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Show DISEASE OF THE ORGANS OF DIGESTION. TABLE XIV. ENTERH‘ Tvrnon) ('l‘vruom FEvER). FIG. 1.--Inflf1mloaf/on of Mr Follicular Apparatus, awn-M. N., a servant girl of seVentccn years, at Gray's Hospital, London. She had been sick a week before entering the hospital, during which time she suffered mostly in her head. After admission she became unconscious and very delirious. Dark-colored stools. Is very feeble; subsultus of tendons. Died next (lay. Necroscopic examination soon after death showed the intestinal inflammation in the first stage; the aggregated follicles enlarged and surroumled by delicate vessels derived from the mesentery. Fm. 2,-Lower portion of ileum, near the eoecum, of a young woman who died from enteric typhoid on the eighteenth day of the fever, in the same hospital. The solitary follir es very much enlarged, and the adjacent mucous membrane very vascular. The plaques, t'anstormcd into solid brownish masses, are still covered with epithelium and stained with bile. (AA), portions of the plaques in primary stage of ulceration; the mesenteric glands exposed by dissection to show their enlargement. FIG. 3.--Same intestine, slightly stretched and spread out. in the light to show the dilated vessels running from the mesentery toward the follicles (CC, DD). The red color is due to the effect of light. Fro. l shows the retroperitoneal surface of an altered plaque, showing cha ‘aeteristic distribution of the vessels. [SECTION VI. Fm.5,-AII1/r/nmw/ Non/r of Emir/‘51) Tim/mill, The case of a man of thirty-five y airs, who (lied on the seventeenth day of the fever. The whole intestinal surface inflamed' near the plaques (CC) arc irregular ulcers, with raised borders~ beginning to slough. The solitary glands (AA, BB) are differentlv affected; some are ulce 'ated, others in the form of pustules. The mesenteric glands (D) are much enlarged and very vascular. Fm. 6,-l'arts of an ileum of a woman of twenty. \Vas affected with a very high and protracted fever, the stomaeh and bowels in a constant state of irritation. Toy 'ard the last she \ 'as seized with severe pneumonia and erysipelas of the. head. Died on the twenty- fourth day of the sickness. The intestine \ 'as graduallv recoveriim from the primary effects of the fever. On its external surface ther: are two dark spots on the peritoneum (G ll), corresponding to the, ulcerated plaques on the inner surface. The membrane had not phanged much, and retained much of its consistence and gloss. lhe mesentcric glands (l) are soft and contain pus. K Flo. 7.-Inner surface of the portion of ileum. The mucous membrane. is very red and highly 'ascular. The ulcers (1. K) correspond to the dark spots (G H, Fig. ti). Fios. 8, 9.-Enlarged figures of granulating ulcers and portions of the intestine exposed to the. light. (AA, l'yl'). C) show different portions, some g'anulating, some having dilated vessels, others formation of eicatricial tissue. stomach may rause the pain, or even a light icterus, by dragging the ductus choledochus out of its place, and simply mechanically close the orifice, and fo * a time prevent the flow of bile into the duodenum. Dry and clay-colored stools of the patientin that condition will indi- cate disturbance of the duodenal function. Duodenal catarrh of the intenser kinds will produce not only the above-named symptoms, but very severe digestive de ‘angements, especially lack of digestion of fatty and many amylacious foods, which are readily discovered in the eliminated fzeces. Subjective symptoms, such as the aversion of the patient for fatty substances, great desire for acid or pungent foods, and pain in the duodenal region, are very unreliable. Icterus, with gastro-duodenal catarrh, is usually manifested by thc blood, of which the serum t‘ansudes through the capillary the spread of the jaundice over the whole body, a small but not cholesterine, fatty acids, acetic, lactic, butyric, a few t arcs of ailm- frequent pulse, often a feeling of great weakness in the region of the heart, usually numbness in the head, pallid, yellowish, either dry or but little moist, flabby tongue, and frequently great mental depression, muscular fatigue, and almost total anorexia. The minates, and Martin. Inorganic soluble and insoluble salts, water holding those in solution or suspension in different quantities. (UV/Isaac.) \thn the alvine fluxes contain only indigestible and unfit, substances to be absorbed, there is but. little or no harm done to the body, but when they airy with them important liquids or solids of thebodythere will arise a state of 1')mnitfo)1,of atrophy and amemia. Such are the consequences ofthe several forms of dysentery in adults and especially children. (‘opious biliary fluxes are usually harmless unless mixed with much mucus, etc. Mucous diarrhoea, I/u'm'rl/ml/ythought to be a discharge of the greatly increased enteric juice, may be considered very problematical. An unhealthy organ secretes either very little or no digestive liquid; but there is often enormous secretiml of mucus so-called, which, mingling with the copious serous transudatc-usually taking place undersuch circumstances-is driven out of the intestine by rapid and painful peristalsis. Although there is pain, sometimes during or at other times gastric trouble is sometimes very prominent, nausea, retelling, but little vomiting, sometimes much thirst, occasionally none at all; either obstinate constipation or very s ‘anty, dry, clay-colored stools. Itching of the skin is a common phenomenon in this form of icterus. (The graver forms of icterus will be described among the diseases of the liver.) Normally the gall bladder is covered by the border of the liver, and no sound can be produced by percussion; but when any dullness of sound is produced in the region beyond the borders of the liver it constitutes a valuable symptom of closure of the orifice of the ductus choledochus and distention of the, gall bladder with bile. Light forms of duodenal catharrh are transitory, and produce but temporary disturbances, but severer forms often end in ulceration, more or less permanent obstruction to the flow of bile, and often of the pancreatic juice, followed by general atony and marasmus, great loss of blood corpuscles, and poisoning of the nerve centra. The biliary components are readily discovered in the urine and often in the oedomatous effusion connected with disturbances