^m MUCOUS MEMBRANES. 



speedily become Iiollowed out into large cavities, '»\ hicli commu- 

 nicate with the stomach by a narrow opening. More rai'ely does 

 the ulcer burrow into the head of the pancreas ; rarest of all is 

 adhesion between the stomach and colon, whereby these divisions 

 of the alimentary canal are made to communicate, giving rise to 

 the symptoms of licnteric diarrhoja. I have seen a case in 

 wliich adhesion and subsequent perforation united the pylorus 

 with the gall-bladder : gallstones being subsequently formed and 

 discharged by vomiting. 



c. SPEciric Inflammation. 



§ 376. The typhous process, in by far the most frequent 

 mode of its occurrence, ileotyphus (typhus (ibdominalis) is asso- 

 ciated with certain changes in the mucous membrane of the 

 intestme, which undeniably possess special anatomical pecu- 

 liarities. Like those of syphilitic gummata, leprosy, and tubercle, 

 these special characteristics arc manifested rather in the coarser 

 anatomy, than in the finer structure, of the morbid products. 

 The attention of physicians has only been directed to them since 

 the thiixl decade of the present century. They were originally 

 described as " inflammation of Peyer's patches *' ; then Heusinger 

 pointed out their similarity to medullary cancer; Rohitanski 

 compared the aspect and consistency of the altered patches to 

 the cerebral medulla of young children, and introduced the term 

 " medullary infiltration," which is still in use, to designate their 

 appearance when mature. 



Concerning the relation of the intestinal and other anato- 

 mical changes (splenic enlargement) to the constitutional dis~ 

 order, great differences of opinion still exist. The Vienna school 

 considered the changes in the bowel as a mode of eliminating 

 the peccant matters from the blood ; at the present day, we have 

 only two alternative opinions from wliich to choose; we may 

 regard the bowel-lesions as standmg in the relation of an exan- 

 them towards the constitutional disorder, or we may ascribe them 



* For reasons alluded to in § 112, note, I have kept the generic term 

 " Typhus '* employed by the author. It is self-evident that the chapter 

 refers solely to abdominal tj-phus or enteric fever. — Tr, 



