Frequent as ulceration of the mucous membrane is in fever, and
characteristic as this lesion is of the febrile state, yet it sometimes
appears to be present when it does not really exist. From the quantity
of adventitious matter deposited beneath the mucous coat, its surface
sometimes becomes irregularly elevated, its valvulæ conniventes
obliterated and its aspect smooth and glistening: in this state it may
be easily mistaken, on a superficial examination, for ulceration, while
more careful observation will shew that the membrane itself remains
entire.
Proportioned to the extent and degree of these changes in the intestine
are, inflammation, enlargement, induration and suppuration of the
mesenteric glands; and invariably those glands which are embedded in
that portion of the mesentery attached to the affected intestine, are
the most diseased.
It is quite remarkable with what uniformity the spleen is diseased in
fever. In almost every case of genuine fever hitherto examined, it has
been found altered in appearance and deranged in structure. Its natural
purple colour is changed to a deeper and darker tint, and, on the
removal of the peritoneum that invests it, its substance, on being
slightly touched with the finger, breaks down into an almost fluid mass.
The pancreas, the structure of which is so seldom changed in any other
disease, is very constantly deranged in fever. Its morbid condition is
invariably the same, and, what is singular, it is exactly the reverse of
that produced in the spleen. It is always more firm than natural; often
it is exceedingly indurated, and that portion of it which is attached to
the duodenum is sometimes nearly cartilaginous.
Each organ having been described in the order of the frequency and
extent of the disease it exhibits, we have hitherto said nothing of the
mucous membrane of the stomach. This viscus having been regarded in
France as the great source and seat of fever, particular attention has
been paid to the appearances it exhibits after death. The uniform result
of the most careful examination of fatal cases in London is, that the
mucous membrane of this organ is less frequently, less severely, and
less extensively diseased than any other portion of the same membrane.
Occasionally it is more vascular than natural; this vascularity is
seldom general; it is almost always confined to its pyloric half; in the
few cases in which it has been very great, the membrane has been
observed to be thickened and sometimes softened: but no instance has
occurred in which it has been the seat of a single ulcer.
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