Ilex

“ Pathology of bacillary dysentery.— The large intestine is the seat of the affection; in some cases the last few feet of the ileum also may be attacked. In early cases the gut wall is thickened and infiltrated, the mucous membrane œdematous and of a cherry-red colour showing small yellow superficial ulcers along the exposed borders and folds. In severe cases, or cases in which the disease has lasted for some time, the mucous membrane may be entirely gangrenous, of a bright-green colour, and forming what appears to be a false membrane on the surface of the bowel. ”

“ Recalling the development of the jejuno-ileum it will not be difficult to recognize in the numerous coils of small intestine which succeed to the duodeno-colic isthmus the results of the increase in length of the descending or efferent limb of the human embryonal umbilical loop. Tracing these coils it will be found that the terminal portions of the ileum correspond to the apex and to the proximal part of the ascending or recurrent limb of the primitive loop, while the remainder of this limb furnishes the cæcum and the next succeeding segment of the large intestine. ”

“ Thus the strongest and most prominent symptom of rectal ulcer is chronic diarrhœa.
“The diarrhœa is generally more troublesome in the morning. The patient often on arising feels an urgent desire to go to stool. This act is often very unsatisfactory, for he passes very little feces and a great deal of wind. Occasionally these small stools are covered with a jelly-like, or white [59] of an egg substance, or the motion may be only a jelly-like mucous, with no feces. There is generally more or less tenesmus, or a disagreeable feeling, as if the rectum was imperfectly evacuated. ”

“ The colon is subject to three main forms of inflammation. In simple colitis the mucous membrane of the colon is intensely injected, bright red in colour, and secreting a thick mucus, but there is no accompanying ulceration. It is often found in association with some constitutional disease, as Bright’s disease, and also with cancer of the bowel. But when it has no association with other trouble it is probably bacterial in origin, the Bacillus enteritidis spirogenes having been isolated in many cases. The motions always contain large quantities of mucus and more or less blood. ”

“ The stomach, fairly well differentiated, is succeeded by the small intestine of considerable length and uniform caliber. The proximal portion of the small intestine is characterized as duodenum by its connection with liver and pancreas. In the remaining portion of the intestinal canal it is not difficult to recognize the elements of the umbilical loop of the higher mammalian embryo. The larger mass of the jejuno-ileal coils is developed from the descending limb of the loop; a smaller number of convolutions belong to the returning or ascending limb, which also includes the ileo-colic junction. ”

“ The part in front of it, which lies dorsal to the heart, is the fore gut, while the part behind the aperture of the yolk-sac is the hind gut.
The pharynx, oesophagus, stomach and part of the duodenum are developed from the fore gut, a good deal of the colon and the rectum from the hind gut, while the mid gut is responsible for the rest. The cephalic part of the fore gut forms the pharynx (q.v.) , and about the fourth week the stomach appears as a fusiform dilatation in the straight tube. Between the two the oesophagus gradually forms as the embryo elongates. ”

“ The facts would thus seem to warrant the assertion that, as a rule, the venous blood flowing from the intestinal tract of an animal, fed on a rich proteid diet, contains a much larger number of leucocytes than the arterial blood flowing to the intestine; although, if space permitted, we might instance certain occasional exceptions due to various causes, which, however, do not reflect against the view that there is a marked production of leucocytes in the lymph spaces surrounding the intestine, and in the lymph glands of the mesentery, as a normal accompaniment to digestive proteolysis. ”

“ The floor of the active dysenteric ulcer may be, and generally is, formed of a sloughy material lying on the muscular coat; but the sore may penetrate deeper than this, and include the muscular coat itself, and even the serous membrane. The largest ulcers are generally found in the sigmoid flexure and descending colon; they are also frequently, though more rarely, found in the cæcum, the magnitude of the lesions diminishing as we trace the bowel upwards or downwards, as the case may be. ”

