IN CONTINUED FEVEIt. 373 



may remark, in regard to the condition of the mucous mem- 

 LraiK; in tlie neighlHmrhood of the patches, that it did not in 

 every case exliibit unequivocal traces of inllammatoiy action. 

 It might be liiglily congested, or it might be perfectly blood- 

 less in cases of weU-developed disease of these patches. I 

 cannot say that I have often observed the mucous membrane 

 pulpy or softened. The villi and follicles of Lieberkiihn have 

 always appeared to me to be healthy. The vascularity, when 

 it did occur, was met with principally in the neighbom-liood 

 of the glandular patches, and resendjled in all respects that 

 described and figured by Di-. I'right in his repoit on the fomi 

 of fever lesion now before us. 



The commencement of the disease is first announced by 

 the smaller patches becoming slightly elevated, so as to be 

 hemispherical or conical, and by the more extended groups 

 assuming a table-like appearance, with perpendicular edges, 

 as if a flat plate had been placed on the mucous surface. Tlie 

 colour varies, according to the case, from bright carmine red 

 to dark purple or black, continuous or iii patches. In the 

 more vascular specimens, the colour is a yellowish grey, con- 

 trasting with the dead white or greyish- white of the intestmal 

 surface. !More closely examined the surfaces of the patches 

 exliibit, as usual, the follicles of Lieberkiihn and villi, differing 

 in no respect from those on a healthy suiface, and arranged 

 around the vesicles of the patch in the usual manner. An 

 examination of this kind must be made under water, and 

 when conducted in tliis manner the vesicles of the patch may 

 be seen by floatuig aside the membranous border and cii'cle of 

 villi which surround each of them. The vesicles tliemselves 

 nuiy thus be seen to be much distended with a yellowish 

 matter — a distension which is now perceived to be the imme- 

 diate cause of the elevation of the patch. 



In tilt' second stage of the disease, the patches stUl con- 

 tinue to rise above the surrounding surface, and tu exhibit the 



