The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![but more frequently in depth, destroying in suc- cession the coats of the bowel. When the diseased process has commenced in the follicles, a small spot of ulceration is observed on their summit; the ulcers then gradually extend both in breadth and depth, so as to expose the muscular coat, which then becomes the floor of the ulcer: in pro- cess of time the muscular coat is destroyed, the peritoneal covering alone remaining; and should the patient survive, this becomes gradually thinner by ulcerative absorption, and at length gives way, constituting intestinal perforutimi: the escape of the contents of the bowels through the aperture being followed by rapid peritonitis and death. The symptoms which indicate intestinal per- foration are sudden excruciating pain and increased distension of the belly ; sometimes vomiting ; small, rapid, feeble pulse ; shrinking of the features ; cold sweats ; and death follows generally within thirty- six hours, though some individuals have existed for a longer period. When the brain has been much affected, the patient is so insensible as not to feel pain in the abdomen, even when the perforation takes place : in such instances it may be suspected from sudden alteration in the features, rapid distension of the abdomen, and small contracted quick pulse. In some instances, the adhesion of the portion of the intestine, at the point where the ulcerative process is going on, to some adjoining viscus, has prevent- ed the peritoneum giving way, and the consequent effusion of the intestinal contents into the abdo- minal cavity. It appears, as we have already observed, that intestinal ulceration is more common in the fevers of France than in those of Britain, and that they occur more frequently at some seasons than at others. It is probable, too, that they are found in a larger proportion in populous places, as in the large towns, than in villages or the open country. Of fifty-four cases examined at the London Fever Hospital, (1828-1829,) intestinal ulcerations were discovered in sixteen ; and in ninety-two cases of two hundred and twenty-nine treated at La Cha- rite by Lerminier. On what this difference de- pends, it is not easy to determine. With regard to the cicatrization of intestinal ulcers, there is now no longer any doubt that this reparative process does take place. Besides the well-authenticated example in the case of the late celebrated Beclard, in whose stomach a cicatrized ulcer was discovered at the small curvature, we have the testimony of Troillet, Louis, and other pathologists, on this point; and though we our- selves have never witnessed an unequivocal in- stance of genuine cicatrix, the minute detail, by those writers, of the various stages observed during this process, and their accurate description of the appearance of intestinal cicatrix, leave no longer any doubt on this subject; but from the want of diagnostic symptoms to indicate the existence of intestinal ulceration, it cannot be determined in what proportion of cases this reparative process takes place. It is probable, however, that it is a rare termination of such lesions. [It has been already remarked, that the intes- tinal affection has been regarded as characteristic of one form of continued fever, the ti/plioid. By some pathologists, indeed, it is considered as the Vol. IL—23 t precursor and cause of all the other morbid phe- nomena. It does not, however, appear to be en- titled to the importance in the causation that has been ascribed to it. All the phenomena may occur without the intestinal lesion; and the latter may exist without being indicated by the ordinary symptoms of the typhoid affection. Hence, objec- tions may well be urged against classifying typhoid fever amongst the diseases of the digestive tube, as has been done by Andral, Piorry, and others. It is difficult to comprehend, that these folli- cles can be so intimately associated in their morbid derangements with the great vital organs, as to occasion the ataxic and adynamic fever, which has been ascribed to them. The follicular affection would appear, indeed, to be a mere symp- tom, and to be produced by the same cause that gives rise to the other symptoms of typhoid fever; but which cause, in the existing state of science, is inappreciable. As elsewhere remarked, (^Prac- tice of Medicine, 2d edit. ii. .503,) the writer is not prepared to admit, from what he has himself seen, and from a careful examination of the testi- mony of others, that the typhoid affection and typhus are proved to be separate and distinct dis- eases. He regards them both as forms of adyna- mic fever, exhibiting different phenomena under different circumstances; generally, in the United States and in France, the abdominal lesion being present, whilst in England it is as commonly ab- sent ; and it is strongly in favour of this view of it, that since attention has been more directed to the represented difference between the affections in Great Britain, it has been shown, that the follicles are not unfrequently diseased in the ordinary con- tinued fever. (Watson, Lectures on the Princi- ples, Sfc, of Phi/sic, Amer. edit. p. 844, Philad. 1844.) In this country, too, epidemic adynamic fever has been described, in some cases of which the glands of Peyer were diseased; in others not. (Western Journal of Medicine and Surgery, 1843.) The singular forms of adynamic fever, which have prevailed, of late, in different parts of the Union, also exhibit the wide difference of ex- pression which it may assume.] The colon, in fatal cases of fever, is considera bly distended with flatus ; it appears to be the portion of intestine in which tympanitic distension usually occurs. The internal or mucous surface sometimes ex- hibits evidence of previous inflammation in the red, softened, or thickened state of this membrane. The mucous follicles are occasionally enlarged; and ulcerations, chiefly in the ctecum, are now and then observed. The mesenteric glands are almost invariably diseased : when there is no intestinal ulceration, they are simply enlarged and indurated ; when ulceration of the bowels has taken place, these glands, besides being enlarged, generally contain pus. The external absorbents, especially those situ ated in the neck, axilla, and groin, are occasionally enlarged and indurated. In some epidemics pa- rotid buboes are not uncommon, indicating a ma lignant form of fever. The only alteration in the liver, which may perhaps, be deemed peculiar to fever, is softening, and this is only occasionally observed. In tjiosi*,](https://iiif.wellcomecollection.org/image/b21116817_0171.jp2/full/800%2C/0/default.jpg)
