418 



STOMACH AND INTESTINE. 



to which this is attached ; or, by extending 

 laterally, and opening into the peritoneum 

 beyond the margin of the adhesion, leads to 

 perforation. 



Haemorrhage to a considerable extent 

 generally occurs at some stage or other 

 of the ulcerative process. In the earliest 

 periods of the ulcer, this haemorrhage seems 

 to proceed chiefly from smaller vessels. But 

 after the coats of the stomach have once been 

 penetrated, the larger vessels which run on 

 its exterior surface become very liable to be 

 attacked, eroded, and laid open. The haemor- 

 rhage thus produced is a frequent cause of 

 death in this disease. The peritonitis pro- 

 duced by perforation is, however, still more 

 frequently fatal. 



Lientery. A peculiar ulceration of the fol- 

 licles of the large intestine has been described 

 by Rokitansky, under the name of lientery. 

 Like other ulcerations of this segment of 

 the canal, diarrhoea is a constant symptom of 

 its presence. The process begins by a disten- 

 tion of the follicles, which is accompanied by 

 a dusky-red injection of the vessels on and 

 around their summits. The contents of the 

 follicle next suppurate ; and are discharged 

 from the resulting " follicular abscess," through 

 an ulcerated or ruptured opening in the 

 summit of the follicle itself. The follicle thus 

 emptied is next removed by a process of ulce- 

 ration ; the limits of which subsequently ex- 

 tend, so as to form a round or oval ulcer, which 

 has the size of a pea or a small bean. The 

 mucous membrane at the margin of these 

 ulcers is relaxed; and of a pale, grey, or livid 

 colour. And the cellular tissue which forms 

 their base exhibits similar appearances, which 

 are sometimes combined with the various re- 

 sults of slight extravasation of blood. 



The subsequent enlargement of these ulcers 

 in various directions, and the fusion of several 

 into one which may thus be brought about, 

 constitute a secondary ulcerative process, 

 which often lays bare a large surface of the 

 submucous or muscular coat. The bases of 

 these irregular secondary ulcers present cha- 

 racters like those of the primary ulcers just 

 mentioned. Like the dysenteric process, this 

 follicular ulceration increases in intensity from 

 the coecum onwards towards the rectum. And 

 in acute cases, it sometimes extends upwards 

 into the ileum. 



Hypertrophy. The hypertrophy generally 

 described by authors as one of the abnormal 

 conditions of the intestinal canal probably in- 

 cludes, under one name, a variety of states ; 

 which differ widely from each other, both in 

 their nature and results,. 



(1.) That thickened state of the tunics of the 

 tube which is generally found behind an ob- 

 struction of gradual origin or long standing, 

 is the best (if not the only) instance, to which 

 we can really apply the word hypertrophy ; 

 in its strict sense of an excessive nutrition of 

 tissue. Here the propulsive powers of the 

 tube have to struggle against the increased 

 resistance which is offered by the constricted 



or obstructed part : and this increased activity 

 results in an exalted nutrition of the unstriped 

 muscular fibres, which materially adds to their 

 bulk. Such a true hypertrophy of the mus- 

 cular coat may be seen in certain cases of 

 simple stricture of the rectum or oesophagus. 

 And a similar condition is not unfrequently 

 associated with the scirrhous constriction of 

 the pylorus ; as a moderate hypertrophy of 

 this tunic over a large part of the stomach. 



But a careful examination into the minute 

 anatomy of this hypertrophy would generally 

 show, that it can hardly be regarded as due 

 to a mere exalted nutrition of previously ex- 

 isting tissues. On the contrary, even in 

 those instances in which it appears, to the 

 naked eye, almost limited to the circular fibres 

 of the muscular coat, the microscope often 

 reveals evidence of a more extended change. 

 The neighbouring submucous areolar tissue is 

 always infiltrated with an exsudation, in larger 

 quantity, and of more gelatinous consistence, 

 than the nutritional fluid proper to the part. 

 The partitions of areolar tissue by which 

 the bundles of the unstriped fibres are 

 normally separated from each other, are in- 

 creased both in solidity and bulk. And, 

 finally, the fibre-cells themselves not only 

 present a more variable, as well as a generally 

 increased size; but are in many places sur- 

 rounded by a more or less perfect layer of 

 what seem to be developmental forms of these 

 structures. 



(2.) In other cases of what is often called 

 hypertrophy, a more partial and imperfect pro- 

 cess of the same kind appears to take place, 

 incidentally to the exsudation of a plasma, 

 which may doubtless be referred to an in- 

 flammatory origin. In such instances, an 

 examination of the tunics of the canal gene- 

 rally shows all of them to be more or less in- 

 filtrated with a proteinous substance ; which 

 renders them much thicker, whiter, and more 

 resisting than natural. Mingled with this de- 

 posit, we often find an unusual quantity of the 

 unstriped muscular fibre. But it is not al- 

 ways easy to verify the exact amount of true 

 muscular hypertrophy that has taken place. 

 For the exsudation, which generally predomi- 

 nates in the submucous and subserous coats, 

 has also a great tendency to involve the 

 fibrous sheaths of the various bundles of the 

 unstriped fibres; and is thus capable of com- 

 municating to the muscular coat an increased 

 thickness, which by no means implies a pro- 

 portionate hypertrophy of its characteristic 

 fibres. 



The author is inclined to conjecture, that, 

 in these instances of interstitial exsudation, 

 the muscular fibres are capable of being af- 

 fected in either of three ways. In some in- 

 stances they seem to be really hypertrophied ; 

 a process which is possibly the indirect result 

 of the immovable and thickened condition of 

 the tube, being such as to demand increased 

 contractions, and stronger muscular struc- 

 tures, in order to effect its various move- 

 ments. In a second class of instances, they 





