CHRONIC GASTRIC CATARRH. 513 



The thickening is not always limited to the mucous membrane ; 

 sometimes the submucous and muscular tissues are changed to a fatty 

 mass, several lines or even half an inch thick. This thickening of the 

 wall of the stomach also depends on simple hypertrophy, in which 

 there is both a new formation of muscular cells, and an increase of the 

 submucous and intennuscular connective tissue. On the cut surface 

 the thickened muscular tissue shows a pale grayish-red, soft, fleshy 

 mass, traversed by parallel connective-tissue striae, running from with- 

 out inward, and having a peculiar fan-like appearance. Occasionally 

 the whole pyloric end of the stomach, and especially the pylorus itself, 

 is changed in this way ; in other cases the thickening of the walls of 

 the stomach is more circumscribed, and forms certain prominent nod- 

 ules (Foerster). The pylorus may be greatly constricted by thicken- 

 ing of the walls of the stomach from simple hypertrophy, and this con- 

 striction may cause great dilatation of the part of the stomach above 

 the stricture. .; 



SYMPTOMS AND COURSE. In chronic gastric catarrh, the patients 

 complain most of a disagreeable feeling of pressure and fulness in the 

 stomach, which is increased by eating, but rarely amounts to severe 

 pain. Where the latter occurs after eating, and the epigastrium is 

 sensitive to pressure, we must always suspect that there is not simply 

 chronic gastric catarrh, but that it is complicated by some more serious 

 disease. With the feeling of fulness there is almost always a promi- 

 nence of the epigastrium, caused by the filling of the stomach with 

 gas, and by the ingesta remaining in it for a long while. The gases 

 in the stomach are formed in chronic catarrh also by the decomposition 

 that the ingesta undergo when the gastric juice, which has become 

 alkaline, no longer causes normal digestion, and the mucus in the 

 stomach acts as a ferment on its contents. The abnormal decomposi- 

 tion is assisted, however, by the fact that, although the muscular coat 

 of the stomach has increased in thickness, its functions are paralyzed 

 by serous infiltration. When the movements of the stomach are 

 retarded, food remains in it a great while, and undergoes abnormal 

 decomposition. From time to time there is eructation of gases having 

 the same composition as those formed in acute gastric catarrh. With 

 the eructation, which is a constant symptom of chronic gastric catarrh, 

 besides the gases, small quantities of sour or rancid fluid often rise 

 into the mouth, and are either spit out or swallowed again. The for- 

 mation of lactic and butyric acids from the transformation of the amy- 

 lacea is often very extensive, and the sour and acrid fluids, rising into 

 the oesophagus and pharynx on belching, cause the burning feeling 

 called heartburn. 



Occasionally, beside the above symptoms there is vomiting / this, 

 34 



