Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands / from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.

by G. J. Guthrie

The glands of Brunner are situated at the commencement of the duodenum, within an inch of the pylorus, and are not visible until the serous and muscular coats have been removed from without. They appear to the naked eye like the little white eggs of an insect. Under the microscope each little gland is found to be lobulated, very much resembling a small portion of a salivary gland or pancreas, each lobule having an excretory duct, which unites with those from other lobules to form one larger one opening on the mucous surface of the bowel. The lobules themselves are made up of vesicles, within which the secretory cells are discernible.

The agminated glands of Grew and Peyer, by the latter of whom they were more minutely described, occur in oval patches at irregular distances throughout the jejunum and ileum, and are situated on the side immediately opposite the part where the mesentery is united to the bowel. Each gland resembles somewhat a Florence oil-flask in shape, the small end or mouth, which is more or less pointed, projecting through among the villi or the follicles. They are composed of cells, supplied by capillary vessels, which Mr. Quekett says have the peculiarity of being unsupported by areolar tissue, and are termed by him, in consequence, naked. These are the glands which are found more or less diseased after phthisis and fevers which have terminated fatally. The oval form of the patches is retained, although considerably raised above the general surface of the mucous membrane, and when injected the parts around are more vascular, the ulcerated portion being less so than usual.

The solitary glands are best seen in the cœcum and appendix vermiformis. They are well developed in the fœtus, projecting slightly above the mucous membrane. Each gland may be considered as one of the agminated form much enlarged, and when the free surface is very flat, an opening may be easily seen in the center. These glands also are frequently the seat of ulceration in fever and dysentery, and particularly in phthisis. The follicles partake of this disease, and the whole mucous coat may be destroyed. In some cases there is an attempt at healing, and the edges of the ulcers become more vascular and even villous.

The sub-mucous areolar tissue—the tunica nervosa of Haller, the fibrous lamella of Cruveilhier—separating yet connecting the mucous with the muscular coat of the intestine, is composed of the yellow elastic and of the white or non-elastic fibers, the latter of which predominate. It is more firmly connected with the mucous than with the muscular coat, and in it the blood-vessels and nerves are supported prior to their distribution in the mucous membrane. This sub-mucous tissue or structure prevails also in the stomach, and is often much altered by disease, becoming thicker, and assuming a more dense and sometimes an almost gristly hardness. It is an important part in the surgical treatment of wounds of the intestines, being firmer, stronger, and more elastic in reptiles, and more distinct in carnivorous than in herbivorous animals or in man.

375. The muscular coat of the intestines is in two layers, the internal being composed of fibers running transversely, the outer fibers running longitudinally; they are thickest in the duodenum and rectum. They are of the involuntary or unstriped kind, as opposed to the voluntary or striped, which are of large size, and characterized by striæ running transversely and longitudinally.

The involuntary fibers, on the contrary, are much smaller in size, are always more or less flattened, and present no trace of striæ or stripes, although the interior appears granular, with an occasional nucleus. The heart is a remarkable exception to this rule, being an involuntary organ, with striped fibers differing in size, resembling in this respect those of a voluntary muscle.

The peritoneal coat is formed of the white fibers, under a structureless or basement membrane, covered by tesselated epithelium, constituting a serous and secreting membrane.

376. Wounds and injuries of the abdomen are essentially of three kinds—1. Affecting the paries or wall. 2. Opening or extending into its cavity. 3. Wounding or injuring its contents.

The wall of the belly is, when severely hurt, liable to a permanent defect, as the ordinary result of a severe bruise. It is the formation of a ventral rupture. A division of the wall to any extent by a sharp-cutting instrument is usually followed by a similar consequence; and it never fails to occur in the openings made by a musket-ball penetrating into or passing through the cavity.

Captain Tarleton, of the 7th or Royal Fusiliers, was struck on the left iliac region by a large, flat piece of shell, at the battle of Albuhera, in 1811. The surface was not abraded, although the iron caused a very severe and painful bruise; the whole of that side of the belly became quite black, and the remaining part much discolored. Some months afterward he drew my attention to the part, and I then found that the whole of the muscular portion of the wall had been removed by absorption to the extent of the immediate injury from the piece of shell, the tendinous parts alone remaining under the integuments. These protruded on any effort, constituting a circular-shaped ventral rupture, with a large base, which required the application of a pad and bandage for its repression.