“ The epithelial cells of the stomach, as well as those of the intestine, are enormously dilated with food-yolk (fig. 57, st) . Behind the stomach is formed the liver. The subintestinal vein bringing back the blood to the liver appears to have the same course as in Teleostei, in that the blood, after passing through the liver, is distributed to the walls of the stomach and is again collected into a venous trunk which falls into the sinus venosus. As the yolk becomes absorbed, the liver grows forwards underneath the stomach till it comes in close contact with the heart. ”

“ He does not seem able to escape from his enemies anywhere.
The mucous membrane lining the orifices of the body is nothing more than the skin turned in to line canals for air, gases, liquids, and solids to pass in and out in order to keep up the physio-logical functions of the body. Very rarely, indeed, do we find, from childhood to old age, the orifice of the intestinal sewer otherwise than chronically inflamed, the invasion extending, moreover, the whole length of the rectum for some distance into the sigmoid colon. ”

“ Diarrhoea is a simple flux of the bowels, without either the sanguinolent discharges or the intestinal excoriation. Lientery is a flux of the bowels with the discharge of undigested food, occasioned by irritability (levitas) of the stomach or intestines. Colical passion and iliac passion derive their names from the supposed origin of the pain in the colon or ileum, a remark which furnishes occasion for the statement that Gilbert divides the bowels into six sections, viz., the duodenum jejunum and ileum, and the orobus, colon and longaon (rectum) . ”

“ This varying development of the valvulæ is the chief reason why a given segment of the ileum weighs less than a corresponding length of the jejunum. This reduction in the fold-formation of the intestinal mucosa toward the terminal portion of the midgut is seen even in the lower vertebrates. Thus in Fig. 112, showing the entire intestinal tract of the conger eel, Echelus conger, in section, the plicæ of the mucous membrane in the proximal segment of the midgut, at and immediately beyond the entrance of the biliary duct, are prominent and numerous. ”

“ All kinds of foodstuffs, at all hours, with seeds, stones, etc., are poked into its stomach, followed by constipating remedies to quiet inevitable troubles, or brisk purgatives given with the hope of expelling the arrested contents of the bowels. Is it any wonder that ninety-eight persons of adult age out of every hundred suffer more or less from chronic inflammation and ulceration of anus, rectum, sigmoid flexure, colon, or appendix? ”

“ ENTERITIS. Enteritis consists in inflammation of the intestine, or, more precisely, in inflammation of the intestinal mucous membrane. All the constituent portions of the intestinal tube may be affected (duodenum, jejeunum, ileum, colon, cæcum) ; but clinical distinctions and localisation of inflammation in the various parts are very difficult in the domesticated animals, and at present it is impossible to describe with any accuracy the differences between duodenitis, enteritis of the jejeunum and ileum, colitis or typhlitis. ”

“ Eolis has no liver. With so much stomach it can carry on the process of digestion-without the aid of that organ, so troublesome to man and beast. A row of hepatic cells extending part way along the intestine represents the rudiment of a liver, or its vestige.
Where are the lungs? Nowhere—or, rather, everywhere. No part is specialized and set apart for aërating the blood. In the vital economy of this sea-slug, there is but little division of labor. ”

“ Rectal ulcer is a more common disease than is generally supposed. Unfortunately the symptoms are generally obscure, and the patient suffers but very little, if any pain, and consequently consults his physician for some of the reflex symptoms, rather than for the initial disease itself; and very often these reflex symptoms are vainly treated till the patient and physician are both thoroughly disgusted and disheartened. There is one maxim which every physician should always bear in mind, and that is, always suspect rectal ulcer in every case of protracted or chronic diarrhœa. ”

“ Chronic Ileo-colitis fellows the acute variety. Cases which are unusually severe or which have been badly managed are likely to become chronic. A child suffering from this disease presents the following picture: The patient is emaciated, the abdomen is usually enlarged with gas, the feet are cold, the circulation of the blood is poor, the fever is low or absent altogether except when the child is having a relapse, when it jumps up suddenly. The bowels are loose and contain mucus, frequently in large quantities. The mucus may stop for a few days ”

