512 DISEASES OF THE STOMACH. 



serve that alcohol acts the more injuriously the more undiluted it is 

 taken ; hence brandy-drinkers are most liable to the affection. 



2. In many cases chronic gastric catarrh depends on congestion of 

 the gastric mucous membrane. The obstruction of the circulation in- 

 ducing this congestion may be located in the portal vein ; hence we 

 find that all affections of the liver, by which the portal vein or its 

 branches are compressed, are always accompanied by chronic gastric 

 catarrh. But more frequently the obstruction lies beyond the liver; 

 all affections of the heart, lungs, or pleura, that cause an overfilling 

 of the heart and obstruction of the vena cava, also obstruct the escape 

 of blood from the li ver, and hence from the stomach ; consequently, in 

 emphysema, cirrhosis of the lungs, valvular disease of the heart, etc., 

 we meet chronic gastric catarrh just as often as we do cyanosis of the 

 skin, and both affections must be induced in the same way. 



3. Chronic gastric catarrh often accompanies phthisis and othei 

 chronic diseases. In part L, we showed that patients with incipient 

 phthisis often complain more of their gastric catarrh than of the lung 

 trouble, and that is what first induces them to apply for aid. 



4. It always accompanies cancerous or other degeneration of the 

 stomach. 



ANATOMICAL APPEAEANCES. In chronic gastric catarrh, the mu- 

 cous membrane is often reddish brown or slate gray, just as it is else- 

 where when it is the seat of chronic catarrh. This is caused by small 

 capillary haemorrhages in the tissue of the mucous membrane, and the 

 transformation of the haematin into pigment. Instead of the fine 

 injection seen in acute catarrh, we usually find a coarse anastomosis, 

 and in some places dilatations of the vessels. Moreover, the mucous 

 membrane has become hypertrophied, it is thicker and firmer, and, even 

 when the muscles are not contracted by rigor mortis, we find the 

 mucous membrane forming numerous folds, and some parts of it are 

 occasionally elevated to soft spongy nodules by a velvety hypertrophy. 

 We often find innumerable small prominences, separated by super- 

 ficial furrows, a state described as the 'etat mamelonne. The mam- 

 millated appearance most frequently depends on partial hypertrophy 

 of the gastric mucous membrane, by which some of the glands and 

 their insterstitial connective tissue have been enlarged. Frericlis 

 asserts that it is also caused by roundish collections of fat in the sub- 

 mucous tissue, or by the development of closely-crowded closed fol- 

 licles ; according to JBudd, they result in some cases from overfilling 

 of the gastric glands with retained secretion. These changes are 

 found most frequently and farthest advanced in the pyloric end of the 

 stomach. The inner surface of the stomach is covered with a grayish- 

 white, tough mucus, which clings firmly to it. 



