On the origin and development of the diseased condition of the intestinal glands : which occurs during the course of certain forms of continued fever.

  • Goodsir, John, 1814-1867.
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: On the origin and development of the diseased condition of the intestinal glands : which occurs during the course of certain forms of continued fever. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the ulcer retaining its former granulating or flocculent appearance. ' At this stage of the process lymph begins to be deposited on the external surface of the gut; and if the patient survives the per- foration eight or ten hours, the lymph rounds off the edges of the hole, and gives it that punched-out appearance so frequently ob- served. The omentum may adhere opposite the incipient per- foration, and after contraction has concluded, it appears as if it had been forced from without into the hole, an appearance resul- ! ting from the contracting agency of the granulations. \ Having now described the changes which the patches undergo in this form of disease, I have to point out the peculiar matter j upon the presence of which these changes appears to depend, I The grey matter which fills the vesicles or the spaces which j they occupy, I find to consist of that universal element of every primitive tissue, healthy or diseased, nucleated cells. These cells are from 2000 to 4000 of an inch in diameter. They do not in general exhibit a nucleus in the sense in which that term is generally applied; that is, the individual cells do not present in their interior smaller cells holding certain relation to them. These cavities appear to contain a number of granules, four, five, or six, as far as could be reckoned. Whether these in the ag- gregate are to be considered as a nucleus proceeding towards the formation of a number of young cells, or whether the appear- ance is to be considered as analogous to that irregular form of nucleus and cell-contents characteristic of certain forms of tu- bercle, I do not know. This matter, of whatever nature it may be, appears first in the vesicles of the patches, and then spreads ! out on all sides, after the manner of other purely cellular struc- tures, till the whole patch, before it is thrown off, appears to be principally formed of it; the surface of the mass, however, as has been stated, and certain parts of its interior, consisting of the somewhat altered mucous and submucous tissue. The morbid changes which the glandulae aggregate of the ileum undergo during continued fever, appear, from the observations I have just detailed, to be of the following nature, viz. the deve- lopment of cells within the constituent vesicles of the patches to such an extent as at last to burst them, or cause their solution —the continued increase in the number of the cells, proceeding | from as many centres as there are vesicles in the patch—the con- I glomeration of the whole into one mass above the submucous and j under the mucous membrane—the distension of the latter, and | the necessary ulceration and sloughing of the mass arising from J this circumstance. i The whole mass, as detached from the gut, is not therefore to bo considered as a slough ; that portion only which consists of the upper halves of the vesicles and of the mucous membrane, being dead, the greater part, consisting of the cellular mass, being