STOMACH AND INTESTINE. 



407 



axis of the spiral and dilated segment of tube 

 around it. The congestion and strangulation 

 of the vessels of the peritoneal fold, as well 

 as of those of the invaginated bowel itself, 

 soon cause a swelling, that fixes the innermost 

 segment firmly in its abnormal position. An 

 exsudation of serum and lymph next increases 

 its size, at the same time that it renders these 

 changes of situation permanent. The dila- 

 tation of the preceding part of the canal, by 

 the fluids passed into it from above, often 

 further exaggerates the above changes. 



The sloughing which from all these causes 

 finally ensues, sometimes has the effect of 

 setting free the intus-suscepted segment in 

 the cavity of the canal. Hence, if the patient 

 survive until this separation occurs, the dis- 

 charge of this segment from the bowels may 

 terminate all the symptoms of obstruction ; 

 and leave the bowel at the site of the intus- 

 susception occupied by a ring of lymph, 

 which gradually contracts into a firm cicatrix 

 of fibrous tissue. 



From the preceding changes in the size, 

 shape, and situation of the digestive canal, we 

 pass on to consider the abnormal conditions of 

 its texture. 



Softening is the first of these conditions 

 which claims our notice. 



In rare instances, this change engages the 

 whole of the digestive canal, to which it im- 

 parts a semi-transparent gelatinous appear- 

 ance, and a pulpy diffluent consistence. In 

 this general softening, the walls of the canal 

 are usually diminished, scarcely ever in- 

 creased in thickness. Their colour is gene- 

 rally pale enough to warrant us in regarding 

 them as in a state of anaemia. But they 

 sometimes exhibit those various shades of 

 discoloration which are present in the more 

 localized forms of softening. 



The latter are usually found in the sto- 

 mach, where they especially occupy the car- 

 diac pouch. But they are sometimes seen 

 in the large intestine : indeed, in most sub- 

 jects, the mucous membrane of this part of 

 the canal has a somewhat softer consistence 

 than that of the small intestine. 



It is in the stomach, in which the process 

 of softening occurs with most frequency and 

 intensity, that we may best notice the details 

 of this change, and the degrees in which 

 it generally engages the different tissues of 

 the coats of the canal. Of these the mucous 

 membrane is that which always seems to 

 suffer first and most; in \\hich the process 

 appears to commence, and to which it is often 

 limited. At first, the only noticeable change 

 is a diminution of its consistence : a change 

 which either occupies isolated patches of its 

 surface*, or is spread over a considerable 

 extent of the cardiac sac, rendering it liable 

 to break down on the application of the 

 slightest pressure. Hence if a portion be 

 taken between the blades of the forceps, it 

 will come away between them on exercising 

 a very moderate traction. The mucous mem- 



* These are sometimes the projecting summits of 

 the ridges formed by its mucous folds. 



brane next becomes absolutely broken down ; 

 so as to form a granular pulp. This pulp 

 covers the subjacent tissues with a layer of 

 variable depth ; the deficiency of which, here 

 and there, lays bare the submucous areolar 

 tissue. The process may next engage this 

 and the muscular textures ; either imparting 

 to the latter a paler, softer, and thinner ap- 

 pearance than natural ; or implicating the 

 whole thickness of the gastric parietes, and 

 giving them a gelatinous appearance. A con- 

 siderable thinning of these parietes almost 

 always accompanies this change, and is some- 

 times so great as to cause the rupture of the 

 organ, and the effusion of its contents. Fi- 

 nally, in extreme cases, the contiguous tissues 

 of the belly, and especially the muscular sub- 

 stance of the diaphragm, become involved 

 in an extension of this process from the sto- 

 mach. 



The colour associated with this loss of 

 consistence is very variable. In some cases, 

 there is a complete anaemia of the gastric 

 coats ; in others, this term is rendered some- 

 what less applicable by the presence of one 

 or two large veins distended with blood. In 

 other instances, we find the softened part of 

 the stomach coloured a variable shade of 

 brown, red, or even black; according to the 

 quantity of blood it presents, and the degree 

 in which its hue has been altered by the gas- 

 tric juice. Finally, in many cases the organ 

 offers no appreciable contrast in this respect 

 with its normal state. 



It is probable that these softened states 

 of the digestive canal are capable of being 

 produced by very different causes. Even 

 after setting aside all those instances in which 

 the softening has been preceded by symptoms 

 of inflammatory action during life ; and all 

 those in which it has been due to the inges- 

 tion of poisons which exert a direct chemical 

 action of this kind ; we may trace the process 

 to three causes, which often coincide in its 

 production, and the exact share of which it 

 is therefore often difficult to estimate in any 

 particular specimen. These causes are, pu- 

 trefaction, digestion, and altered nutrition. 



The amount of influence which has been 

 exerted by putrefaction, might seem very easy 

 to determine. But we cannot always esti- 

 mate Jt by the date which has elapsed since 

 death, or the temperature to which the body 

 has been exposed ; since its access and rapi- 

 dity vary remarkably according to the state of 

 the organism, and the nature of the fatal dis- 

 ease. 



The capacity possessed by the secretion of 

 the stomach for digesting its coats after 

 death is one which will obviously depend on 

 the nature and amount of this fluid present : 

 and will, other things being equal, attain its 

 maximum in the case of the sudden death of 

 a healthy person, soon after the ingestion of 

 food. 



The softened state of intestines, which is 

 often found in diarrhoea, fever, and other 

 disorders, as well as the peculiar softening* 



* The characters of this softening appear to in- 



D D 4 