of circulation in the portal system, which often are caused by intense gastro-duodenal catarrh with icterus. Causes of walls, or such as either have been elaborated or exuded from the intestinal structures. Normally cxcremcntitious matter con- sists ofthe undigested or indigestiblc substances, and the intestinal secretions, bile, and pancreatic juice. The greatest. portion of the bile is r ‘absorbed in the intestine; the balance is changed in the process of digestion and eliminated (viz: dyslysincfcholedoic acids, taurin, changed coloring matter). The cholatcs and choleatcs are only discharged when the food passes swiftly through the anal, in mucous diarrhd‘a or by the action of saline purgativcs. Fats and other substances which, acted on by several digestive liquids, are often found in considerable quantities; with these are shortly before e 'aeuation, coli‘ and tenesnius are not so frequent. This class of diarrhma seldom assumes a very chronic form, except a permanent static. hypera‘mia supervcnes by reason of ‘ascular paralysis, such as obliteration or destruction of the coeliac ganglion. (Bur/yr.) In its acute form, it is produced by either local vascular disturbance or general derangclnents of the circulation and nerve duodenal diseases are. as a rule, those of simultaneous dis *ases of functions; under the intlueuccof obstacles to circulation, from whatever cause; in diseases of the organs of respiration or circulation the stomach, for idiopathic duodenitis is very rare. Gastro-duodenal icterus is ascribed by nearly all authors to closure of the orifice of the ductus choledochus, either by a mucous thrombus, or mechan- ically by a. swollen fold of the intestinal wall. Glam, in a very when the venze "avae cannot freely or suflieicntly empty into the heart: in hepatic diseases, disturbing or obstructing the circulation in the portal vein. Intestinal fluxionary hyperzcmia, consequent upon alteration of periphe 'al circulation, such as occur in exten- able article, decidedly repels the idea of closure, but states that it is sive burns or scalds of the skin, call forth in the intestine at first nearly always due to disturbance of hepatic circulation, for thereby an obstacle is placed in the way of the biliary ducts leading from simple catarrh of the mucous membrane and gradually a very dangerous and often fatal mucous diarrhtra. The most frequent ‘ases of mucous diarrho-a are caused by the irritating action of lodged stercoral masses in the intestines. These, by remaining too long in the canal, undergo abnormal decomposition and fermen- tation by the living and clici'nical ferments always present in the whole tract. (treat quantities of gases dilate the intestines, which itself hinders peristalsis and expulsion of the decomposing mass. llypersecrction is invariably produced, which, with the dilated vessels transuding considerable serum and irritation of some of the the liver to eliminate the bile by way of the duodenum, and hence the freer passage of that liquid into the circulation by the cent 'al vein where it meets with no resistance. In many diseases of the liver this is certainly the arse, but whether such is always the case in the duodenal catarrh or not seems to require further research. Disturbance of duodenal digestion is liable to produce great disturbance in the alimentary canal, from the irritating action of the partly digested food, and especially fatty emboli in the smaller veins. Diarrhoea, or lodgment of the hardened fzeces may follow with subsequent dysenterie discharges. In the spr‘ad of the 'atarrhal process into the common duct, the pancreas is very seldom affected. The subjects of these disturbances are, to a very great extent, 1111111vestigated as yet. The disturbamses of the intestines below the duodenum are such as befall all cavities lined with mucous membranes, and added to them are the derangements in their functions. llypermmia and hvpersecrctions, satarrhal, exudative and hyperplastic inflamma- tions, are manifested by a variety of symptoms,which dittcraccording to the extent and intensities of those disease processes. In the smaller intestines hypersecictions invariably determine either partial or total suppression of absorption. Fluxes, alvine discharges of a watery. mucous. bloody or albinninoid, or sometimes puriform character are usually the prominent symptoms of those diseaSes. Fevers with typi ‘ill or atypic oscillations of bodily temperature, nervous de 'angements, circulatory and respiratory disturbances. either from the nervous troubles or actual concomitant functional disturbances o ' anatomical lesions. are produced by the same cause as that of the disease of the intestine. Trophic and alimentary disturbances invariably exist even in the lighter grades of those diseases. Doom/raw. The substances discharged in diarrlnra are either those normally found in the intestinal cavities, or such as are derived from sensory fibres in muscular tunic, produce sudden spasmodic move- ments of The bowels and expulsion of the whole offending mass. Local peritonitis is very frequently produced in such constipations (Vow/mu), which are usually followed by displacements, torsions, flexions. or stricture of the intestines, and thus invetc 'atc the evil. Sometimes the intestines become enormously dilated. the abdomen tense, the diaphragm driven upward into the thorax, respiration made difficult, the arterial vessels compressed, congestions in the face and head. The patient having to continually dwell on his miscrv will become morose. discouraged, often hy}lochondriacal. and will intentionally, from fear of pain or diarrhu-a, abstain from going to stool. lvsually a brisk. reactive discharge improves all the trouble some phenomena. The stools are tllellrcithcl‘ frrcal matter mixed with the liquid or even solid mucous strings or membranes entolding the stercoral masses, or, in the intervals, glairy mucous, some- times mixed with blood or some serum. Sty-ous- [)furrlura. Intestinal transudatcs having the character of the serum of blood verv rcadilv take place. Saline purgativcs. concentrimal Illlllt'ml sullstanccs.lor in fact most of the ordinary cathartics usually produce such alvine discharges. They are composed of some albumen, considerable quantities of saline substances found in the blood serum. and great quantities of water. (('. NW/im/v/l.) l'athologically they make up three different types of morbid discharges: the |
