of the surfaee following sueh a eondition will soon beeome readily visible to the naked eye. The disease has either a eatarrhal or a diphtheritie eharaeter. or sometimes both. In the lighter forms the deeay of the tissue is very superfieial. In the, graver forms there is found extensive destruetion of the glandular layer only or of the whole inueous membrane. This membrane becomes an opaque granular mass. in whieh the form of the struetural elements and their arrangements are totally obliterated. The deeay of the superfieial portions is usually not very extensive. and usuallyeontined to the edges of the mucous folds. They have a grayish-white. gray or blaek eolor. whilst the still living tissue is of an intensely red or a grayish-red eolor. Upon the intermediary strueture there is sometimes found a deposit of very fine bran-like flakes-white or of grayislmvhite. or ey'en brownish part. of whieh are still adherent to and part de- taehed front the surfaee. Larger flakes than the ones deseribed very seldom exist. Below the mortified portions the tissues are very mueh infiltrated with lymphoid eells. )Hitll the stilHItlleolts and the mnseular tissue beeome also infiltrated. The lymph-follieles are distinetly infiltrated and soon beeome uleerated. \Vhen the quantity of pns is very great the mneous tissue may beeome undermined. and detaehed in large flakes. and the denuded tisstte very readily uleerates. Sueh exfoliation and subsequent uleeration may he eonfined to very small spots. or to very large portions of the surfaee. At any stage of inflammation its pro- eesses may stop and repair may begin. (if eoltl'se. the less extensive the injury the more favorable are the prospeets for eomplete reeovery. Yet. even the most mitigated uleerative eonditions leave behind an atrophit: state of the mueous membrane. Extensive and severe nleerations are followed by extensive, eieatrizations. Extensive destruetion and long-iu'otraetwl inflammations are sues ceeded by permanent and extensive alterations. The glandular strattn'n is then permanently obliterated. the deeper layers become tough and indurated, the eonneetive tissue hypertrophie. There is itormed more or less strieture of the eavity. narrowing mav beeome so eXeessive that mueus ean The be seereted by only a very limited portion of the mueous membrane. and the glandular strueture beeomes thereby very mueh thirkened and hypertrtwhie. forming ridges and other exereseenees on its free surfaee similar to that of the stomaeh. ()r the seeretory funetions of the glands may remain. but as the seeretions eannot ooze out from the eavities on aeeount of the elosed orifiees by the enlarged and thiekened epithelium. they dilate to an excessive degree and are eonverted into mueous eysts. [Lil/I'v/I'Illrle (illovltll'll, The anatomieal elianges in epidemie eholera are eharaeterized by aeute inflannnation extending over the whole intestinal eanal. in \vbieh an enormous quantity of liquid is transnded. Within the intestinal eavity of those who die shortly after the eholeraie att'aek there is found a very abundant opaque grayishwvbite. inodorons alkaline liquid. in wbieh tioat very many opaque-white flakes or floeeuli. The inueous membrane is in'ieeted. rather thiek. moist. of a pink t'tlltll', the serous tissue is also somewhat opaque. After death the epithelium exfoliates very shortly. the follieles are found more or less swollen. either gi'zr\'isli-\\'liite or of a very bright red Besides the epithelial exfoliation the lnieroseope shows eolor. eellular infiltration into the mueous and subsmueons tissues. The serous membrane is often similarly afleeted. \Vhen death takes SI-It'Ton VLJ tuberettlar uleeration. (A) raised border of the ulcer infiltrated with tubereulous matter. (b e) sub-mueous mnseular eoat in the same condition. \((') sphaeelus of peritoneal tissue. (1)) border of another uleer. (E) nutsettlar eoat. (I‘l) serous membrane. (t?) perforation. Flo. 5.-]§xternal appearanee of sloughing of the peritoneum in tubereular uleeration. (A) a probe passed through the pertbrated intestine. (B) eenter ofthe slough. Fm. (i.