INTESTINAL CATARRH. 567 



7. At certain times intestinal catarrhs prevail from unknown causes, 

 tvhich, without our exactly understanding, are usually called genius 

 epidemicus gastricus. 



Finally, it is frequently only a symptom of a general disease. In 

 the lower animals it may always be excited by the injection of putrid 

 substances into the veins (Stick), it always accompanies typhoid fever, 

 and is the severest symptom in Asiatic cholera. We shall hereafter 

 speak of these symptomatic forms, as well as of those accompanying 

 ulceration and degeneration of the intestinal canal. 



ANATOMICAL APPEARANCES. Catarrh rarely affects the entire 

 inttstinal canal. It is most frequent in the large intestine, less so in 

 the ileum, and rarest in the jejunum and duodenum. The anatomical 

 changes left in the cadaver by acute catarrh are sometimes pale, at 

 others dark, redness, swelling, relaxation, and friability of the mucous 

 membrane, which is sometimes diffuse, at others limited to the vicin- 

 ity of the solitary glands and of Peyer^s patches, and a serous infil- 

 tration of the submucous tissue. Occasionally, after death, the injec- 

 tion has entirely disappeared, and the mucous membrane appears pale 

 and bloodless. Swelling of the solitary glands and glands of Peyer 

 is an almost constant appearance ; they distinctly project above the 

 surface of the mucous membrane. The mesenteric glands also are 

 usually found hypersemio and somewhat enlarged. The contents of 

 the intestines consist at first of plentiful serous fluid, mixed with 

 detached epithelial and young cells, subsequently of a cloudy mucus, 

 which is adherent to the wall of the intestine, and contains epithelial 

 structures. 



In chronic intestinal catarrh the mucous membrane looks more 

 brownish-red or slate-gray; it appears puffed up, and, particularly in 

 the rectum, forms polypoid protrusions. The enlarged follicles usually 

 project even more distinctly than in acute catarrh, as white nodules 

 above the surface, covered with tough, gray, or puriform mucus. Some- 

 times, though more rarely than in chronic gastric catarrh, there is 

 hypertrophy of the muscular coat, which may cause a constriction of 

 the intestinal canal analogous to simple stricture of the pylorus. 



In some cases catarrhal inflammation has a diphtheritic character. 

 Then superficial sloughs form on the very red mucous membrane, so 

 that it looks as if sprinkled with bran. After the sloughs have been 

 thrown off, shallow erosions, which bleed readily, are left. This 

 anatomical appearance, which is almost exclusively found at the lower 

 part of the large intestine and in the rectum, and occurs there from a 

 collection of hardened faeces at that place, answers to the clinical pic- 

 ture of a mild catarrhal dysentery. 



The severe forms of intestinal catarrh mav lead to ulceration ; we 



