STOMACH AND INTESTINE. 



421 



But it is very rarely, if ever, that such a me- 

 tamorphosis really occurs. In general the 

 process thus designated consists merely in 

 the deposit of new cancerous matter within, 

 and especially around, the scirrhous mass ; 

 and not in any true metamorphosis t>f the 

 latter growth itself. 



The cancerous disease of the intestinal 

 canal is often associated with the existence of 

 a limited amount of hypertrophy. For the 

 deposit of scirrhus in the coats of the canal 

 not only thickens and hardens their substance; 

 but, by the annular form it affects, has a 

 special tendency to obstruct the calibre of the 

 tube. Where it does this slowly, and with 

 little disturbance of the general health, the 

 obstruction is often partially compensated by 

 a true conservative hypertrophy of the mus- 

 cular coat behind the diseased part. But, 

 for similar reasons, this hypertrophy is often 

 associated with dilatation : an alteration 

 which is indeed sometimes carried to an 

 enormous extent ; so that the stomach, for ex- 

 ample, fills almost the whole abdominal cavity. 



Of the various morbid conditions already 

 alluded to, there is only one which is very 

 liable to be mistaken for cancer ; namely, that 

 fibrous thickening of the gastric and intestinal 

 parietes which is usually termed hypertrophy. 

 This state offers so many points of resemblance 

 to the scirrhcus deposit, that it seems worth 

 while to enumerate the chief points of con- 

 trast between them. Of these we will only pre- 

 mise that, though they generally afford ample 

 materials for a satisfactory decision, they 

 occasionally leave us in great doubt as to the 

 fibrous or scirrhous character of the particular 

 specimen under examination. 



Comparing these two states in their ordi- 

 nary form, as seen in the stomach, we may 

 sum up their chief differences as follows : 

 1. The scirrhus affects the submucous tissue 

 in a greater degree than the hypertrophy, 

 which is more evenly distributed throughout 

 the three coats. 2. The scirrhus often presents 

 a similar irregularity of distribution in the 

 horizontal plane of the gastric coats them- 

 selves, which it thus renders uneven and 

 protuberant ; while the hypertrophy forms 

 what is generally a larger and more uni- 

 form expanse. 3. The appearance of the 

 scirrhus is white, hard, and gristly or carti- 

 laginous ; that of the hypertrophy is yellower, 

 tougher, and more elastic. 4. The mus- 

 cular substance is involved in hypertrophy 

 chiefly by the atrophy or enlargement of 

 its bundles, within their thickened cellular 

 sheaths. But in scirrhus, it undergoes a 

 characteristic metamorphosis; by virtue of 

 which its structure may almost be * said to 

 approach that of colloid cancer. The fibrous 

 septa become the seat of a development of 

 new fibres ; while in their loculi or intervals, 

 the muscular fibres are replaced by a reddish- 

 yellow gelatinous substance, which consists 



* Marked specimens of this kind are, I believe, 

 sometimes mistaken for the rarer true areolar cancer. 



of characteristic cancerous cells, in various 

 stages of development. 5. The scirrhus fuses 

 and confounds the various tunics; which, in 

 the hypertrophy, generally remain tolerably 

 distinct. 6. In scirrhus, ulceration is of more 

 frequent occurrence, of earlier access, and 

 of wider extent, than in hypertrophy. 7. In 

 scirrhus, the neighbouring glands and organs 

 generally become at length affected by an 

 enlargement and deposit, which itself par- 

 takes of the cancerous characters. 8. The 

 microscopic characters of the two morbid 

 products are usually decisive; the scirrhus 

 almost always offering the cell-forms charac- 

 teristic of cancerous growth, in some part 

 or other of its mass. Thus, for instance, 

 even where the fibres of the central and 

 cartilaginous substance are so numerous and 

 well-developed as to obscure the cells they 

 involve, the gelatinous matter enclosed within 

 the meshes immediately around this harder 

 mass will generally yield an abundant cell- 

 growth ; or the still softer periphery of the 

 tumour will afford the unmistakable cells 

 of medullary disease. 



Of the various segments of the digestive 

 canal, the stomach is by far the most frequent 

 seat of cancer. The large intestine stands 

 next to it in liability to this disease, the lia- 

 bility diminishing successively from the rectum 

 through the sigmoid flexure, to the remainder 

 of the colon. In the coecum, however, it seems 

 somewhat increased. The small intestine is 

 very rarely affected, except in acute and ge- 

 neral cancerous cachexia; in which the mucous 

 membrane, and its submucous tissue, are some- 

 times infiltrated with medullary deposit in the 

 situation of the agminate follicles. 



In the stomach, cancer generally occurs as 

 a scirrhous deposit which surrounds the py- 

 loric extremity of the organ. The cancerous 

 growth is strictly limited towards the duo- 

 denum, by the pyloric valve; but it extends a 

 variable distance along the right side of the 

 organ, generally favouring the lesser curvature. 

 The neighbouring gastric surface is often oc- 

 cupied by small isolated deposits of cancerous 

 matter, which lie beneath the mucous mem- 

 brane. And the healthy muscular coat, as 

 before mentioned, is also frequently hyper- 

 trophied over a large extent of the same 

 locality. 



The chief peculiarities of the scirrhous 

 mass have been enumerated in speaking of 

 the differential diagnosis between it and 

 hypertrophy of the stomach. Beginning in 

 the submucous tissue, and the subjacent mus- 

 cular coat, it rapidly involves both of these 

 structures in a white cartilaginous-looking 

 mass ; the more opaque and fibrous parts of 

 which often seem to give off bundles of fibres, 

 that pass completely through the muscular 

 coat. The anatomy of these fibrous bundles has 

 already been mentioned. The disease advanc- 

 ing, involves the subserous tissue and the pe- 

 ritoneum, on the one hand; and the mucous 

 membrane on the other. The latter of the 

 two extensions is generally both earlier in 



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