“ The mouth, pharynx, and gullet are generally found free from any inflammatory action. The small intestines may or may not be affected: in most cases the duodenum alone shows any signs of irritation. The rectum is that part of the large intestine most prone to inflammation. I have seen marked ulceration of the colon after death from inhalation of arseniuretted hydrogen. The other internal organs—the liver, spleen, and kidneys—do not appear to be appreciably affected by arsenic. ”

“ We should remember that ulcerative proctitis and colitis have made the use of the enema a necessity; that, accordingly, the diseased, constricted gut or canal must be treated very gently and not irritated in any avoidable way. The least irritation will result in still greater muscular contraction. It stands to reason that the effort to reach the healthy portion of the bowel with a slightly flexible colon tube frustrates its own purpose, and that it is besides a source of serious and unnecessary irritation. ”

“ In making experiments upon the state of the abdominal viscera during digestion, and under the influence of hunger, I have observed, that whilst the food is only in the stomach there is very little flow of bile; but it increases when the aliment passes into the duodenum, so that then there is a considerable quantity in the intestines. During hunger the gall bladder is distended, and but little bile flows into the intestines. At the end of digestion, and even when that process is half finished, the gall bladder contains but half of its full quantity ”

“ Cases have been reported where the adrenals showed congestion and necroses, as if subjected to the action of a toxin.
In man we have an acute inflammation of the mucosa of the large intestines and, in the tropics, we frequently find the lower third of the ileum involved as well. In amoebic dysentery the process rarely extends beyond the ileo-caecal valve. A catarrhal process with hyperaemia and sero-purulent exudate is first noted, to be succeeded by fibrin formation in the mucosa, a process of coagulation necrosis. When the process invades the ileum there is no involvement of Peyer’s patches. ”

“ I must here mention, that jaundice does not necessarily follow upon absence of the gall-bladder; just as in the horse, the deer, the rat, and other animals that possess no gall-bladders, the biliary function is perfectly well carried on, so it may be in the human subject, labouring under a congenital or accidental deficiency of the gall-bladder. In such cases, the hepatic ducts are pervious, and consequently the secreted bile finds no difficulty in reaching the intestines. ”

“ The floor is thrown into numerous wrinkles by ridges in the supporting gelatine resulting in increase of digestive surface. The four perradial grooves of the proboscis are continued in the perradii along the floor of the stomach as four fairly deep furrows, which lead directly to the gastric ostia and stomach pockets—structures to be described presently. These furrows are lined with crowded columnar cells, smaller and denser than the other cells of the digestive epithelium, containing no granules and but little beside the relatively large, compact, deeply staining nuclei. ”

“ So much attention and flirtation does the liver receive from the liver-persuaders that the pancreas ought to be very jealous. The pancreas excretes quite as much fluid into the duodenum as its larger neighbor, and is, therefore, no mean organ. And we need not wonder should we find the intestinal glands piqued at our over-attention to the liver, as they, in their work at the metamorphosis of digested food into blood, excrete two or three gallons of fluid in a day to the liver's two or three pints ”

“ All these appendages of the alimentary canal, large and independent as some of them seem, really arise by differentiations from its coats. The primordial liver consists of nothing more than bile-cells scattered along a tract of the intestinal surface. Accumulation of these bile-cells is accompanied by increased growth of the surface which bears them—a growth which at first takes the form of a cul-de-sac, having an outside that projects from the intestine into the peri-visceral cavity. ”

“ The iliac passion, passio iliaca of the old Latin, is usually taken to signify some obstruction of the intestines causing severe pain, vomiting, and eventually fecal vomiting. A good many different forms of severe painful conditions, especially all those complicated by peritonitis, were included under the term, and the modern student of surgery is likely to won [Pg 280] der whether these old observers had not noted that the right iliac region was particularly prone to be the source of fatal conditions. ”