STOMACH AND INTESTINE. 



seem to be but little affected. Finally, in 

 others an J especially in those cases in^vhich 

 the copious exsudation has subsequently con- 

 tracted, so as to diminish the calibre of the 

 tube, the muscular fibres themselves seem 

 to undergo a process of atrophy, which ends 

 in their complete disappearance. 



(3.) The above remarks may serve to illus- 

 trate a brief allusion to a third (and very fre- 

 quent) variety of what is called hypertrophy of 

 the digestive canal, in which it is still more dif- 

 ficult to determine the exact change that has 

 taken place. In these cases an albuminous 

 plasma exsudes into the coats of the canal : 

 either pretty equally throughout ; or with a 

 more or less marked preference for the sub- 

 mucous or subserous areolar tissue, and with 

 marks of inflammation in the neighbouring 

 mucous membrane or peritoneum respectively. 

 When examined under the microscope, this 

 albuminous plasma generally exhibits all the 

 appearances which attend the abnormal de- 

 velopment of fibrous tissue. But the fibres 

 thus developed as the product of a diseased 

 (and often an inflammatory) action, offer 

 marked differences in their structure and ar- 

 rangement from those of the normal areolar 

 tissue among which they originate. While, as 

 regards the changes undergone by the latter 

 or healthier texture, it is often impossible to 

 decide whether it has been augmented or 

 hypertrophied ; or whether it has not rather 

 experienced such an interference with its nu- 

 trition, and such a loss of its substance, as 

 amounts essentially to its atrophy. 



Polypi. The tumours which have received 

 the name of polypi agree in the common 

 character of projecting into the cavity of the 

 digestive canal, by means of a peduncle or 

 stalk of variable length, that attaches them 

 to its walls. Their size varies from that of a 

 pea to a pigeon's or hen's egg. They are 

 almost always covered by the mucous mem- 

 brane : in the submucous areolar tissue 

 beneath which they appear to be generally 

 formed. 



It can scarcely be doubted that the shape 

 of these polypi like that of the papilliform 

 tumours on the external integuments is 

 sometimes determined by a definite arrange- 

 ment or development of the plasma out of 

 which they are constructed. It is, perhaps, 

 chiefly in this way that isolated malignant 

 growths under the mucous membrane so fre- 

 quently assume the pedunculated or polypoid 

 form. But it seems certain that, in many 

 instances, their form is partly the result of a 

 mechanical traction, such as the muscular 

 contractions of the alimentary canal itself 

 might exercise on almost any small tumour 

 projecting from its mucous surface. The pe- 

 dicle* of the tumour is thus continually 

 drawn out and lengthened. And the intus- 



* The movements of the intestines upon each 

 other often seem to exert a similar mechanical in- 

 fluence on tumours or deposits attached to their 

 peritoneal surface. 



susception of that segment of intestine from 

 which this pedicle arises, sometimes affords a 

 remarkable testimony of the mechanical ac- 

 tivity of the bowel. 



The interior of the non-malignant poty- 

 piform tumours generally consists of a more 

 or less completely developed fibrous tissue. 

 In some cases, however, they contain a mass 

 of adipose tissue, which causes them to re- 

 semble appendices epiploicae. In very rare 

 instances, their contents approach the amor- 

 phous character, and friable consistence, of a 

 tuberculous deposit. And finally, they some- 

 times constitute true mucous polypi ; which 

 are distinguished by their tabulated form, 

 their great vascularity, and their erectile and 

 dilatable texture. 



The various small tumours which occa- 

 sionally occupy the submucous tissue of the 

 bowel scarcely require any separate descrip- 

 tion. Cysts are comparatively rare in this 

 situation. Fibrous, or fibro-cartilaginous 

 masses are less infrequent. The latter rarely 

 become the seat of a process of true ossi- 

 fication. The inorganized earthy matters 

 oftener found in their interior are formed, 

 either by obsolete tubercle, or by the cretified 

 contents of old abscesses, the pus of which 

 has undergone a partial absorption. 



Tubercle. The digestive canal is more 

 frequently the seat of tuberculous deposit 

 than any other organ of the body, the lungs 

 only excepted. The pulmonary tubercle is, 

 however, far more frequent than the intestinal. 

 And the latter is not only generally preceded 

 by the former ; but is rarely seen to any ex- 

 tent, before the tuberculous matter deposited 

 in the lungs has already reached the stage of 

 softening and suppuration. 



The different segments of the canal are 

 affected by it in the following order of fre- 

 quency : the lower part of the ileum; the 

 ccecum; the large intestine generally; theupper 

 part of the ileum ; the jejunum ; the duode- 

 num ; and (very rarely) the stomach. 



Both forms of tubercle are met with in the 

 intestinal canal. In a vast majority of in- 

 stances, none but the crude, yellow, or caseous 

 tubercle is detected. But in cases in which 

 the disease has taken an unusually chronic 

 course, the grey granulations are sometimes 

 met with. The latter appear gradually to as- 

 sume the caseous form ; the change beginning 

 at their centre, and extending thence to their 

 circumference. 



The deposit usually begins by engaging the 

 agminate and solitary follicles of the lower 

 third or half of the ileum ; filling and distend- 

 ing their cavities with crude tubercle. A 

 marked *( and often intense) redness of this 

 segment of the bowel usually accompanies 

 the deposit; and remains, as a more or less 

 distinct hyperaemia, during the remaining 

 stages of the process. 



The caseous tubercle contained in these 

 follicles next undergoes the process of soften- 

 ing. The summit of the sac bursts or ulcerates; 

 and its contents escape into the cavity of 



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