616 DISEASES OF TEE STOMACH. 



lerference with resorption, caused by the tough mucus on the gastric 

 and intestinal mucous membrane ; the fat disappears, the muscles be- 

 come relaxed, and the skin dry. Not unfrequently, scorbutic affec- 

 tions, loosening of the gums, bleeding from them, and even ecchymoses 

 on the extremities, are seen. Excessive emaciation is suspicious ; when 

 it occurs, we may fear that the gastric catarrh is a secondary or symp- 

 tomatic affection, which is caused or maintained by carcinoma. 



The frequent change observed in the urine in this disease is pecu- 

 liar, and difficult to understand. Even taking into consideration the 

 fact that disturbed absorption must excite a change in the excretions, 

 we cannot explain the high color, the sediments of urates, or the 

 frequent appearance of quantities of oxalate of lime in the urine 

 of patients who have chronic gastric catarrh (see chapter on dys- 

 pepsia). 



As to the course and results of chronic gastric catarrh, the symp- 

 toms above described may run on for months, or even years, with more 

 or less severity, and often with frequent variations of intensity. When 

 the causes can be removed by proper treatment, the disease is often 

 cured ; in other, not very frequent, cases, it induces severer lesions of 

 the stomach, particularly chronic ulcer of the stomach (?), and, when 

 induced by mechanical disturbances, it may cause haemorrhage from 

 the stomach. Not counting the secondary affections, this disease is 

 rarely fatal ; although cases do occur where the patients finally die of 

 marasmus and dropsy, but they more frequently die of the diseases 

 complicating or causing the gastric catarrh. 



Hypertrophy of the membranes of the stomach cannot be recog- 

 nized during life, unless the calibre of the pylorus is diminished. This 

 may result from the villous hypertrophy of the gastric mucous mem- 

 brane which we described among the anatomical appearances. 



Stricture of the pylorus, from hypertrophy of the mucous mem- 

 brane, impedes the exit of the contents of the stomach ; a new cause 

 of abnormal decomposition is thus added to those resulting from the 

 catarrh. This explains why, in stricture of the pylorus, the symptoms 

 that we deduced from abnormal decomposition of the contents of the 

 stomach (such as eructation of gases and badly-tasting fluids, heart- 

 burn, etc.) reach even a higher grade, and are more distressing than 

 in simple chronic gastric catarrh. Besides this, we have vomiting, 

 which does not occur, or comes only occasionally, in many, or even in 

 most cases of simple chronic gastric catarrh, as one of the most con- 

 stant symptoms of pyloric obstruction ; it usually comes quite regu- 

 .arly two or three hours after eating. This is occasionally different 

 when the stomach is much distended, and hence can hold a largo 

 quantity ; then there may be no vomiting for two or three days ; after 



