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

  • Anders, James M. (James Meschter), 1854-1936.
Date:
1902
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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    (hyperplasia), particularly Peyer's glands in the ileum and near to the valve, and, to a lesser extent, in the lower part of the jejunum. Fre- quently, the solitary glands in the small intestines, the colon, and rarely the rectum, become similarly infiltrated. In about 33 per cent, of the cases the chief morbid lesions are confined to the large intestines. In mild cases a few Peyer's patches in the lower part of the ileum are alone the seat of infiltratif^n and subsequent changes. The follicles are grayish- white in color, and may project—particularly the patches of Peyer— from 3 to 5 mm. or more. Rarely, the solitary glands, which vary in size from a mustard-seed to a large pea, become very prominent and show a bold attempt at pedunculation. The histologic changes at first consist in a marked dilatation of the capillary blood-vessels, which later are more or less compressed (as a consequence of cell-infiltration), giving to the follicles their whitish, anemic appearance. The cellular elements partake of the nature of lymph-corpuscles. Some of these cells are larger and are epithelioid in character, wnth ten or more nuclei. The mucosa and muscularis ad- jacent to the glandular structures may be similarly infiltrated. From the eighth to the tenth day the stage of infiltration terminates either in resolution or in necrosis and sloughing. The infiltrated cells may undergo granular or fatty degeneration, followed by absorption. This process—resolution—during its progress produces pitting of the swollen follicles. In consequence of these minute points of necrosis the plaques now present a characteristic reticulated appearance (plaques a surface reticulee). When resolution occurs, accompanied by destruc- tion of the follicles, small hemorrhages may take place into the glandu- lar structure. These hemorrhages may occasion pigmentary deposits in the follicular depressions, giving rise to the so-called shaven-beard appearance. Resolution, however, terminates the stage of medullary infiltration with comparative infrequency. Far more frequently the hyperplasia of the lymph-follicles ends in (6) Necrosis or Sloughing.—In all save the milder grades of cell- infiltration the hyperplasia of the lymphatic tissue cannot subside before necrosis occurs. The latter process results partly from com- pression and choking of the blood-vessels by the cell-infiltration, and partly from the direct action of the typhoid bacillus, leading to so-called anemic necrosis. Thus, necrotic crusts (sloughs) are formed, which are gradually separated and cast ofi. While not all of the glands of Peyer which are the seat of cellular infiltration undergo subsequent necrosis, as a rule those situated in the lower portion of the ileum do, and show the process in its completest development. The depth to which the necrosis extends is quite variable. It may involve only the most super- ficial layers of the mucosa, or it may extend in depth till it reaches, or even perforates, the outer or serous coat; but usually this work of destruction does not dip beloAv the submucosa or muscularis. The necrosed portions become detached—a process that proceeds from the periphery toward the center—leaving behind the typhoid ulcer. The stage of necrosis and sloughing begins betAveen the eighth and tenth days, and ends on or about the twenty-first day. (<?) Stage of Ulceration.—The size and shape of the ulcers corre- spond exactly to the necrosed areas in these respects. A single gland