598 AFFECTIONS OF THE INTESTINAL CANAU 



to ha re been attained Since, in intussusception, the in version of the 

 intestine almost invariably takes place from above downward, there is 

 a contraindication to the exhibition of laxatives, which would force the 

 invaginated portion still deeper into the sheath. This is still more 

 true of quicksilver. When the intussusception has been recognized 

 early, we may perform gastrotomy, as has been successfully done in 

 some cases. If we can reach the invaginated intestine through the 

 rectum, we should attempt to replace it by carefully introducing an 

 cesophageal bougie that has a sponge fastened to its end. This pro- 

 cedure has been particularly successful in some cases in children. If 

 we cannot reach the invaginated part, we may inject large quantities 

 of liquid, or blow air into the rectum with an air-bag, so as to press 

 back the invaginated portion, if possible. As soon as severe perito- 

 nitis has occurred, these procedures can be of no use, but may do harm, 

 as the portions of intestine have become glued together. Then we 

 should confine ourselves to large doses of opium, and to covering the 

 abdomen with cold compresses. The same treatment should be fol- 

 lowed where the symptoms of extensive peritonitis occur with other 

 forms of obstruction of the intestine. 



CHAPTER IV. 



SOEOFULOUS AND TUBERCULOUS DISEASES OP THE INTESTINES AND 

 MESENTEKIC GLANDS. 



ETIOLOGY. Tuberculosis of the intestine and mesenteric glands is 

 not, by any means, so frequent as is taught ; many so-called tubercu- 

 lous diseases of these parts are not at all due to the formation of mili- 

 ary tubercle, the only form of tubercle that we recognize, but to a 

 cheesy degeneration of the intestinal follicles and mesenteric glands. 



The solitary glands, and glands of Peyer of the intestine, which 

 are known not to be secretory organs, but elementary lymphatics, are 

 sympathetically affected in the different diseases of the intestinal mu- 

 cous membrane. In acute and chronic catarrhs of the intestine they are 

 always found more or less swelled, and projecting above the surround 

 ing parts. This swelling of the follicle, which depends partly on the 

 increase of cellular elements, and still more on increased absorption of 

 fluid, usually disappears without leaving a trace, on the subsidence of 

 the catarrh. But, under some circumstances, it becomes more decided 

 and obstinate ; the cellular hyperplasia particularly attains a high 

 grade, and then, as occurs elsewhere, when there is an extensive collec- 

 tion of cellular elements, atrophy, or an incomplete metamorphosis into 

 fat (cheesy degeneration), readily occurs. The mesenteric glands that 



