410 



STOMACH AND INTESTINE. 



variety. But even here, just as it is evident 

 that lesions of the vessel themselves always 

 constitute the immediate cause of the ex- 

 travasation, so we can hardly doubt that such 

 lesions may (and often do) form a predomi- 

 nant, though not an exclusive, element in the 

 process. 



Inflammation. Inflammation constitutes 

 the most frequent and important of all the 

 morbid conditions of the alimentary canal. 

 Indeed, there are very few of these condi- 

 tions with which it is not more or less 

 directly concerned. It is generally, if not al- 

 ways, preceded by hyperaemia ; often by down- 

 right haemorrhage ; and itself usually precedes 

 the occurrence of ulceration and gangrene. 

 It is the necessary result of mechanical in- 

 jury to the various tissues of the tube ; and 

 is often an immediate consequence of the dis- 

 eases or injuries of neighbouring organs. 

 There is little doubt that it is often concerned 

 in the production of those conditions which 

 we at present include under the name of 

 hypertrophy. And it is also capable of being 

 evoked by the presence of adventitious 

 growths, even though their origin may be 

 regarded as independent of its presence. 

 Finally, it constitutes one of the most charac- 

 teristic phenomena by which various diseased 

 states of the blood declare their influence on 

 the system. 



Such a diversity in the forms of the inflam- 

 matory process, as it affects the intestinal 

 tube, might well lead us to expect variations 

 at least as considerable and numerous in its 

 nature. These, however, the space allotted to 

 the present article will not allow us even to 

 sketch. As little can we enter upon the dif- 

 ficult subject of its true pathological relations 

 to the other morbid processes just alluded to. 

 We must be content to accept the term in- 

 flammation as it is ordinarily made use of; 

 and to enumerate its appearances, as they are 

 usually seen in the dead body. 



The mere existence of congestion we have 

 already found to be no certain indication of 

 the inflammatory state ; but, on the contrary, 

 one which would often deceive us, if viewed 

 in this light. And though the presence of an 

 exsudation forms a test which is far less 

 frequently fallacious, yet even it requires 

 some qualification, before it can be accepted 

 as tantamount to proof of inflammation. For 

 just as, to speak physiologically, it is the very 

 office of the blood-vessels to mediate and 

 permit an exsudative process of definite na- 

 ture and amount, so slight differences of the 

 exsuded fluid in both these respects, from 

 that normally poured out, are not even in- 

 compatible with health, much less character- 

 istic of inflammation. Hence, in saying that 

 " exsudation " is a main feature of inflamma- 

 tion, we are using the word, not so much to 

 express an isolated fact, as to imply a com- 

 parison : an exsudation, of such a quality, 

 and in such a quantity, as to offer a marked 

 contrast with the specific fluid which is 

 poured out by a secreting organ, on the one 

 hand ; or with the healthy nutritional fluid 



which bathes the interstices of its tis- 

 sues, on the other. Of the two contrasts 

 thus implied, that of quality is obviously 

 much the more important. Thus, while 

 the copious interstitial juices of the swollen 

 but flaccid intestine of a very corpulent 

 person, offer little difference from those of 

 the typical healthy adult, save in their (so 

 to speak) more diluted state, or while the 

 intestine of a dropsical abdomen is chiefly 

 enlarged by an increase of the ordinary fluid 

 of its submucous tissue, the vessels of the 

 inflamed alimentary tube take on what is 

 more or less a new, as well as an increased 

 action ; by virtue of which they pour out, 

 into the tissues or the cavity of the canal, 

 fluids which a"e very different to those nor- 

 mally present in this situation. Using the 

 term " exsudation " in this restricted sense, 

 we should scarcely do wrong in regarding it 

 as the chief feature of the inflammatory pro- 

 cess ; and as an appearance which, w r hen seen 

 accompanied by the ordinary marks of hy- 

 perasmia, quite entitles us to affirm that the 

 part in which it is situated, was the seat of 

 inflammation during life. 



And not only does the presence of exsuda- 

 tion form the characteristic mark of inflam- 

 mation, but the basis of the classification 

 under which we may best arrange the varie- 

 ties of this process. 



Thus according as the characters of mucus, 

 pus, or amorphous protein, predominate in 

 the exsudation poured out, we distinguish the 

 process which has given rise to it as catarrhal, 

 puriform, or croupy inflammation. The ra- 

 pidity of its effusion is at least a frequent and 

 important element of these peculiarities which 

 are summed up in the epithets "acute" and 

 " chronic" And finally, as regards its extent 

 and situation, it not only ranges from an in- 

 flammation of the mucous surface only, to one 

 which successively involves the subjacent 

 muscular and peritoneal coats, but may even 

 specially affect the submucous areolar tissue 

 of the canal, or engage certain parts of its 

 secretory apparatus in the shape of its tubes 

 or follicles. Each of these modifications will 

 be noticed in a few words. 



The catai*rhal inflammation of the mucous 

 membrane offers precisely the appearances 

 seen in catarrh of other mucous surfaces. 

 The numerous vessels of the membrane exhi- 

 bit a state of more or less intense hyperaemia, 

 giving it a corresponding shade of that red 

 colour which is generally producible by vas- 

 cular injection. This increase of vascularity 

 is stated by Rokitansky to be chiefly visi- 

 ble, sometimes in the villi, sometimes around 

 the follicles. But it seems to me that its 

 being limited to the latter is often due to the 

 contraction of the villi * having thrown back 

 the blood they contain, into the adjoining fol- 

 licular network with which they anastomose. 

 The exsudation thrown out in this form of 

 inflammation, may be traced in two situations : 

 in the textures of the canal itself, and in 



* Compare p. 54. 



