On a Peyerian ulcer-lesion of the small intestines, apparently new / by H. Vandyke Carter.

Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: On a Peyerian ulcer-lesion of the small intestines, apparently new / by H. Vandyke Carter. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    110/164 (page 94)
    liave ov have uofc been seen elsewhere and at times been regard- ed as of ordinary typhoid nature. The clinical and etiological aspects of this subject, remain at least equally undecided. Eegarding the mixed-fever of stations in the iVlediterranean, Egypt, the West Indies and at the Cape, so frequently alluded to in reports of the Army Medical Department, all I need here state is that nowhere have I found the description of a lesion identical with that under review. (There are some details of interest in Surgeon-Major P. H. Welch's Alexandra Prize Essay, ]883, on Enteric Fever in the British Army.) As regards more recent Indian records, I would note first the significant remark of Dr. Wall, late of Calcutta (quoted in Fayrer, I. c, p. 175), that in some cases of fever nearest resem- bling the remittent, there may be found an intestinal ulceration 'distinctly not typhoid, being irregular aud by no means select- ing the site of Peyer's patches and very often encircling the bowel.' More particularly, Dr. G, F. A. Harris has described (Ind. Med. G-az., August, 1884), the case of a young Euro- pean recently arrived in Calcutta, who died after 20 days' per- sistent fever without any symptoms of enteritis; at the autopsy there being found 'no disease anywhere except in the jejunum about its middle, where were numerous superficial ulcers or erosions sometimes transverse and blood-stained, with clean margins overhanging and not thickened; these ulcers were not in the least like typhoid ulcers, nor were they tubercular;' the corresponding mesenteric glands were not enlarged, and the ileum was healthy. The precise dimensions of these lesions is not given, nor is allusion made to their connection (if any) with the lymph-follicles of the intestine; and hence it remains with me uncertain, if they be identical with the ' Septic' ulcer under discussion. As this last remark applies also to the ' perforat- ing' ulcers shortly to be mentioned, I will only add that accord- ing to my experience the remains of a Peyer's patch may be both scanty and indistinct, and not to be detected without the aid of a lens, the portion of the bowel also being submerged iij a clear medium, gently brushed ovei', and somewhat stretched out: of course the site of the ulcer, as regards periphery of gut,