168 



DISEASES Of THE DIGESTIVE APPARATUS. 



with small blood-clots, which are dark and attached to the thrombi 

 of the vessels of this membrane and to the submucous connective 

 tissue. The small intestine contains a bloody liquid ; its wall is 

 stained with the coloring principles of the blood, which give it a 

 dark -red shade. The same alterations are found in the large intes- 

 tine, the walls of which show a marked thickening — three or four 

 times greater than normal. They consist essentially in a sero- 

 hemorrhagic infiltration, particularly marked on the level of the 

 mesenteric insertion. Where the hemorrhagic infarction is thickest 

 the mucous membrane is necrotic and forms merely a crust of the 

 consistence of rotten wood, around which the serous infiltration is 

 often enormous. At the base of this crust we ordinarily find a 

 thrombosed intestinal artery, and in dissecting this toward its origin 

 we come to a verminous aneurism. Gelatinous infiltrations are met 

 with at numerous places in the abdominal cavity (especially at the 

 points of attachment of the mesentery), and the peritoneal sac con- 

 tains a considerable quantity of sero- sanguineous liquid. Often we 

 observe all the lesions of septic infection. 



Treatment. The predominating symptoms must be fought. 

 We must try to prevent those complications to which intestinal 

 paralysis predisposes, particularly coprostasis, which of itself may 

 provoke a local phlegmasia and intestinal gangrene. The évacuants 

 are therefore useful ; tartar emetic, calomel, and alkaline laxatives 

 are particularly favorable, Eserine must not be used ; the abrupt 

 and violent contractions that it might provoke in those portions of 

 the intestines remaining sound may occasion a volvulus or an 

 invagination. Frictions and walking exercise are to be recom- 

 mended. The rectum should be emptied frequently with the hand 

 or by means of water injections. 



The treatment of hemorrhagic thrombo-embolic gastro- enteritis 

 is confounded with that of common gastro-enteritis. A good diet 

 is of the greatest importance for the patients in convalescence. 

 In necrosis of the mucous membrane we should give calomel. In 

 order to combat septic fever we must resort to the various anti- 

 pyretics. Violent drastics (emetics, aloes, and croton oil) must be 

 strictly excluded as agents in treatment. 



Bollinger's theory upon the close relations of verminous aneurism 

 with the colics, which has just been mentioned, has numerous sup- 

 porters, also many enemies. Gerlach^ denies absolutely all relation 



1 Gerlaeh : Gerichtl. Thierheilkde., 1872. 



