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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![a high degree of mischief, the result of inflamma- tion ; as eflusion of coagulable lymph, suppura- tion, or gangrene, in the neighbouring parts. Inflammation of the Colon. — This, like inflammation of the rest of the intestinal canal, may afiect either the peritoneal or the mucous coat. When seated in the latter, we have the phenomena of dysentery, (q. v.) When the peritoneal coat is inflamed, there may be constipation, and the usual signs of exo- enteritis, except, that the mischief is referred to some part of the colon,—the ascending, transverse or descending portion, and that the affection of the general system is much less than when the same pathological condition is seated in the small intes- tine. The nearer, too, the inflammation is to the rectum, the less acute and violent is the disease. When in the transverse colon, it is often ex- tremely obscure. Commonl)^ there is considera- ble pain upon pressure, with more or less disten- sion of the colon, meteorism, constipation, vomit- ing, great restlessness, along with the signs of internal inflammation. When colitis passes into the chronic state, we may have all the results of chronic inflammation of the peritoneal surface of the small intestines,— adhesion of the colon to other viscera, thickening of the parietes of the intestines, with diminution of the caliber,—at times, to such a degree as to occasion obstruction, and death, &c. «&c. Many morbid conditions, that are referred to the stomach or liver, have their seat in the colon. Owing, too, to the attachments of the colon, and its immediate proximity to several important organs, its unequal distension and frequent changes of position, various sympathetic affections are induced, the nature of which is often mis- understood.] The foregoing view of the symptoms of inflam- mation of the mucous membrane of the intestine will suffice to give a general idea of the disease, of which, however, there are many other modifi- cations. To enter more fully into these would occupy too much space, and hence we shall pass at once to the consideration of the pathological anatomy of the digestive tube. Now, in order properly to estimate the morbid, it is necessary, in the first instance, to take a view of the healthy condition of this organ. It is now demonstrated that a great variety of shades of colour may exist in the mucous mem- brane, independently of any diseased action what- soever. The situation of the part, the age of the patient, the process of digestion, and the length of time after death, will all modify the colour of this tissue. Its natural colour, however, may be stated to be greyish-white in the duodenum and jejunum; the greyish tint diminishes to the end of the ileum, and in the large intestine the colour is white. This may serve for a general descrip- tion. When we examine the intestinal mucous membrane of the foDtus, we find it of a rosy colour, which diminishes after birth ; in youth, the white colour becomes gradually less vivid; and as the individual advances in age, the greyish tint be- comes manifest. The mucous membrane, however, is seldom met with so slightly coloured, and when we speak of the value of redness as a sign of disease, we shall examine the various sources of this change of colour. In the state of health the gastro-intestinal mu- cous membrane varies in its thickness, according to the part of the tube examined. Billard has described it as most thick in the duodenum, and the thickness as diminishing in the following order of parts: the stomach, rectum, jejunum, ileum, and colon, where it is thinnest: it is obvious, however, that unless the increase or diminution of thickness be considerable, its value in a patho- logical view cannot be great; and, independent of intestinal disease, it may present appreciable differences. Thus, in cases of great emaciation, the atrophy of the membrane is often extreme, while in examples of mechanical congestion its thickness is frequently much increased. Louia has attempted to determine the exact depth of the mucous membrane by measurement; but this is a mode not applicable to general use. As to its consistence, this is stated to be in the direct ratio of the thickness ; hence, if in those situations where the membrane has naturally the greatest thickness, we find its consistence only equal to the thinner portions, it is plain that from some cause this has been diminished. It is difficult to meet with cases on which to try the accuracy of this assertion. We have been led to doubt il more than once, but the impediments to the in- vestigation are very considerable; the greatest experience is required to enable us to decide on the healthy consistence of the part; and we seldom meet with the tube free from some active or passive congestion: add to this, that many other circum- stances cause variations in the cohesion of the membrane, such as the presence of liquids in the tube, putrefaction, atmospheric heat, and a fluid state of the blood. The mucous follicles have lately attracted the particular attention of patholo- gists ; and to their inflammation several remarka- ble disorganizations may be referred. Thus, in very many cases of intestinal ulceration, the de- structive process seems to be primarily seated in these glands. Bretonneau has indeed described a peculiar disease, called by him dothin-entej-itis, consisting in an inflammation of these glands alone; but it is still to be shown whether this disease in reality differs from other examples of intestuial inflammation. In these countries the writings of Drs. Hewett, Bright, and Abercrombie have contributed to draw the attention of physi- cians to these glands. We find these bodies, in the state of health, most developed in the duodenum and stomach, and in some cases also the glands of Peyer are observed distinctly in the small intestine. This is more remarkable in children, but still their en- largement alone in the adult must not be consi- dered as an unequivocal indication of former or actual disease. Lastly, we have the sub-mucous and sub-seious cellular membranes, and the two orders of muscu- lar fibres, in which tissues disease may produce a great increase or diminution of volume. The muscular fibres are compared by Andral to the muscles of white-blooded animals, and are found strongest at the pyloric portion of the stomach and in the rectum. This tunic of course appears thicker where the intestine is contracted, a.'vJ](https://iiif.wellcomecollection.org/image/b21116817_0057.jp2/full/800%2C/0/default.jpg)
