568 AFFECTIONS OF THE INTESTINAL CANAL. 



may have either diffuse catarrhal or follicular ulcers in the intestine. 

 Diffuse catarrhal ulcers result from acute or still more frequently 

 from chronic inflammation, to which an acute attack supervenes. The 

 most frequent cause is foreign bodies in the intestine or retained faeces. 

 Hence they most frequently occur where the contents of the intestines 

 are most readily arrested ; in the caecum, ascending colon (typhlitis 

 stercoralis), processus vermiformis, then in the rectum and colon, above 

 constricted or distorted places. The dark-red and swollen mucous 

 membrane softens, and is destroyed by suppuration in its tissue ; the 

 result is a loss of substance which exposes the submucous or muscular 

 tissue. If the ulcer heal at this stage, the loss of substance is filled 

 with granulations, and a firm cicatrix remains, which almost always 

 constricts the intestine. In other cases the muscular and serous coats 

 are also destroyed and the intestine perforated. While the destruc- 

 tion proceeds from within outward, a partial peritonitis may occur, and 

 cause a union with neighboring portions of intestine, thus preventing 

 the escape of the contents of the bowels into the abdomen. This 

 course is most frequently seen in perforation of the vermiform append- 

 age. Perityphlitis (a phlegmonous inflammation of the loose connec- 

 tive tissue attaching the caecum and ascending colon to the iliac 

 fascia) occurs as frequently as peritonitis in inflammation and ulcera- 

 tion of the caecum, which is called typhlitis stercoralis. As this may 

 also occur independently of disease of the intestines, we will speak of 

 it in a separate chapter. 



The second form of catarrhal ulceration, the follicular ulcer, occurs 

 almost exclusively in the large intestine, particularly at its lower part. 

 It causes great destruction, and is characterized by the slight reaction 

 Bhown by the mucous membrane, in the vicinity of the ulcer. Accord- 

 big to HoJcitansTcy^s masterly description, it conies in this way : At 

 first the follicles are greatly swollen, surrounded by a dark-red vascu- 

 lar ring; subsequently they ulcerate from within; the pus breaks 

 through ; there is a small, follicular abscess, which has red, spongy 

 walls, and a small, ulcerated, finely-fringed opening. While the ulcer- 

 ation gradually destroys the whole follicle, the hyperaemia of the adja- 

 cent mucous membrane gradually disappears ; the ulcer is then about 

 the size of a lentil-seed, round or oval. The ulceration soon extends 

 to the surrounding mucous membrane ; the round form of the ulcer is 

 lost ; large, irregular ulcerations occur, or, for a considerable distance 

 of the intestine only, some islands and irregular projections of the 

 membrane are preserved, while elsewhere the submucous or the mus- 

 cular tissue is exposed. In the intestine we usually find a grayish- 

 red, half-fluid, floccular substance, mixed with undigested ingesta. 



SYMPTOMS AND COURSE. In acute intestinal catarrh, besides the 





