On a Peyerian ulcer-lesion of the small intestines, apparently new / by H. Vandyke Carter.

Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: On a Peyerian ulcer-lesion of the small intestines, apparently new / by H. Vandyke Carter. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    a certain want of conformity in such current descriptions of Typhoid as I have access to, because the tendency of some ac- counts is to approximate the beginnings, at leasts of both Septic and Typhoid lesions : thus, as regards the Enteric I find one recent writer upholding what is probably the generally accept- ed view, viz., that this affection consists of an inflammatory swelliuo' of the closed follicles and of the mucous membrane in their neighourhood, the inflammation often going on to ne- crosis and sloughing—he having just previously remarked that it is very probable the specific poison of the disease finds en- trance by the intestine and produces irritation of the follicles and mesenteric glands on its passage to the blood (Coats, I. c, p. 623) : Professor Ziegler also writes of the disease as being attributed to the invasion of a specific bacillus, the intestinal changes consisting essentially of a necrotic inflammatory infil- tration of the follicular structures and of the parts around them, accompanied by catarrhal inflammation of the rest of the mucous membrane (I. c, p. 291, and see also Dr. Gaff'ky^s views—Mitt, a. d. Konl. Gesund., 2nd Vol., 1884, p. 372) : whilst on the other hand Dr. J. Harley, mentioning the usual presence of very acute inflammation, asserts that the inflammatory pro- ducts are formed around the closed follicles and not in their interior [l. c, p. 363 )—a statement certainly warranted in my opinion by ordinary inspection of the parts; and there are, I may add, passages in Dr. Klein's description (Z.c, p.p. 100- 102) showing that even if the earliest morbid alterations take place within the lymph-follicles (which is not expressly stated so far as I perceive), still the necrotic changes are attribut- able to a deposition, probably by exudation from the sub-foUi- cular blood-vessels, of dark material in the inter-fascicular con- nective lymph-spaces, with a consequent breaking down of the corresponding parts which gradually extends to the neighbour- ing lymph-follicles. Adverting now to the Indian specimens, from my earliest scrutinies it was apparent that the first event consists of minute scattered blood-stases in the sub-mucosa, which were attended with cell-infiltration around and soon followed by a moderate difi'usodturgescence of the supcr-jacout