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Show SECTION VI.] DISEASES OF THE ORGANS OF DIGESTION. TABLE XV. 15 and of an olive-green color from imbibed biliary coloring-matter Flg. {3, part of ileum. coecum, ileo-coecal ASIATIC CHOLEM-Ilmninummnc ENTERITIS 1x SM.\LL~Pox- 'alve, and appendix. The solitary follicles (F l") are enormously enlarged, and project 311:1..ixo'r1c INMLTKATIUN. FIGS. 1, 2, 5, ti.-E[a«/cnuc ('lmlcm. A portion of the ileum. eoecum, and vermiform appendix of an individual who died in the, ~arly stage of asphyctic ehole "a. The mucous membrane is in some places intensely red. in others a little less so. The veins aml arteries are turgid with thick, dark blood, far above the pink-colored surface of the mucous 111cmbranc. usually found in the early stages of epidemic cholera. The vast number of miliary luemorrhagic points visible over the whole small intestine (I Gr) show the great number of affected points. The vermitbrm appendix (A C) is thin and shriveled. the eoecum (L) pale and in flat tolds. The plaques (l' T) are enlarged and corrugated, aml highlv injected. (V I C), ilet:)-coecal valve. Flo. 3.-A portion of an ileum of a person who died of haunor- especially near the follicles, some of which are so infiltrated as to appear as dark-red spots raised above the surface of the 111embrane. Fig. 2 shows a portion of the ileum, higher up than in Fig. 1, enormously injected, of a greenish color, having assumed thattint by imbibition with (1/1/1-1'1'1'1/[11 in the intestine. The vessels are enormously enlarged and thickened. Fig. 13 shows a. portion of an exceedingly-enlarged and thickened ileum, the. follicles of which are infiltrated and surrounded with turgid blood-vessels. The plaque is enlarged,its epithelium exfoliated(1‘)),the membrane in thick folds rhagle variola. The intestine is dark-colored and thick; great numbers of luemorrhagic erosions are found on its surface, markinc' the situation of the agmiuated and solitarv follicles. D Fm. 4.-I'art of an intestine of a ‘ase ofvery acute haunorrhagie enteritis. Thetissues are enormously bloated from the grcatquantity of infilt ‘atcd blood, which turned a dark purple bv theraction of sulphureted hydrogen in the decomposing contents of the intestine. choleraie, the (, .\ 'e11teric,a11d typhoidal. Of the three, cholera diarrhtca is the charzu-tcristic type, as it presents great analogy with diarrlnea of purgation. Epidemic (let/‘d. It is imposible to give an extensive description of the clinical phenomena of this dread disease in so narrow a scope as these compendious pages afford. Only the chief characteristics ran here be sketched. The intestinal derangements constitute the most prominent morbid manifestations. I11 light cases the derangement is not very great, and is really the only important morbid process. Graver arses usually begin with some diarrhoa followed by intense attacks in a few days. There is nothing pecu- for in the intestinal canal there are more than enough ferments to produce all forms of fermentation. Next to the intestinal symptoms are those of circulation in importance. The quantity ofblood of course becomes exceedingly reduced by enormous watery depletion. It loses much of its sodic chlorides and becomes richer porportiouately than normal blood, in solid substances,especially urea and liarly clmraeteristie about the diarrlnca, besides its being generally grows weaker with the increase of the discharges. faintin 1‘, beating very copious, about eight or ten stools a day, which in the beginning have a rather bilious character, unless the discharges are very frequent at once. Usually colic and straining do not exist, but rolling and rumbling in the bowels are heard in most cases. Generallythere is a loss of appetite. \Vith the loss of liquids from the body, intense desire for drink and great prostration soon follow. Some cramps in the calves ofthc legs and huskiness of voice indicate its transition into the gravcr forms. It is conceded on all sides that, at this primary stage, the disease yields most readily to rational treatment. Very many people are thus affected in epidemics of cholera, and from the disease having that comparativcly light form it has not been heeded and therefore neglected. Still the persons affected with this primary of the