412 



STOMACH AND INTESTINE. 



of" variable thickness. It is almost always 

 the result of a rapid or acute inflammatory 

 process. Hence it is for the most part found 

 connected with an intense redness and vas- 

 cularity of the whole depth of the mucous 

 membrane. And this appearance, which often 

 extends to all the other tunics of the bowel, 

 in some instances rapidly merges into a 

 sloughy or even gangrenous state. 



The exsudation of this croupy lymph 

 occurs in a variety of morbid conditions. As 

 an idiopathic disease of the canal, its effusion 

 is very rare. In some of the exanthemata, 

 and especially in scarlet fever, it is occasion- 

 ally poured out over a very large extent of 

 the inflamed mucous surface of the alimentary 

 tube. In the tuberculous cachexia it is also 

 now and then effused. In the inflammation pro- 

 duced by mechanical injuries, we may gene- 

 rally observe it; mingled, of course, with blood, 

 where there has been any lesion of the blood- 

 vessels. Finally, in cases of poisoning by irri- 

 tant substances, its presence is by no means 

 uncommon. Here, however, it is important 

 to distinguish it from the false membrane 

 which is often produced by the chemical effect 

 of the poison on the membrane itself, and on 

 the exsudation it subsequently pours out. 



The morphology of the proteinous mass 

 poured out under these very different morbid 

 states, seems to be even more variable than 

 its physical and chemical properties. The 

 observations which the author has hitherto 

 been able to make, would lead him to infer the 

 following conclusions : (1.) The croupy ex- 

 sudation of the intestinal mucous membrane 

 generally contains a considerable proportion of 

 a cell-growth; which is an abortive epithelium, 

 homologous with that of the healthy struc- 

 ture. (2.) The amount of this constituent 

 attains its maximum in the tough white lymph 

 thrown out during the acute inflammation of 

 a previously healthy organism; for example, 

 in the lymph of the inflammation that follows 

 mechanical injuries of the bowel, or in the 

 croupy casts of the intestine, sometimes voided 

 in the earlier stages of scarlet fever or cholera. 

 (3.) The form of this constituent is never that 

 of the columnar cell proper to the healthy 

 membrane ; but, even when best developed, 

 rarely exhibits more than its cytoblast, devoid 

 of an outer cell-wall. (4.) The degeneration 

 of these cytoblasts, as marked by the disap- 

 pearance of their distinct nucleus, and the 

 appearance of more refractile and granular 

 contents, mark their transition to the charac- 

 ters of true pus-corpuscles ; which thus be- 

 come admixed with the croupy substance, and 

 communicate to it the softer consistence and 

 yellower colour of pus. (5.) The minimum 

 of this modified cell-growth is found in the 

 chronic forms of inflammations of the mucous 

 membrane, and in the cachetic states of the 

 system ; for example, in the exsudation as- 

 sociated with the tuberculous state. (6.) 

 The bulk of such deposits is a mass, which 

 generally has a yellowish colour, and is rarely 

 mixed with small masses of black pigment. 

 This mass possesses a soft friable consistence, 



and presents an amorphous granular appear- 

 ance under the microscope. In exceptional 

 cases, it varies from this description : in the 

 firmer deposits, by offering an indistinctly fi- 

 brillated texture ; in the softer, by exhibiting 

 numerous highly refractile (and probably fatty) 

 molecules of variable size. (7.) The applica- 

 tion of re-agents under the microscope, seems 

 to indicate a corresponding variety of compo- 

 sition in these various forms of the croupy 

 exsudation. At any rate, this very imperfect 

 mode of examination permits us to conjecture 

 that these exsudations consist in great part of 

 protein-compounds, which possess very dif- 

 ferent degrees of solubility in different cases, 

 and are capable of undergoing a partial de- 

 generation into a fatty material. 



The acute and chronic varieties of inflam- 

 mation, like the preceding, merge into each 

 other by infinite shades of resemblance. 

 But they are contrasted by a number of cir- 

 cumstances, all of which seem more or less 

 dependent on the rate and duration of the 

 process. 



Thus the acute inflammation presents a 

 maximum both of hyperasmia and effusion; 

 the latter having usually either a croupy ap- 

 pearance, or a more or less purulent compo- 

 sition. It involves a greater depth of the 

 mucous membrane ; and often spreads to the 

 subjacent muscular and peritoneal coats, so as 

 to cover various portions of the latter with 

 lymph. In its most intense form, it may even 

 convert the whole of the intestinal parietes 

 into a comparatively uniform mass, of a dirty- 

 red colour, and a rotten (or almost friable) 

 consistence. 



The chronic variety of inflammation chiefly 

 testifies to its duration by the presence of 

 some one or other of the following pecu- 

 liarities : Its colour varies from pale red 

 to dark brown or blackish red ; variations 

 which are due to the exsudation being mixed 

 with more or less of blood or pigment, as be- 

 fore alluded to. Its consistence is less re- 

 gularly affected, but is often increased by a 

 kind of hypertrophy. The exsudation is, on the 

 whole, in smaller quantity; and of a less croupy 

 or albuminous quality. And finally, it is ex- 

 ceedingly prone to pass into ulceration. 



Concerning the inflammations of the various 

 microscopic constituents of the mucous mem- 

 brane, it must be confessed that our knowledge 

 is at present very limited. 



In most instances, the villi and tubes appear 

 to share pretty equally in the disease. Of the 

 two involutions of the mucous surface, how- 

 ever, the villi seem the most liable to suffer ; 

 a fact for which it would be easy, though 

 scarcely justifiable, to assign a mechanical ex- 

 planation. In some instances, the blind ex- 

 tremities of the gastric or intestinal tubes 

 appear to suffer disproportionately, as com- 

 pared with their upper extremities, and with 

 the general surface of the canal. In such cases 

 we may often see the capillaries around these 

 blind extremities deeply injected, or their 

 blood extravasated into the cavity of the tube; 

 and in other instances, their natural cell con- 



