IN CONTINUED FEVER. 375 



recognised as being the cellulo-vascular sheaths of the patch- 

 vesicles. 



Occasionally the free surface of the altered portion comes 

 away first, in the form of flocculent laminae, and the deep pro- 

 cesses continue to be attached for some time in the cellulo- 

 vascular capsules, like little nodules or pellets of a rounded 

 or pyriform shape. 



The altered portion, even immediately before detachment, 

 may still present on its surface traces of its original structure. 

 The orifices of the follicles in which the vesicles are situated 

 are visible here and there on the surface, and the membrane 

 retains sufficient consistence to bind the mass together. 



Fourth stage. When the sloughy mass has separated, the 

 surface of what may now be called an ulcer appears flocculent ; 

 but, when examined under water with a couple of needles, a 

 number of foveae, the remains of the cellulo-vascular capsules, 

 may be observed on it. In some of these, the little pellets 

 of deposit may still remain attached, appearing like mustard- 

 seeds scattered over the surface. The edges of these ulcers 

 are thick and everted, and exhibit the natural structure of 

 the mucous membrane. In some ulcers the eversion of the 

 edges proceeds so far as to throw the mucous surface of the 

 edge completely over, so as to apply it to the surrounding- 

 mucous membrane. 



Fifth stage. The ulcer may now heal, or proceed to per- 

 foration of the gut. In the former case, granulations, I pre- 

 sume, appear, and the reaction of these cellular elements 

 carries on the contraction and cicatrisation so well displayed 

 in some of the preparations on the table. In the present 

 form of ulcer, as in others affecting the mucous coat of the 

 bowels, it is some time before villi again make their appear- 

 ance on the cicatrised surface ; but these changes I have not 

 watched or observed. When the ulceration proceeds towards 

 perforation, it is generally one spot of the. patch which is 