sounds into a cates a urates. is thin, thready, occasionally imperceptible in the extremities. Jilin/1mm and [fifth/«Melt, opened several arteries in that stage and found that they \vere but little filled, collapsed; the blood did (‘yanosis indi-ates the not jet but simply leaked slowly out. The blood from an venous condition of the asphyctie blood. opened vein flows no more than from an artery. Post mortem: The heart is contracted, the left ventricle empty. the right containing some dark coagnla and lardaceous erasscmentum. To the enteric stage the asphyxia is soon added. the blood can not circulate any more, extensive portions of the blood vessels are empty, and the distribution of the blood in the body becomes very unequal. The b'ain and the spinal marrov are the last to lose their blood. In the. respiratmy organs the same g‘adual enteeblcmcnt and loss of function take. place. The inhaled and exhaled air are nearly the the seeds of the devastating chole 'a scourge. The (,lischargcs of such persons tarry the infectious matter. whatever may be their nature. \Vith this diarrlnea there is usually vomiting of a greenish, bilious, tbickish liquid, aml eventually a simple watery ejection from the stomach. Some pressure in the gastric region painful on pressure. Thirst becomes excruciating, distressing weakness, the heart's action at first nearly unchanged, the pulse rather frequent. Cholerine is the true transitory stage to true ehole ‘a. In the supervening asphyeto-enterie stage, the discharges from the boWels change from yellow, bilious to a more watery form. The more frequent the dejection the more it loses its fzeeulent cha‘aete‘ and odor. This is the so-eallcd 1'11'13-11‘ufrr stool. It constitutes a very watery, grayish liquid of 1.006 to 1.013 sp. grav., holding in suspension many fioculi. It has a decided alkaline r "action. Besides the great quantities of water there are some epithelial cells of the mucous membrane, a few lymphoid corpuseles, some granular same,but little absorption of oxygen and as little diminution of earboni 3 acid is 'arricd on,which also hasten the asphyxia. The husky voice becomes feebler, is only a whisper, and then quite extinct. The teml'ic‘ature differs in different Death follows asphyxia. portions of the body. according to the quantity of the blood. '11 becomes dark, dry, and wrinkled from loss of moisture, The but is occasionally covered with sticky sweat. Sensation in this ctr/id state is gradually lost, and no pain or reflex phenomena, which were at first very pronounced and severe, such as muscular cramps in the bowels and lower extremities, are manifested now. All secretions are stopped aml every function in the body finally ceases. The change for the better. if it takes place after the algid state, is manifested by cessation of the watery discharges and Sometimes this takes place wonderfully quick and the vomiting. indicates renewed absorption of the etfuscd liquids in the intestine. Reaction begins with-re-established circulation, cyanosis disappears, the, peculiar characteristic cbolc 'a-exprcssion of the face is changed, urination, which had c arsed, is re-established, although with presIn six or eight days polyurea ence of albumen in the urine. usually ends. The skin resumes its normal function and is covered with warm perspiration. Thus enters reaction sometimes very speedily. Return of the attack is the 'arcst occurrence. The reactive phenomena are sometimes very violent, the pulse becomes detritus, urea, traces of salts of potash and phosphates, but much chloride of sodium and *arbonate of ammonia. The t'aces of albumen become only turbid by boiling. The micro-organisms present in the stool resemble those found normally in the lower portion of the intestine, aml in common diarrlaea. Vomiting is nearly always associated with the Inn'ging. The vomited liquids resemble those of the stools; finally they pass off involuntarily both In so-called Mule/11, sir/«u, dry cholera. when the discharges are absent, the rice wafer is found in the whole intestine in great quantities. with the same characteristics. The quantity of liquids thus emptied amount sometimes to one- fifth of the weight of the body. It is of course self-evident that such quantities cannot come from the intestines alone. The water is undtmbtcdly