In cases running a longer course the. inflammatory changes may be more pro nounced. In a proportion of these the lesions may be described as catarrhal in •araeter. The macroscopic changes are to a great extent confined to the lower end of the ileum and to the colon, where the congestion is very pronounced, some times general, at other times localized in patches; the lymph-nodules are enlarged and can frequently be seen with com mencing ulceration at their summit; Peyer's patches are also swelled and hyperaemic. Under the microscope hardened sections from stomach and small intestine reveal marked cloudiness of the epithelial cells and in places loss of superficial epithelium. The connective tissue of the villi and that supporting the glands of Lieberkiihn is more or less densely infiltrated. The ducts contain an excess of and are dis tended with mucus. The loss of super ficial epithelium is very general through out the colon. Associated with it is a more or less dense infiltration of the mu cosa, an infiltration which in places may extend even to the muscular coat. Should the case be more protracted, ulceration may supervene, chiefly in the colon, very rarely in the lower portion of the ileum. Such ulceration is, for the most part, superficial, rarely extending deeper than the mucosa. The ulcers, in general, are circular, but in the more severe cases several ulcers may coalesce, forming large, irregular patches, two to three inches in diameter (Holt).
In a larger group of cases the intensity of the inflammation appears to fall chiefly upon the lymph-nodules, which, throughout the colon and especially in the neighborhood of the sigmoid flexure, show indications of a destructive inflam mation. Under the microscope they are seen to be swelled and infiltrated, many showing focal necroses. The surround ing tissues are deeply infiltrated with lymphoid cells. If life be longer pre served the follicular tissues break down, forming small, but deep, ulcers, with overhanging edges, exhibiting a tendency to extend chiefly in the submucous tissue. These cases have very generally a fatal issue. In those cases in which such a termination is avoided convalescence is very slow, the diarrhoea assuming a chronic form, maintained by the pres ence of these ulcers, which, with diffi culty, take on a healing action.
In a few—fortunately very rare—cases the inflammation is of such an intense fibrinous character as to lead to the formation of false membrane. This is the most severe form, and, although the pyrexia may be relatively moderate, the constitutional symptoms are very grave; death generally takes place in from eight to twelve days.
The central nervous system examined in 7 cases of infants under three months old; fever was present in 5 cases, and in 2 death took place without any appear ance of fever; in 3 cases the infants had been ill for some time; the rest, however, had short illness. Changes is the brain and spinal cord were found in all cases. Cells showing various degrees
of degeneration were seen in close prox imity to one another; the different stages in the morbid process could be accurately determined. The first abnormality was an irregular distribution of Nissl's cor puscles; this was dependent upon a process of disintegration affecting either the whole of the cell-body or else por tions in the neighborhood of the nucleus or the periphery of the cell. Concur rently with this disintegration process the corpuscles either diminish in size or else enlarge; they become either paler or darker than normal. and they often lose their polygonal form. In more ad vanced cases the corpuscles disappear en tirely, and their place is taken by a fibrillary net-wo•k containing a clear substance in its meshes. In the cells showing marked changes the nuclei were darker than normal. and the nucleoli were enlarged. Miller and Manieatide (Dent. med. Woch., Mar. 3, '99).
Study of the white corpuscles in 20 nurslings suffering from various di gestive disturbances. The blood was examined at 4 o'clock in the afternoon, before the taking of food. The results of investigations are as follow: 1. In mild acute gastro-enteritis (I case ex amined) the number of red cells is dimin ished; the total number of white cells normal. The leueocytic proportion is about normal, save that the eosinophiles are absent. 2. In acute grave gastro enteritis (3 eases examined) the number of red cells is diminished; the total num ber of white cells is sometimes augmented and sometimes normal. The lymphocytes are always augmented; the mononu clears always diminished; the polynu •lears and polymorphonuclears are some times augmented and sometimes normal. The eosinophiles are absent or normal. Nucleated red cells were observed twice. 3. In mild chronic gastro-enteritis (3 cases examined) the number of red cells is normal or a little diminished; the total 'number of white cells normal or increased. The number of mononuelears is always diminished; the lymphocytes, polynuclears, and polyinorphonuclears normal or augmented. The eosinophiles were absent in 2 cases. There were no nucleated reds. 4. In grave chronic gas tro-enteritis (II cases) accompanied by a cachexia more or less profound, the num ber of red cells is almost always dimin ished. The total number of white cells is augmented or normal in one-half the cases, diminished in the other half. The number of mononuelears is always di minished, while the polymorphonnelears are always augmented. The lympho cytes and polynuclears are augmented or normal. The eosinophiles are absent in one-half of the cases; the nucleated reds were present in 3 cases. A striking feature of these results was the constant diminution of the large mononuclear leu cocytes and the rarity of the eosinophiles. P. d'Orlandi (Phila. Med. Jour.; Revue Men. des Mal. de l'Enfance„Tuly, '99).