538 THE DIGESTIVE SYSTEM. 



the connective tissue of the inucosa and subniucosa. The exudate may 

 be diffuse or localized in the form of abscess. As an independent affec- 

 tion it is rare. It is more frequent in connection with puerperal fever 

 and other infectious diseases; it has been ascribed to injury. 



The accumulation of exudate may be slight, the interglandular and 

 submucous tissue being osdematous with few pus cells. The mucous 

 membrane may under these conditions remain intact or show slight ca- 

 tarrhal lesions. When this relatively slight accumulation of exudate 

 occurs in the pyloric region it may apparently occasion temporary steno- 

 sis. On the other hand, a considerable or large amount of exudate may 

 form, and the process may involve diffusely a large part of the wall of 

 the stomach; or the process may be circumscribed and abscesses may 

 form. The suppurative process may extend to the mucous membrane, 

 or to the serosa, and thus perforations may occur and the incitement of 

 peritonitis. Little is known of the direct excitants of phlegmonous gas- 

 tritis. 1 Streptococcus pyogeues has been found in the exudate. 2 



Toxic Gastritis. The mineral acids, the caustic alkalies, arsenic, 

 corrosive sublimate, and the metallic salts, phosphorus, camphor, and 

 other irritating materials, induce different lesions of the stomach, accord- 

 ing to their quantity, their strength, and the length of time which has 

 elapsed before death. 



In large quantities they destroy and convert into a soft, blackened 

 mass both the mucous membrane and the other coats, so that perforation 

 may take place. In smaller quantities they produce black or white 

 sloughs of the mucous membrane, surrounded by a zone of intense con- 

 gestion. If death does not soon ensue, the ulcerative and cicatricial 

 processes which follow such sloughs may contract and deform the stom- 

 ach in various ways. 



If the poisons are of less strength they may induce a diffuse conges- 

 tion of the mucous membrane, with catarrhal or croupous exudation on 

 its surface and serous infiltration of the submucous coat (see chapter on 

 Poisons). 



Tuberculous Gastritis of the stomach is rare and is usually secondary 

 to tuberculous lesions elsewhere. There may be miliary tubercles or 

 small or large, single or multiple ulcers involving especially the mucosa 

 and submucosa.* 



Syphilitic Inflammation of the stomach with ulceration has been occa- 

 sionally observed. 4 



1 Reference to the bibliography of micro-organism of the normal stomach may be 

 found in an article by Weiss on "Bacteria in the Stomach of the Cat," Jour, of Applied 

 Microscopy, vol. iii., p. 827, 1900; also Coyon, "Flore microbienne de 1'estomac," These 

 de Paris, 1900, bibliography. For bibliography of phlegmonous gastritis see Leith, 

 Edinburgh Hospital Reports, vol. iv., p. 51, 1896. 



2 See Kinnicutt, Trans. Assn. Am. Phys., vol. xv., p. 127, bibliography. For a 

 study of lesions of the stomach as portals of entry of bacteria see James, Trans. Assn. 

 Am. Phys., vol. xvi., p. 72. 



3 Consult for bibliography of tuberculosis of stomach Blumer, Albany Medical An- 

 nals, March, 1898. 



4 Consult for bibliography Flexner, American Journal of Medical Sciences, vol. 

 cxvi., p. 425, 1898. 



