Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 5: Supplementary Volume
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit36060/489/
STOMACH AND INTESTINE. 
seem to be but little affected. Finally, in 
others — and especially in those cases in^which 
the copious exsudation has subsequently con¬ 
tracted, so as to diminish the calibre of the 
tube,—the muscular fibres themselves seem 
to undergo a process of atrophy, which ends 
in their complete disappearance. 
(3.) The above remarks may serve to illus¬ 
trate a brief allusion to a third (and very fre¬ 
quent) variety of what is called hypertrophy of 
the digestive canal, in which it is still more dif¬ 
ficult to determine the exact change that has 
taken place. In these cases an albuminous 
plasma exsudes into the coats of the canal : 
either pretty equally throughout ; or with a 
more or less marked preference for the sub¬ 
mucous or subserous areolar tissue, and with 
marks of inflammation in the neighbouring 
mucous membrane or peritoneum respectively. 
When examined under the microscope, this 
albuminous plasma generally exhibits all the 
appearances which attend the abnormal de¬ 
velopment of fibrous tissue. But the fibres 
thus developed as the product of a diseased 
(and often an inflammatory) action, offer 
marked differences in their structure and ar¬ 
rangement from those of the normal areolar 
tissue among which they originate. While, as 
regards the changes undergone by the latter 
or healthier texture, it is often impossible to 
decide whether it has been augmented or 
hypertrophied ; or whether it has not rather 
experienced such an interference with its nu¬ 
trition, and such a loss of its substance, as 
amounts essentially to its atrophy. 
Polypi.—The tumours which have received 
the name of polypi agree in the common 
character of projecting into the cavity of the 
digestive canal, by means of a peduncle or 
stalk of variable length, that attaches them 
to its walls. Their size varies from that of a 
pea to a pigeon’s or hen’s egg. They are 
almost always covered by the mucous mem¬ 
brane : in the submucous areolar tissue 
beneath which they appear to be generally 
formed. 
It can scarcely be doubted that the shape 
of these polypi — like that of the papilliform 
tumours on the external integuments — is 
sometimes determined by a definite arrange¬ 
ment or development of the plasma out of 
which they are constructed. It is, perhaps, 
chiefly in this way that isolated malignant 
growths under the mucous membrane so fre¬ 
quently assume the pedunculated or polypoid 
form. But it seems certain that, in many 
instances, their form is partly the result of a 
mechanical traction, such as the muscular 
contractions of the alimentary canal itself 
might exercise on almost any small tumour 
projecting from its mucous surface. The pe¬ 
dicle* of the tumour is thus continually 
drawn out and lengthened. And the intus¬ 
* The movements of the intestines upon each 
other often seem to exert a similar mechanical in¬ 
fluence on tumours or deposits attached to their 
peritoneal surface. 
susception of that segment of intestine from 
which this pedicle arises, sometimes affords a 
remarkable testimony of the mechanical ac¬ 
tivity of the bowel. 
The interior of the non-malignant polv- 
piform tumours generally consists of a more 
or less completely developed fibrous tissue. 
In some cases, however, they contain a mass 
of adipose tissue, which causes them to re¬ 
semble appendices epiploicæ. In very rare 
instances, their contents approach the amor¬ 
phous character, and friable consistence, of a 
tuberculous deposit. And finally, they some¬ 
times constitute true mucous polypi ; which 
are distinguished by their tabulated form, 
their great vascularity, and their erectile and 
dilatable texture. 
The various small tumours which occa¬ 
sionally occupy the submucous tissue of the 
bowel scarcely require any separate descrip¬ 
tion. Cysts are comparatively rare in this 
situation. Fibrous, or fibro-cartilaginous 
masses are less infrequent. The latter rarely 
become the seat of a process of true ossi¬ 
fication. The inorganized earthy matters 
oftener found in their interior are formed, 
either by obsolete tubercle, or by the cretified 
contents of old abscesses, the pus of which 
has undergone a partial absorption. 
Tubercle. — The digestive canal is more 
frequently the seat of tuberculous deposit 
than any other organ of the body, the lungs 
only excepted. The pulmonary tubercle is, 
however, far more frequent than the intestinal. 
And the latter is not only generally preceded 
by the former ; but is rarely seen to any ex¬ 
tent, before the tuberculous matter deposited 
in the lungs has already reached the stage of 
softening and suppuration. 
The different segments of the canal are 
affected by it in the following order of fre¬ 
quency : the lower part of the ileum ; the 
cæcum; the large intestine generally; the upper 
part of the ileum ; the jejunum ; the duode¬ 
num ; and (very rarely) the stomach. 
Both forms of tubercle are met with in the 
intestinal canal. In a vast majority of in¬ 
stances, none but the crude, yellow, or caseous 
tubercle is detected. But in cases in which 
the disease has taken an unusually chronic 
course, the grey granulations are sometimes 
met with. The latter appear gradually to as¬ 
sume the caseous form ; the change beginning 
at their centre, and extending thence to their 
circumference. 
The deposit usually begins by engaging the 
agminate and solitary follicles of the lower 
third or half of the ileum ; filling and distend¬ 
ing their cavities with crude tubercle. A 
marked (and often intense) redness of this 
segment of the bowel usually accompanies 
the deposit; and remains, as a more or less 
distinct hyperæmia, during the remaining 
stages of the process. 
The caseous tubercle contained in these 
follicles next undergoes the process of soften¬ 
ing. The summit of the sac bursts or ulcerates; 
and its contents escape into the cavity of 
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