Mesenteric gland

“ Although dysentery is a disease of the large intestine, its lesions are not exclusively limited to this structure. It is always a purely local disease at first, and, strictly speaking, continues so throughout its course, yet it produces in severe or chronic cases widespread and general effects. Rapid emaciation sets in, and anæmia is soon pronounced in all the internal organs. The mesenteric glands show signs of irritation or of absorption of specific products in hyperæmic pigmentation and hyperplasia. ”

“ Calcareous concretions have been observed by Andral and others in the mesenteric glands in cases of chronic pulmonary disease; and Soemmering records several observations of a tartar-like substance found in devastated mesenteric glands in cases of rickets.
The morbid appearances in tabes mesenterica are not usually confined to the changes in the glands. In very many cases the evidences of disease of the peripheral glands are quite manifest, and in much the larger number of cases pulmonary phthisis and disease of the bronchial glands are present. ”

“ Digestion and nutrition should be maintained at a healthy standard. The hygiene of person, dwelling, and sleeping apartments merits constant and intelligent supervision.
As stated above, tabes of the mesenteric glands is so frequently secondary to other diseases of a scrofulous nature that the danger lies in the failure to arrest or cure such affections. It is unfortunately too true that some of them are often beyond the resources of medical skill, but in many cases the initial manifestations of the strumous diathesis are either entirely neglected or inappropriately treated. ”

“ The mucous membrane of the fourth stomach is often punctuated with brownish-red patches, traces of the capillary hæmorrhages which were produced at the onset of the disease. The mesenteric glands are swollen, gorged with serum, but not hæmorrhagic; the liver is large and of a yellowish tint; the spleen is little altered; the urine always contains albumen; the lungs are seldom quite sound; they usually contain here and there small diffuse centres of catarrhal pneumonia, of nodular bronchial pneumonia, or simply of atelectasis. ”

“ When present, they generally involve the peritoneum or the mesenteric glands. The liver is sometimes attacked, the stomach rarely.
Benign tumours are not of common occurrence in the digestive organs. Simple growths of the salivary glands, cysts of the pancreas and polypoid tumours of the rectum are the most frequent.
The intestinal canal is the habitat of the majority of animal parasites found in man. Frequently their presence leads to no morbid symptoms, local or general ”

“ Fatal perforations are delayed or prevented by these adhesions. General peritonitis with soft lymph or sero-purulent effusion is found with perforation. The mesenteric glands may be enlarged. The liver is larger or sometimes smaller than normal, and its tissue is softened and may be fatty. Abscess of the liver31 is a very rare result of chronic intestinal catarrh, with ulceration. The gall-bladder is usually filled with bile. The spleen is small and firm in texture; less commonly it is soft and friable. The pancreas is healthy. The kidneys are large and pale ”

“ When peritoneal adhesions that cannot be easily torn are present it may be necessary to remove the intestines with mesentery attached.
After the removal of the intestines from the body they are opened by the intestinal shears, beginning either with the jejunum or the large intestine, the cut being made in the line of the mesenteric attachment. As the intestine is opened careful attention should be paid to the contents of each portion. It is very poor technique to dilate the intestine with water or to run water through it before it is opened. ”

“ The weight of the bowel and its contents, along with the rapid distension of the intestine above, fixes the gut in this state of torsion and effectually prevents it from untwisting. A semi-rotation of the paretic and distended bowel about the mesenteric axis is sufficient to interfere with the supply and return of blood and provoke enteritis. Indeed, the rotation is rarely sufficiently great to produce complete obstruction, and the symptoms are frequently rather those of inflammation than of internal strangulation. ”

“ The blade of the knife is held slightly obliquely against the mesenteric insertion of the intestine, and as the left hand pulls up the coils of intestine against the knife, the latter in the bowing or sawing movement severs the mesentery from the intestine as close to its insertion as is possible without cutting the intestine. The freed portions of intestine are caught in the tray resting on the thighs, and the left hand grasps in succession new portions of the small intestine and pulls them against the knife until the entire intestine is freed up to the duodenum and the root of the mesentery. ”

“ The arteries supplying the yolk-sac and subsequently the intestinal canal are the vitelline or omphalo-mesenteric. At first they are branches derived from the two primitive aortæ, and after the fusion of these vessels they arise from the resulting single abdominal aorta. The omphalo-mesenteric arteries are at first multiple and later are reduced to two. When the primitive intestine loses its original close contact with the vertebral column and the common dorsal mesentery develops, the two omphalo-mesenteric arteries unite to form a single vessel, running between the layers of the mesentery. ”

“ The anterior mesenteric artery distributes its branches to the small intestines the most motile portion of the intestinal tract, and the cæcum and colon the most heavily loaded with solid ingesta, it is therefore the most subject to traction, and distensions, and the more so that the parent trunk is extremely short and the divisions pass in all directions and to a large extent at right angles, so that there is a dragging of the walls apart as well as an obstruction to the blood flow and an increase of internal tension. ”

“ When the saving of time is of great importance the large intestine may be freed as described above, a ligature put around the upper end of the jejunum, and the mesentery severed at its root, so that the entire mass of small intestine with its mesentery is removed for further separation from the mesentery outside of the body. ”

