IN CONTINUED FEVEK. 373 



may remark, in regard to the condition of the mucous mem- 

 brane in the neighbourhood of the patches, that it did not in 

 every case exhibit unequivocal traces of inflammatory action. 

 It might be highly congested, or it might be perfectly blood- 

 less in cases of well-developed disease of these patches. I 

 cannot say that I have often observed the mucous membrane 

 pulpy or softened. The villi and follicles of Lieberkuhn have 

 always appeared to me to be healthy. The vascularity, when 

 it did occur, was met with principally in the neighbourhood 

 of the glandular patches, and resembled in all respects that 

 described and figured by Dr. Bright in his report on the form 

 of fever lesion now before us. 



The commencement of the disease is first announced by 

 the smaller patches becoming slightly elevated, so as to be 

 hemispherical or conical, and by the more extended groups 

 assuming a table-like appearance, with perpendicular edges, 

 as if a flat plate had been placed on the mucous surface. The 

 colour varies, according to the case, from bright carmine red 

 to dark purple or black, continuous or in patches. In the 

 more vascular specimens, the colour is a yellowish grey, con- 

 trasting with the dead white or greyish- white of the intestinal 

 surface. More closely examined the surfaces of the patches 

 exhibit, as usual, the follicles of Lieberkuhn and villi, differing 

 in no respect from those on a healthy surface, and arranged 

 around the vesicles of the patch in the usual manner. An 

 examination of this kind must be made under water, and 

 when conducted in this manner the vesicles of the patch may 

 be seen by floating aside the membranous border and circle of 

 villi which surround each of them. The vesicles themselves 

 may thus be seen to be much distended with a yellowish 

 matter a distension which is now perceived to be the imme- 

 diate cause of the elevation of the patch. 



In the second stage of the disease, the patches still con- 

 tinue to rise above the surrounding surface, and to exhibit the 



