A text-book of the Practice of medicine / by James M. Anders.

  • Anders, James M. (James Meschter), 1854-1936.
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the Practice of medicine / by James M. Anders. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    of Peyer generally presents several ulcers of irregular outline separated by strips of mucous membrane. Rarely, the entire plaque is implicated, in which case a large oval ulcer is the result, and at the lower end of the ileum the ulcers often coalesce until they almost encircle the bowel. The ulcers of the solitary glands assume a rounded form. The character of the floor of the ulcer will vary with the character of the intestinal coat which forms its base, though usually it is clean and smooth. The edges are usually irregular, engorged, soft, and frequently overhanging. In the lower segment of the ileum ulcers may be numerous, Avhilst in other portions of the gut Peyer's plaques may be merely hyperemic. In about 25 per cent, of the cases the typhoid ulcers are found in the large intestines—i. e. in the cecum and colon. Perforation of the large bowel is exceedingly rare. Exceptionally, the appendix is the seat of ulcer, and in a recent case of my own that came to autopsy per- foration had occurred during the fourth week of the disease. Localized abscesses have been found under these circumstances. Hemori'hage usually results from erosion of a vessel—an accident which is occasioned by the separation of the sloughs—but small bleed- ings may take place from the swollen, hyperemic edges of an ulcer. Perforation of the bowel occurs in a small percentage of cases (about 6 per cent.). In the inajority of instances it is attributed to a perfora- tive necrosis; hence it is that the sloughs are usually found attached to the orifice. Perforation may also occur after the separation of the necrosed portions during the stage of ulceration. The perforations may be multiple, though they are usually single and rarely exceeding two in number. The small, deep ulcers are more apt to lead to complete per- foration than larger ones, and the site of the orifice is usually some- where in the course of the lower third of the ileum. The lesions of peritonitis are invariably present, and during the stages of necrosis and ulceration a catarrhal state of the mucosa of the small and large intestines exists. The diarrhea which usually accompanies this aifection is to be ascribed chiefly to the catarrhal state of the large bowel. {d) Healing follows promptly upon the formation of the ulcer. At first a granular tissue covers its floor. The mucous membrane is replaced, including the glandular elements and epithelial layer, and, as in the stage of necrosis and sloughing, so the healing process advances inward from the border of the ulcer. Indeed, it is this process that dis- lodges the necrotic crust. Occasionally, ulcers are seen extending in one direction while healing in another. The cicatrix formed by the healing of an ulcer presents a smooth and often pigmented surface. The stages thus far described do not, strictly speaking, follow one another, since two or more may be illustrated at once by a group of ulcers occupying the same section of the intestine. Again, when death occurs during a relapse fresh ulcers are observed by the side of others that are partially healed. The Mesenteric Grlands.—Changes in the mesenteric glands occur simultaneously with those in the intestines, and those situated opposite to the lower third of the ileum, the portion of the bowel showing the most extensive ulceration, are most profoundly involved. Hyperemia, and later swelling due to cell-infiltration, are among the earliest