“ At first the stomach and intestine form a straight tube, which is connected to the dorsum of the embryo by a dorsal mesentery and to the mid-ventral wall in front of the umbilicus by a ventral mesentery. Into the ventral mesentery the liver grows as diverticula from the duodenum, so that some of the mesentery remains as the falciform ligament of the liver and some as the lesser omentum. Into the dorsal mesentery the pancreas grows, also as diverticula, from the duodenum, while the spleen is developed from the mesoderm contained in the same fold. ”

“ An overloaded condition of the large intestine may cause inflammation of the liver or dropsy of the abdomen. When the colon is distended, it becomes a mechanical impediment to the free circulation of the blood in other organs, and causes congestion of the portal system, predisposing to chronic inflammation or cirrhosis of the liver. This latter is a structural affection, and may, in turn, give rise to abdominal dropsy. In a word, the accumulation of feces in the colon irritates both the large and small intestines, thus causing congestion of the bowels, liver, or stomach. ”

“ This passage to the right is accompanied by a throwing over of the duodenal loop to the right, so that the right side of its mesentery becomes pressed against the dorsal wall of the abdomen and obliterated. This accounts for the fact that the pancreas and duodenum are only covered by peritoneum on their anterior surfaces in man. The formation of the lesser sac is due to the turning over of the stomach to the right, with the result that a cave, known sometimes as the bursa omentalis, is formed behind it. ”

“ 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. ”

“ 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. ”

“ It occurs in greatest abundance in dysenteric lesions and especially in the solitary lymphatic follicles of the large intestine, and in the mucus in the stools during the most acute stage of " epidemic " dysentery. It is pathogenic to many animals, but it does not produce in them, or only exceptionally, dysenteric lesions, although the toxins of the bacillus, pounded and killed cultures, when injected intravenously into rabbits and other animals, produce necrosis of the large intestine into which they are excreted by some selective action. ”

“ There is no armature, and no glands, and the whole tract can only be divided into an oesophagus and an intestine. The latter runs with no twists or coils straight to the anus, which is situated at the junction of the trunk with the tail. A median mesentery running dorso-ventrally supports the alimentary canal and is continued behind it into the tail, thus dividing the body cavity into two lateral halves.
There are no specialized circulatory, respiratory or excretory organs. ”

“ The only point which seems admissible is that this disease, which Moussu considered to have analogies with chronic sporadic dysentery in man, is due to one or several organisms, which develop in the intestine and produce toxins, causing diarrhœa, without, however, marked inflammation of the intestinal mucous membrane. ”

“ Along the ventral edge of the mesenteron, which becomes the branchial sac, the endostyle is formed as a narrow groove with thickened side walls. It probably corresponds to the median portion of the thyroid body of Vertebrata. A curved outgrowth from the posterior end of the mesenteron forms the alimentary canal (oesophagus, stomach, and intestine) , which at first ends blindly. An anus is formed later by the intestine opening into the left of two lateral epiblastic involutions (the atria) , which rapidly become larger and fuse dorsally to form the peribranchial cavity. ”

“ Normally the intestine contains an extremely large number of different microbes, which may prove of service so long as circulation, secretion, and peristalsis continue normal; but as soon as any perturbation occurs, either in the blood supply or in the movement of the bowel, normal secretion is impeded; abnormal organic fermentation commences, producing irritant principles or toxins which at once set up local irritation, or, being absorbed, produce that complex of symptoms which we recognise as enteritis, intoxication of intestinal origin, or even infection. ”

“ The gland becomes very intimately connected with the serous layers of the primitive dorsal mesentery. In order to clearly comprehend the adult serous relations it is necessary to make a distinction between two divisions or portions of the gland, based upon the altered relations of the primitive dorsal mesentery which result from the differentiation of the primitive simple intestinal tube into stomach and duodenum. ”

“ Fulminating dysentery.— Strong and Musgrave thus describe the lesions in this type of dysentery as it occurs in the Philippine Islands:— "In the most acute cases (death after three or four days' illness) the mucous membrane of the large intestine presents in general a reddened, swollen, puffy appearance. There is a superficial necrotic mucous layer which generally extends over the mucosa throughout the large bowel, and sometimes for a distance of 10 or 12 cm. into the ileum. ”

“ When bile is redundant, the intestinal excretion is often putrid and offensive, with bilious diarrhœa or dysentery, in repetition and quantity profuse, exciting tenesmus, and sometimes excoriation of the anus; to these may be added pain in the stomach and intestines, tension and elevation of the belly. According to Lind, the tropical remittents are the most virulent, yet are not contagious, unless accompanied with dysentery, or the sick crowded together ”

“ The tenth objection to using an enema is in being obliged to use it from the fact of having such a disease as chronic inflammation of the rectum and colon. Every victim hates to be compelled to do a thing; and the victim of proctitis and colitis is no exception to the rule. In fact, he is beginning to realize that unless he uses it his system will be poisoned by the absorption of the sewage waste. Let the victim object to the disease that necessitates the use of the enema, and all will shortly be well. ”

“ 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. ”