35 



Because of this function of the omentum, localized suppurations 

 are common. Ulcers may also perforate into the subperitonemn 

 at almost any point, the abscess as a usual thing remaining circum- 

 scribed, although it may burrow widely. One case of this class of 

 burrowing abscesses had perforated in the retroperitoneum in the 

 crecal region and had extended upward and perforated into the right 

 pleural cavity. 



III. — Healing. — As healing takes place, the mucous membrane 

 gradually extends from the margins, so that in the early stages the 

 ulcer seems to be lined with epithelium, except upon its base. In 

 the case of very small ulcers there may be complete repair, in other 

 more advanced cases there is consideraljlc formation of scar tissue 

 which may lead to contractions. This we have not seen. The 

 commonest outcome in cases of long duration, especially in those not 

 treated sj-stematically and continuoush', is the establishment of a 

 chronic catarrhal condition with subsequent atrophy — a condition 

 of enteritis chronica atrophicans. This is recognized in various 

 parts of the world as sprue or psilosis. It is not a result of amse- 

 biasis only, although it may be so in imperfectly treated cases. The 

 gross features of the bowel in such a condition are thinness, absence 

 of normal folds, atrophy of the mucous membrane, and increased 

 length. Combined with this atrophic condition may be one of local- 

 ized hypertrophy, resulting in the formation of more or less well- 

 developed polypi. 



Epitome of the gross appearances. — In a general way the process 

 studied is as follows : In the early stages of the disease there occurs 

 a catarrhal condition of the mucous membrane with hypertrophy 

 and cystic and mucoid degeneration. At various points, from the 

 lower part of the ileum to the lower part of the rectum, small raised 

 hemorrhagic spots occur, which later lose their mucous coverings 

 and resemble erosions, and later still ulcerate. If abscesses have 

 formed in the submucosa, they rupture into the bowel and produce 

 the early step of undermined ulcers. The ulcers resulting from 

 simple erosions are not, as a rule at least, of the undermined type, 

 but they may become so. Undermined ulcers are usually, while the 

 cause persists, progressive. 



When secondary infections occur the processes of the disease may 

 be modified by diffuse congestion, hemorrhagia, diphtheritis, or gan- 

 grene. Perforations may occur in the course of the ;dcerative 



