STOMACH AND INTESTINE. 



411 



its contents. In the former, it gives a soft- 

 ened, swollen, relaxed, and watery appearance 

 to all the coats of the tube, and especially to 

 its epithelium and submucous areolar tissue. 

 In the latter, we notice certain changes in the 

 fluids poured out upon the inner surface of the 

 tube. The contrast between these fluids and 

 those whicli are present in health is probably 

 closely analogous to that which obtains in 

 other catarrhs. The specific normal secretion 

 is arrested, and is replaced by a variable 

 (usually a large) quantity of a thin watery 

 fluid. The effusion of this fluid coincides 

 with the detachment of the proper epithelium 

 of the mucous coat from the subjacent base- 

 ment membrane ; a process that is generally 

 followed by the shedding of large numbers of 

 imperfect or abortive cells, which take their 

 origin in the same situation. The admixture 

 of this cell-growth imparts to the catarrhal 

 exsudation its well-known gelatinous or 

 mucous characters, and viscid consistence ; 

 properties which the microscope shows are 

 partially due to the solution and rupture of 

 these delicate cells, causing the escape of their 

 contents into the surrounding fluid. The 

 latter is either transparent, or of a cloudy, 

 whitish, reddish, or grayish colour. The last 

 of these appearances, when not due to an 

 admixture of foreign ingredients, is mainly 

 derived from the quantity of these cells, many 

 of which generally assume more or less of the 

 characters of pus. The reddish hue is due 

 to an admixture of blood, by that process of 

 haemorrhage which so frequently results from 

 congestion in the delicate mucous mem- 

 branes. 



The puriform variety of inflammation might, 

 at first sight, seem scarcely worthy of dis- 

 tinction from the catarrhal. For the two 

 merge into each other by innumerable grada- 

 tions in the character of their exsudation. 

 And the general tendency of catarrh of the 

 mucous surfaces, to end in the production of 

 pus, is too well known to require any com- 

 ment. But while there always seems sufficient 

 reason for distinguishing it as a separate stage 

 of the inflammatory process in the digestive 

 canal, there are circumstances which render 

 it not improbable that the mucous and puri- 

 form inflammations of the intestinal canal are 

 often distinct, both in their origin and nature. 

 Thus there are some catarrhal affections of the 

 bowels, in which lapse of time seems to have 

 no effect whatever in exchanging mucus for 

 pus ; while there are others in which this mor- 

 bid product appears to be formed very speedily, 

 or even at once. And that there are many 

 cases which we should find it difficult to 

 assign to one or other of these divisions, is an 

 objection which would equally apply, not only 

 to all the other varieties just alluded to, but 

 to almost all the classifications we are com- 

 pelled to use in describing the various results 

 of disease on the healthy organism. 



The presence of pus in any considerable 

 quantity, is of course easily recognized by 

 the glairy consistence and yellow colour it 

 imparts to the exsuded fluid, as well as by its 



microscopical characters. It is usually ac- 

 companied by a swollen and sodden state of 

 the various textures, such as greatly exceeds 

 that noticed in the catarrhal inflammation. 

 The redness and vascularity of these tissues 

 is sometimes also increased in intensity. 

 Often, however, the bowel acquires a grayish 

 or ashy gray hue ; or a dark reddish brown, 

 or even slate-colour. The latter appearances 

 are chiefly characteristic (as Rokitansky 

 points out) of the duration of the disorder. 

 It may be conjectured that these varieties of 

 colour depend upon phenomena of at least 

 three kinds. The paler tint, where not due to 

 an interstitial deposit of pus, seems dependent 

 on an abnormal influence which the disease 

 exercises upon the circulation of the part, 

 obstructing in some way the flow of blood in 

 its vessels; an obstruction which the micro- 

 scope permits one to suspect is rarely due to 

 the mere physical effects of the surrounding 

 exsudation. The various shades of red and 

 brown appear to be determined by the changes 

 undergone by blood, w hich has either stagnated 

 within the vessels or what is much more 

 frequent been extravasated from them. 

 And the darker bluish or blackish tints are 

 evidently caused by a variable quantity 

 of black pigment, which probably forms the 

 last relics of a similar degeneration of the 

 blood, in the shape of masses of accrete (and 

 now insoluble) colouring matter. With ordi- 

 nary care, an admixture of biliary colouring 

 matter can rarely be mistaken for these ab- 

 normal products. The production of pus 

 may, however, take place in a less diffuse 

 form, and by a much more rapid process, 

 than that which causes the discharge of 

 puriform mucus from an inflamed intes- 

 tinal surface. These acute local suppura- 

 tions, as we may call them, often at once strip 

 off the whole of the cell-growth that normally 

 covers the basement membrane of the mucous 

 coat ; and then immediately proceed to erode 

 and ulcerate the subjacent textures. These ul- 

 cerations seem peculiarly liable to form sinuses, 

 by extending in various directions through the 

 loose and yielding submucous areolar tissue. 

 In rare instances, scattered abscesses are 

 found in this situation ; abscesses which are 

 occasionally so isolated from each other, as 

 to appear due to a process of purulent infec- 

 tion by means of the vessels themselves, and 

 not to any mere extension of a continuous 

 suppurating cavity. Finally, in extreme 

 cases, the whole of the tunics become so in- 

 filtrated with pus throughout, as to form a 

 soft or pulpy yellowish-gray mass ; which 

 breaks or tears up on applying the slightest 

 violence ; and, if life be sufficiently prolonged, 

 becomes converted into a rotten membranous 

 slough. 



The crovpy or diphtheritic variety of inflam- 

 mation is distinguished, as its name implies, 

 chiefly by the greater consistence of its exsu- 

 dation ; which, in well marked cases, forms a 

 more or less solid, opaque, white, or yellow 

 mass, and is generally moulded to the shape 

 of the inflamed surface, as a false membrane 



