ACUTE INFLAMMATIONS 85 



proceeds to suppuration, and a submucous abscess 

 forms. This soon bursts through the thin overlying 

 mucous membrane, and an ulcer results. The process 

 is multiple, and numerous fine ulcerating points can 

 be seen at this stage. When the protecting epithelium 

 is destroyed the attacks of the initial virus are strength- 

 ened by the irritating juices of the alimentary canal 

 (salvia, hydrochloric acid, or tryptic ferments, as the 

 case may be), and other ^inds of bacteria, so that a 

 chemically-irritated wound with a mixed infection 

 ensues. 



This stage of multiple fine ulcers can be seen in the 

 vermiform process and in the aggregated lymph 

 nodules. In the tonsils minute ulcers, corresponding 

 to the lymph follicles, are not visible, as they occupy 

 the sides of the crypts. 



The ulcers soon extend and coalesce, and extensive 

 areas of denuded epithelium can be seen at such a 

 stage in inflammation of any of the subepithelial 

 lymphatic glands. 



With the appendix' and the Peyer's patches the 

 poisons may be so deadly as to produce localised patches 

 of gangrene, involving the whole thickness of the in- 

 testinal wall. 



The deepening of the ulceration may lead to abscess 

 formation beyond the organ — always a serious condi- 

 tion. With the faucial tonsil a quinsy or peritonsillar 

 abscess may be set up ; with the pharyngeal tonsil a 

 retropharyngeal abscess ; with the lingual tonsil deep 

 submaxillary suppuration (Ludwig's Angina) ; with the 

 solitary lymphatic nodules of stomach and duodenum, 

 with the aggregated lymphatic nodules of the' ileum 

 and with the vermiform process, various forms and 

 degrees of peritoneal suppuration. 



With the solitary lymphatic nodules of stomach and 

 duodenum, and with the aggregated lymphatic nodules 



