370 DISEASES OF THE G ASTRO-INTESTINAL TRACT. 



over quite extensive areas, and ulcer is not an infrequent com- 

 plication. 



As might be expected, the secretory activity of the gastric 

 tubules is greatly increased. Not only is the quantity of the 

 gastric juice augmented, but it is much richer in pepsin and 

 hydrochloric acid. 



Gastritis Glandularis Atrophica. 



Gastritis glandularis atrophica may occur as a terminal 

 stage of other varieties of chronic gastritis, as a senile change, 

 or complicating various chronic diseases, and rarely as a 

 primary aifection. It is characterized by a degeneration of 

 both the cylindrical cells of the surface of the mucous mem- 

 brane and vestibular alveoli, and the cells lining the gastric 

 tubules. The former undergo a mucoid, and the latter a 

 granular and fatty degeneration. In the tubules it becomes 

 impossible, by reason of their loss of staining properties and 

 indistinctness of outline, to distinguish between the chief and 

 parietal cells. 



Macroscopically the mucous membrane presents a smooth, 

 thin, white surface. In addition to the glandular elements, 

 the submucosa and muscular coats may be involved by the 

 atrophic changes, a thin layer of fibrous tissue taking the 

 place of the latter. In other cases a similar destruction of 

 glandular tissue is the result of a proliferation of the inter- 

 glandular connective tissue. Instead of a thinning of the 

 stomach-wall, it may be greatly thickened by an overgrowth 

 of connective tissue beneath the mucosa often resulting in 

 great reduction of the size of the organ, even to a capacity 

 of a few ounces. 



The natural result of these lesions is a total abolition of the 

 secretory functions of the stomach. In spite of this, however, 

 the patient may remain well nourished and free from other ill 

 consequences as long as intestinal digestion is normal. The 

 evil results produced are often alone due to a failure of such 

 compensation on the part of the small intestine. 



A purely interstitial inflammation of the stomach indepen- 

 dent of lesions of the parenchyma is described by Hayem ; but 



