On the pathology and treatment of dysentery : being the Gulstonian lectures delivered at the College of Physicians, in February 1847 / by William Baly, M.D.

  • Baly, William, 1814-1861.
Date:
[1847]
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Credit: On the pathology and treatment of dysentery : being the Gulstonian lectures delivered at the College of Physicians, in February 1847 / by William Baly, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    lesion in chronic diarrhoea, and notices the occasional appearance of irritation and softening of the follicles in cases resembling dysentery, evidently inclines to the belief that these latter cases are not instances of true dysentery.* Yet, during the last year, another author, who has manifestly observed with great diligence and intelligence, Dr. Parkes, has published a minute description of the morbid anatomy of the disease, and has drawn from it the following conclusions : Admitting the inflammatory nature of the dysentery, the peculiarity about it, he says, seems to be, that ulceration of the large in- testines occurs with great rapidity, and, except in one rare form, a case never pre- sents true dysenteric symptoms without ulceration being present. It is evidently not from the severity of the inflammation that ulceration is so rapidly and so con- stantly produced, for it occurs in the com- paratively slight cases. * * * It is owing to the glands of the mucous membrane being particularly implicated in the inflammatory action.f Here, then, we have the statements of an able observer directly opposed to those of two of the most eminent morbid anatomists of our time. How are these contradictions to be recon- ciled ? Does difference of climate cause a difference in the structural changes attendant on the disease? Are distinct epidemics characterized by distinct local lesions ? Have two or more distinct diseases been confounded under the one term of dysentery ? Or are the various local changes described by different writers only so many forms of the same diseased process, this process being modified in particular instances by constitu- tional peculiarities of the patients or other circumstances ? Some aid towards solving these questions may be derived from an examination of the morbid anatomy of dysentery, as it has shown itself at Millbank. We shall at least gain data for an inquiry concerning the intl uence of climate on the disease—an in- quiry, the result of which I will anticipate by stating that all the well marked-varieties of structural change in the large intestines observed in tropical dysentery, are found likewise in fatal cases of the disease occurring in our own climate. From a study of the various anatomical lesions met with in cases of dysentery at Millbank, and their relations to one another, we shall also find grounds, I think, for giving an affirmative answer to the question, whether these various lesions are modifica- tions of the same diseased process. But to afford solutions to these questions * Op. citnt. p. 2fio. t Remarks on the Dysentery and Hepatitis of India, by E. A. Parkes, M.U. London, 1846, p. is not the only object with which I enter upon a description of the structural changes which have offered themselves to my obser- vation in the bodies of those who have died of dysentery in the prison at Millbank. I shall endeavour to show that the opinion which is now, I believe, generally entertained respecting the mode of formation of ulcers in the internal coat of the intestines is, to a certain extent, erroneous,—that these solu- tions of continuity in the mucous membrane, whatever their size and shape, are produced, at all events at their commencement, by a process of mortification and sloughing, and not by simple ulceration. With a view to facilitate the description of the alterations which the mucous mem- brane of the large intestine undergoes in duease, it will be useful to glauce for a mo- ment at its structure in the healthy state. To enter upon a minute account of the ana- tomy of the mucous membrane of the intes- tinal canal generally, is unnecessary, since this subject was treated of most fully by Dr. Todd, in the Croonian lectures for 1842. The different component strata which are found at every point of the mucous mem- brane of the large intestine are,the epithelium, the membrana propria on which the epi- thelium rests, and the vascular tissue which is subjacent to both these structures. There are besides seen, here and there, small glandular bodies scattered through the substance of the mucous membrane, and known as the solitary glands of the large intestine. The disposition of the membrana propria, a transparent homogeneous structure, which has also been named the basement mem- brane, and intermediate membrane, determines the character of the surface of the mucous membrane. In the large intes- tines it dips inward at innumerable points very close to each other, forming so many blind tubes like the fingers of a glove. These are the simple tubular follicles, the openings of which are seen when the surface of the mucous membrane is examiued with a lens. The epithelium invests every part of what would otherwise be the tree surface of the membrana propria, those parts which dip inwards to form the follicle, as well as those which look towards the cavity of the intes- tine. This epithelium is of the kind called by llenle, cylinder epithelium, but more appropriately, by Dr. Todd, columnar epithelium. That is to say, it is formed of little pillar or column-shaped particles placed side by side. The vascular tissue subjacent to the mem- brana propria is composed of a close network of capillaries, and of a mass of amorphous matter, in which a large number of the small bodies called nutlei or