86 



DISEASES OF THE DIGESTIVE APPARATUS. 



mucous membrane is usually of a marked coloration ; in some 

 places it is marked with red-brown or slaty spots ; in others it is 

 pigmented and of the nature of an eel- skin; its surface is covered 

 with a thick exudate, which is grayish, mucous, or purulent, and 

 sometimes granulous ; its vessels are distended and varicose; the 

 follicles are enlarged at first, later they become atrophied and dis- 

 appear, giving the mucous membrane a perforated appearance. 

 The intestiual contents are often very liquid, like curds, and hold 

 certain flake-like masses in suspension. The mucous membrane 

 rarely becomes thin (personal observatiou). We find it almost 

 always thickened, hard, folded, and offering the same papillar and 

 polypous proliferation as that of the stomach (see Dilatation and 

 Atrophy of the Stomach). 



Koll states that the follicles of the large intestine (especially in 

 the caecum and the large colon) take part in the inflammation. 

 They project in the shape of small tumors of the size of a millet- 

 seed to a pea, are of soft consistence, and may become unfolded in 

 forming follicular ulcerations, covering at times a considerable 

 portion of the large intestine. Roll describes these ulcerations 

 thus: they are of the size of a grain of juniper, or of a lentil, 

 reaching as far as the submucous connective tissue, the edges of 

 which are cut in shape of a point, and are infiltrated ; sometimes 

 they are detached with a suppurating base. They may become 

 confluent and have a small cicatrix ; at times they persist, occasion 

 diarrhea, intermittent colic, and in certain cases perforation of the 

 intestine (see Ulcers of the Intestine). 



Symptoms. The manifestations of the disease are easily under- 

 stood, if one bears in mind the various anatomical alterations found 

 in gastro-intestinal catarrh, especially atrophy of the pepsin gland 

 of the stomach, fatty degeneration of the epithelium, hypersecre- 

 tion of the mucous membrane, and irregular distribution of the 

 blood. 



1. When the catarrh has its particular seat in the stomach we 

 first observe a change in the appetite, which diminishes or becomes 

 capricious ; aberrations of the taste, frequent gapings ; the defeca- 

 tions are infrequent, and there is constipation ; the tongue is coated, 

 the mouth dry and fuliginous. It is rare that we have a serious 

 febrile reaction. These symptoms, which form the clinical picture 

 at the beginning of the trouble, are subject to strange variations : 

 the derangement of the appetite is always more marked when the 