derived directly from the blood. for speedily all available liquids of the body, even prc-existing dropsi 'al effusions, are attracted by the blood aml then discharged through the intestines. Vcry seldom are corpuscular portions of the blood met in the stools. \Vhen found they bear the character of dccomposcal solid blood elements, and have a very timid odor of gangrene. That the very full and bounding, the vessels turgid, the head and lungs congested, delirium and fever app air. This constitutes the socalled clnilcra-typhoid. As a rule this does not last very long. Con'aleseence soon follows. rice-water discharges are transudates and not secretions, as (baton) cannot eliminate, and dangerous glomerulitis takes place, with diphthcritic inflammation. which usually lead to death. (if course the 'ast changes of the blood very often lead to many sequclafi and many cholera patients recover but very slowly from this terrible disease. Enter/c Tim/mill. TYPlJOid fever is produced by a thoroughly well-defined infection, the bacillus typhosus. Both its parasitory nature and its bylf/«rz'n/zro'r/l and Li'H/H/s/o'r( Vow/1,. Arc/1.. 184", Vol. II). The modus operandi of the transudation lies in the actual participation of the veins in the process of exudation, as Sui/(ml, in [11‘s Mfr I/fs'srrM/(on (In (f/m/cra. 1383, states: " llealthy veins absorb without any pres- sure whatever; those altered by inflammation exude. the entire blood-Vessels. to be due to the peculiar products of the fcrments. Sometimes. when the nephritie troubles produced during the algid state are not corrected, the (lisaise will assume a very grave, especially urzemic character, as there is formed great destruction of the blood corpuscles which the kidneys claims, Vow/«om has clearly set forth (in his Arc/1., Vol. .\'('.. 1882), for the epithelial desquamation takes place very extensively during life. and traces of them are found plentifully in a very broken-down form. The whole coatingof villi and largerpatches have been found Tatarrh increases the exudation and checks absorption. the exfolia- tion and lrvperwmia are readily seen after death by the pink color of the mucous membrane. (Sec. VI. Tab. XV.) The serous exudate soon changes into a hzemorrhagic as seen in the same table." l'athologically cholera is one ofthc most intense forms of enterie eatarrh caused by 1nicl‘opzll‘asites, flu: ('/H)/(/'/I bur/111'. They may act chemically. they may atfeet the mucous membrane. or may directly invade the capillary \‘alls and then produce morbid alterations. \Vithout the definite knowledge of the peculiar thalophite its action is ditiicult to ascertain: everything speaks in favor of the process being a mycotic form of fermentation aml infection of the h *art, gradual disappearance of the apex beat; the cardiac become more and more feeble, the first sound is changed murmur, the second disappears. I'ericardial friction indidry pcricardial surface. At first the frequency of the. pulse increases to 100, 120, or to 140, the pulse wave is lower, the pulse form, misnamed UnoLERINE, are able to move about. aml tlms scatter through the mouth and the anus. It becomes thick and condensed, and unfit for circulation. \Vith the diminished quantity of blood passing through the heart there is a reduction of blood pressure, an increase of friction. and hence a lesser velocity of the circulation in the capillaries. The disturbance of circulation is early observed. The heart's action mode of invasion are known and studied. Besides theirdiscovercrs, [\V/r/Is and Elm-M, very many pathologists have since made great researches into the subject. nature of the disease aml its causes. (‘aused by a specific infection it follows its own special typical course and presents itself as a special discasc form. The peculiar form of its localization in the follicula ' apparatus of the intestine and its well-defined. morbid phenomena following each otbcr in nearly regular succession in the enteric inflammation have given it the l l name it bears--Euhric 'l'li/p/m/«l. Like cholera. the same infection acts with greater or lesser intensity upon different persons. of course the quantity of the i11fectious elements being at the same time taken into consideration. The lighter forms of the disease. like the graver, have a definite, |