INTESTINAL CATARRH. 577 



move the collections of faeces at these points and thus arrest the 

 inflammation. 



Follicular ulcers of the intestines are most frequently met in cachec- 

 tic individuals. At first the symptoms are those of protracted catarrh 

 of the large intestine ; but we soon find peculiar translucent lumps, 

 resembling swelled sago, in the mucous, white, and transparent masses, 

 whose passage is preceded by slight tormina, and accompanied by mod- 

 erate tenesmus. Occasionally there are passages of faeces with whitish 

 or bloody mucus and the sago-like lumps. The mucous masses now 

 become more opaque, fluid, yellowish white, and purulent, and we have 

 the form of diarrhoea that was formerly called fluxus coeliacus, or diar- 

 rhoea chylosa. In this stage, also, the passages may sometimes be of 

 normal color and consistence. If the follicular ulcers heal, strictures 

 almost always result, and hence there are obstinate constipation, great 

 inclination to flatulence, and the above-described symptoms of chronic 

 catarrh. 



DIAGNOSIS. Acute intestinal catarrh, unaccompanied by fever, is 

 not readily mistaken for other diseases. 



We shall hereafter speak of the diagnosis of idiopathic gastric 

 and intestinal catarrh, occurring in the commencing stage of typhoid 

 fever. 



Those cases of chronic intestinal catarrh, where constipation, flatu- 

 lence, and mental disturbance are the prominent symptoms, are often 

 mistaken. Not long since it was almost universally believed that these 

 symptoms depended mostly on disease of the large abdominal glands, 

 particularly of the liver. The patients were sent to Karlsbad to be 

 cured of their " biliousness," and, when they returned improved, it was 

 considered as an evidence that the diagnosis had been correct. After 

 accurate and unprejudiced autopsies had shown that chronic abdominal 

 derangements, as the above symptoms were characterized, were rarely 

 caused by perceptible changes of the liver, spleen, or pancreas, and, 

 on the other hand, that great degeneration of these organs, as found 

 on autopsy, had not always been accompanied during life by severe 

 indigestion, a new error crept in. Many physicians, with Itademacher, 

 considered it as proved that there are numerous diseases of the liver, 

 spleen, and pancreas, which leave no perceptible changes of structure. 

 It is unnecessary to enter into an argument against such a hypothesis, 

 and we shall only call attention to the unheard-of method by which 

 these diseases of the liver, spleen, pancreas, etc., are diagnosticated. 

 If an affection, which, according to our physiological knowledge, has 

 not the most remote connection with any organic or functional derange- 

 ment of these organs, is improved by the use of St. Mary's thistle, nux 

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