Lectures on the acute specific diseases : being the Gulstonian lectures, delivered at the Royal College of Physicians, March, 1853 / by William Jenner, M.D.

  • Sir William Jenner, 1st Baronet
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the acute specific diseases : being the Gulstonian lectures, delivered at the Royal College of Physicians, March, 1853 / by William Jenner, 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.

    28/60 page 26
    And sometiines by caiising perforation of the peritoneum. When this occurs, the patient may sink rapidly from acute <?eneral peritonitis, or more gradually from a more chronic form of the same disease. The primary breach of surface of the intestinal mucous membrane seems to be effected in three modes : — 1st, By thickening and softening of the mucous membrane, and then the detachment of the softened membrane, in the form of molecules of inappreciable magnitude. 2nd. By the effusion of lympli on and into the mucous membrane, and the separation of the former with minute portions of the latter,—still portions of some size. 3rd. By the detachment of large sloughs. In these last cases there is always, at an early stage of the disease, a deposit of protein matter— using that word in its largest sense —in the subjnucous cellular tissue. This substance is friable, of a pale yellowish colour, and now and then marked with vascular striee, appa- rently the vessels of the tissue in which it is placed. It has been called typhous matter, and is susceptible only of the lowest form of cell development. It is probably rarely, if ever, absorbed from the submucous tissue, and never enters into permanent relation with the structures amid which it is placed. Before the thirtieth day of disease, the whole of this matter is ejected; and in this wise, by its accumulation in the submucous tissue, the nutrition of the mucous membrane is so seriously impaired that it dies, and then both it and the foreign matter are thrown off in the form of a slough of considerable size. Sometimes the whole of the newly-deposited protein matter is separated at the same instant, at others it comes away in several pieces. But however this may be, when the whole of it has been thrown off, the mucous membrane is found to have been detached from the submucous tissue to a greater extent than it has been destroyed ; so that, if a portion of intestine, on which is an ulcer in this stage, is place'd in water, the edges of the ulcer float upwards, as in this preparation put up by my friend Dr. Sankey, and this from University College Museum. Destruction of the other coats of the intestine is effected thus—by ulceration, or, as ulceration is pathologically termed, by molecular death, the inferior layer of the sub- mucous cellular tissue is destroyed, and then the floor of the ulcer is formed of the muscular fibres of the intestine. These fibres swell, grow intensely red, soften, and then die moiecularly, and so the peritoneal coat is exposed. The actual perforation of this membrane may be the result of the continuance of the process by which the muscular coat was destroyed, viz., molecular death, and then one or more minute rounded apertures are formed in the floor of the ulcer; more commonly a ])ortion of the peritoneum of some magnitude dies, and then a slough dyed with the intestinal flui'ls may be found in some cases attached to one point of tlie aperture; and, lastly, but so rarely that it has been denied by some, rupture of the
    digitised image 1
    digitised image 2
    digitised image 3