376 ULCERATION OF PEYER'S PATCHES 



more particularly affected, the rest of the ulcer retaining its 

 former granulating or flocculent appearance. At this stage 

 of the process lymph begins to be deposited on the external 

 surface of the gut ; and if the patient survives the perfora- 

 tion eight or ten hours, the lymph rounds off the edges of the 

 hole, and gives it that punched-out appearance so frequently 

 observed. The omentum may adhere opposite the incipient 

 perforation, and after contraction has concluded, it appears 

 as if it had been forced from without into the hole, an 

 appearance resulting from the contracting agency of the 

 granulations. 



Having now described the changes which the patches 

 undergo in this form of disease, I have to point out the 

 peculiar matter upon the presence of which these changes 

 appear to depend. The grey matter which fills the vesicles 

 or the spaces which they occupy, I find to consist of that 

 imiversal element of every prunitive tissue, healthy or 

 diseased — nucleated cells. These cells are from 2000 to 4000 

 of an inch in diameter. They do not in general exhibit a 

 nucleus in the sense in wliich that term is generally applied ; 

 that is, the individual cells do not present in their interior 

 smaller cells holding ceitain relations to them. These cavities 

 appear to contain a number of granules, four, five, or six, as 

 far as could be reckoned. Whether these in the aggregate 

 are to be considered as a nucleus proceeding towards the 

 formation of a number of young cells, or whether the appear- 

 ance is to be considered as analogous to that irregular form 

 of nucleus and cell-contents characteristic of certain forms of 

 tubercle, I do not know. This matter, of whatever nature it 

 may be, appears first in the vesicles of the patches, and then 

 spreads out on all sides, after the manner of other purely 

 cellular structures, till the whole patch, before it is thrown 

 off, appears to be principally formed of it ; the surface of the 

 mass, however, as has been stated, and certain parts of its 