-I'll/‘i/H‘m'l‘ffl's Ill/I] [VI[roof/Irun/buses. Therti is dilatation of the veins of the reettnn and verv extensive hyperplasia of the mueous and sub-mueons tissues. (A A) present venous stases. thrombotie eondition of the smaller veins. and infiltration in the loose (touneetive tissue. (li) a pendttlous ttnnor. vaseularized and subsequently transformed into a spongy ereetile growth. (b b) other tumors of the satne kind. (d d) varieose eondition of the veins showing a partly red and partly white thrombus. (E) other veins varieose. (E (6) highly dilated and tortuous veins. Flo. T represents the internal surfaee of a portion of a. eolon atl‘eeted with pale inflammatory softening of the mueous membrane. and its follieles. (A A) enlarged folli- (‘les and dilated vessels. (b b) eireular patches formed by destruetion of the follicles. its mtteous Covering still adherent to their walls. ((‘ (‘) portion of sub-mueous structure denuded by destruction of the mueous surface. part white. part grayish blue. (I) D) remnants of the mueous membrane left in ragged shreds. plat-e in the later stages of the disease. the intestines eontain but a small quantity of a more eondensed liquid. usually mixed with bile. sometimes a little blaek blood. In the eolon hard fzeees are often found. The mueous membrane is either pale. of a drab or a deep gray eolor. or green (spbaeelusi. and intensely itl'iet‘fwl. and pert'eetly impregnated with lnemorrlntgie extravates. In the eolon. in the lower portion of the ileum and in the sigmoid flexure manv uleers of different depths and extent may exist. In the eoloit alterations similar to those found in dysentery are very often found. ‘v1/;(/r;,,,[lorl Torin". Typhoid enteritis is an infeetions disease. produeed. aeeording to [Wt/m and Elm r//«. by invasion of the typhoid baeillus. It is ehieflv in the lower portion of the ileum and in the upper portions of the eolon where the anatomieal alterations in this fever are found. Very seldom are there any ehanges above, or below these parts, It eon. stitutes essentially an infiltration of the follieular apparatus and its surroundings. whieh soon beeome mortified. whilst it is aeeom- panied by a eatarrhal inflammation ofthe rest ofthe mtteous mem» brane. In the first days of the eourse of the disease the mueous membrane in the lower part of the ileum. as well as its follieular plaques. are intensely red and unitormly swollen. A little later the inflammation inereases in these plaques more than anywhere else. and there are formed raised pappilhe and ridges. whieh have some resemblanee to the eerebral eonvolntions in their arrange» ments and eonfiguration. The swelling extends sooner or later to the whole plaque. and munerous ridges are formed thereon. "'hen the swelling has reaehed its highest point then the whole surface, beeomes Men, and only little depressions, being here and there, indieate the position of the follieles. (in the isnrlaee. in the plaee of the solitary follieleseireular nodules are formed. At. this stage both the agminated and solitary alquiratuses pass from an intense red into a grayish white eolor. whieh gtv s them the appearanee of soft tallow. or cerebral matter. This swelling is produeed by higlrgraded infiltration of lymphoid eells. both into the min-ous and stllHIlllt‘olis strueture (medullary tumefitetion of the older anatomists). The glands are displaeed and separated in the mueous membrane by the excessive infiltration. The villi are equally swelled and infiltrated. The sub-inneous is uniformly itnpregmttwl with the eellular ex» travasates beneath the whole plaque. so that they gradually lose their form altogether. l'>oth the mnseular and in very severe eases the serous eoats beeome equally infiltrated. The number of the follieles and the extent of atfeetion ot' eaeh is very variable. A few are sometimes or even only one inflamed plaque may be. the whole extent of the afli-etion: or the whole intestine. till way up in the jejunum. or down into the lowest part of the reetuin. may be thus involved. In the seeond Week of the eourse of the disease partial mortitieation of the swollen plaques takes lllllt‘K‘. (Tab. XIV. this Seetion.) Either the whole or parts of these are gradually destroyed. The surfaee of the plaques assumes a jagged appearanee. and turns either vellow. grayish yellow. or dark brown. from the quantity of biliarvl pignn-nt imbibed. Little by little the dead portions of tissue loosen from the still living and are detaehed both from the bottom and the sides. The snrfaee tbns denuded presents a smooth and fairly elean appearanee. lts edges still remain for sometime raised and swollen. As a rule the typhoid nleers are eontined to the <olitarv and agtninated follieles; very seldom does the uleera- tive and s'pbaeebts prln‘ess pass beyond the follienlar apparatus. Uw'asionallv there are some uleeration and destrnetion in the ileoeoeeal valve and its surrounding mneons snrlaees. ln the follieular portion both the tnueons and sub-Inneons struetures are. as a rule, involved in the uleerative destruetion. The mnseular eoat gen- erallv is preserved. lillt when it is stronglv infiltrated then it beeotnes disintegrated as well as the other tissue. The serous tissues. as a rule.are the least involved of all. Even when it is mueb atfeeted |