Although the intumescence of the intestinal follicles occurring in various morbid conditions is not the consequence of palpable inflammatory action, it may yet be fairly considered at this place, as it commonly appears to result from the relation of certain general morbid states to the follicular apparatus.

We find that the patches of Peyer in the small intestine, the solitary follicles of the small and large intestine, and the follicles of Lieberklihn, in the small intestine, may be affected in this manner. The affection is observed:

1. In substantive affections of the intestinal mucous membrane, as in diarrhoea, and particularly when occurring in children, in whom it is marked by more or less vascularity and congestion, but frequently also by an anaemic condition of the parts. In the diarrhoea of children and young persons we find, besides an enlargement of the solitary and of Peyer's glands, a dilatation of Lieberkuhn's follicles; a grayish-white creamy matter accumulates in their interior, which produces a whitish punctiform appearance in the intestinal mucous membrane, or, in transmitted light, gives rise to so many opacities.

2. The affection occurs most frequently as a reflex of constitutional disease: under these circumstances, the swellings of the solitary and of Peyer's follicles are found principally in the colon in typhoid gastroenteric fevers, as an imperfectly-developed secondary typhous eruption in almost all the exanthemata, but especially in scarlet fever, variola, and erysipelas; in acute rheumatism and gout; in croup; in suppurative and gangrenous disease; in febrile affections of the lymphatic glands in scrofulous individuals; in hydrocephalic fever; in a marked form in common Asiatic cholera; and lastly, in acute convulsions, trismus, and tetanus. The villi are generally also much swollen, but we invariably find the mesenteric glands in a state of tumefaction.

Swelling of the follicles is the consequence of a deposition of a grayish-red, dull-white, or yellowish substance, of a lardaceous or creamy and glutinous consistence in the cavity of the follicle, accompanied by an analogous infiltration of its parietes; thus the follicle and the deposit not unfrequently appear to constitute a homogeneous body, to which the term "granulations of the intestinal mucous membrane" has been applied. This follicular affection differs from that occurring in typhus in everything that characterizes the latter, and especially in reference to the metamorphosis of the typhous follicle.

According to the predisposing constitutional causes, the affection we are treating of is more or less acute and transitory; the deposit, the follicular tissue, and the mucous membrane in very rare cases fuse into a small shallow ulcer; induration and a further development occasionally take place, and the mucous membrane being pushed forwards, a species of polypoid pediculated growth is formed.

3. Gangrene Of The Mucous Membrane

We have had occasion to examine the ulcerative process consequent upon inflammation in a variety of forms, and any further investigation of the subject were superfluous. We pass at once to gangrene of the mucous membrane, although we must observe that it rarely is a direct consequence of inflammation.

Gangrene of the mucous membrane is brought on by compression and traction, and is generally accompanied by gangrene of the other intestinal coats, as in incarcerated hernia at the point of strangulation, or in consequence of excessive dilatation of a portion of intestine above a stricture, at various scattered points; it may occur in large patches in consequence of mechanical hyperaemia brought on by incarceration, or of passive congestion induced by paralysis; it may take place in the shape of a circumscribed slough of the mucous membrane consequent upon inflammatory action (gangrenous inflammation strictly so called), in which the peculiar anomalous state of the blood and the peculiar nature of the product, are the cause of mortification. To this head belong the sloughs of the intestinal mucous membrane, which occur with symptoms of general adynamia and putrescence, in acute dyscrasia of the blood, in purulent and ichorous infection of the blood, under the form of degenerated typhus, cholera typhus, etc.

After the slough has become detached there is a loss of substance in the mucous membrane which demands some attention, as it may be confounded with an intestinal ulcer; the diagnosis is established by the existence of an external or internal cause of gangrene, or by a correspondence, in seat and form, between the latter and the external influence (compression, traction); again, the slough of gangrenous inflammation is distinguished by its oblong, striated form, and very varying seat, by its defined contour, and by the absence of morbid growth at the edge, at the base, as well as in the circumference of the eroded part.

4. Inflammation Of The Submucous Cellular Tissue

In several of the processes we have hitherto considered, we have had occasion to notice the various modes and degrees in which the submucous cellular tissue is involved in disease of the mucous membrane. An isolated inflammation of the submucous cellular tissue is very rare, and when it does occur it is commonly metastatic and terminates in suppuration. It takes place in the shape of distinct foci of varying extent, which either give rise to perforation of the mucous membrane, or advance towards the peritoneum, and here produce peritonitis; or in certain portions of the intestine, as in the caecum, colon ascendens, and rectum, produce extensive suppuration of the cellular tissue.

5. Softening Of The Intestinal Canal

We may pass over the softening of the intestinal mucous membrane which we have described when treating of the Exudative Processes and Dysentery, as converting the tissue into a pulp, which, in proportion to the state of vascular action, and to the quality of the exuding matters, is either easily removable or is spontaneously detached. We have here to allude to the gelatinous ramollissement of the intestinal mucous membrane, which offers an analogue to the gelatinous softening of the gastric mucous membrane. It is of much rarer occurrence than the latter, though like this, it affects the small intestine as a complication of cerebral disease, of acidity in the primae viae, of extreme general collapse, atrophy of the muscular tissue, and anaemia of the intestine; it involves the external coats of the intestine, converts them into a homogeneous, grayish-red, transparent, and deliquescent gelatine, and leads to spontaneous perforation. We also advert to the analogue of black softening of the stomach, which occasionally, though much more rarely, attacks the intestine. It occurs under the same conditions, and mainly affects the mucous membrane of the caecum, and in this case occurs, like gelatinous softening, on the cellular base of the typhous ulcer.