TABES MESENTERICA. This name is applied to a particular slowly-disorganising affection of the mesenteric glands, and expresses the marked emaciation which attends the disease. It is through the mesenteric glands that the nutritive products of digestion are trans mitted in their course to the great current of the circulation ; and any disorder which destroys or obstructs these organs must, in proportion to its intensity, affect their function, and derange the process by which healthy materials of renovation should constantly be commingled with the blood. Hence in part arises the loss of flesh in this form of tabes ; but the direct hindrance of nutrition which the disease involves is not the sole, though an important cause of the symptom ; for the general ill-health, of which tabes mesenterica is but a part, and other co-existing complaints, usually co-operate in producing it.
The disease is one among many manifestations of scrofula ; and is essentially the same to the glands of the mesentery as those obstinate glandular enlargements of the neck, with which the eye is more familiar, are to their region of the body. From difference of position and of relations it includes other symptoms and graver consequences than theirs; but it originates in the same constitutional tendencies, and follows the same general progress. It belongs, like other forms of scrofula, to early life; the ordinary period of its invasion being from the second to the twelfth year. In the Hopital des Enfans, of Paris, children ars received from a year after birth till the com pletion of sixteen years of age; and M. Ouersent, the physician of this institution, states that the disease exists among those admitted in the proportion of 7 or 8 to 100 ; and that it is more frequent among female children than among males.
The morbid appearances on dissection of fatal cases are, a more or less complete transformation of the glands into tubercular masses, with various consequent or coincident diseases of the adjoining organs. The glands appear at the commencement of the complalint to be the seat of a feeble inflammatory action, under which they merely swell and become preternaturally reddened with blood; but this stage of simple congestion soon induces a further change, in which the charac teristic product of scrofulous inflammations becomes deposited in the tissue of the gland. The dull white granular tubercles, by which the infiltration commences, arc gradually multiplied in number or increased in volume ; and, in like proportion, the glandular substance itself is absorbed to make room for the encroaching disease, till at length a rounded tubercular mass results, varying for each tumour from the size of a marble to that of an egg. 111 a still more advanced condition of the disease suppuration frequently occurs in these tumours, and they are then seen to contain the cheese-like matter of softened tubercle mixed with pus. The abscess so formed excites irritation in its neighbourhood ; the folds of peritoneum covering it become glued together, and its progress occasionally -extends to discharging itself into the nearest intestine, or through the external integument of the abdomen. A certain amount of inflammation of the peritoneum, with
adhesions and effusion of serum (ascites), attends these latter stages ; and some inflammation and ulceration of the mucous membrane of the intestines are likewise frequently found.
For a particular account of its causes the reader may refer to those of SCROFULA. Original weakness of constitution, shown in general susceptibility to the impressions of disease, in slowness and insufficiency of reactive and reparative power, is the groundwork of these, and con stitutes the main peculiarity of the so-called scrofulous diathesis. But this weakness may, where inborn, be aggravated, or, where naturally absent, be artificially produced by a variety of depressing causes ; by insufficient or unhealthy food, by neglect of cleanliness and exercise and clothing, by residence or constant occupation in ill-ventilated buildings, by exposure to cold and damp : all of them influences to which the young of the poor in crowded towns are exposed, and with which too frequently an inherited predisposition powerfully co-operates. Derangement of the bowels must be considered the most fretment special cause of this particular form of scrofula; the irritations, inflam mations, and ulcerations of their mucous surface (of which such full evidence is given in the state of the tongue and excretions, and in the tympanitic abdomen) excite corresponding conditions in the absorbent glands connected with them (precisely as a lesion of the hand irritates the glands of the axilla), and the inflammation so beginning takes a course determined by the peculiar constitution of its subject.
As regards symptoms, it may be observed that in its earliest stages the disease has no signs by which it may be certainly distinguished ; that it is not till the glands are so enlarged as to become sensible ex ternally that their affection can be positively declared. The early symptoms are those of the intestinal disorder or irritation, which is acting as a cause of the disease : capricious appetite, irregular and unhealthy stools, flatulence or occasional vomiting, loaded tongue, foul breath, harsh skin, sallow complexion, and loss of flesh, with an accelerated pulse, may have existed for sonic' time, before enlargement of the abdomen attracts notice. It will then usually be found that steady pressure on this part causes uneasiness or pain. As the growth of the glanular tumours continues, the signs of intestinal disease become more marked ; diarrhcea with mucous stools, increased emaciation, frequent pulse, and evening accession of fever, marking this stage, in which the tumid abdomen contrasts remarkably with the wasted limbs and shrunken wan face of the patient. Finally, hectic fever with exhaustive diarrlicea, or acute abdominal inflammation, or the progress of the constitutional disease in other organs, or absolute starvation (atrophic), terminates life.
The treatment of tabes mesenterica must be in accordance with the general rules for management of scrofula, and consists in that modified tonic system, to which the name of "alterative "is given. [SettoFeta).