418 MUCOUS ME:.[BRANES. 



secretions, v/liicli are perhaps unable to escape v>'itli due rapiditVy 

 owing to the narrowing of the efferent duct, but which, in any 

 case, do not escape fast enough. 



§ 357. From this point of view we can readily see how, 

 under certain circumstances, the dilatation may preponderate 

 over the hypertrophy, and how it is that we so often find cystoid 

 DEGENERATION associated with glandular In^^ertrophy, in mucous 

 membranes affected by chronic catarrhal inflammation. The 

 two conditions complicate one another in various ways, giving 

 rise to a series of coarser alterations of the mucous surface, which 

 we may now briefly consider. 



What is known as the etat mamelonne of the gastric 

 mucous membrane, is due to the fact that the mucous membrane, 

 whose glandular layer is hypertrophied, comes to be too large 

 for the area of its bed, and is therefore thrown into folds with 

 intervening hollows. This plication of the mucous membrane is 

 to some extent — as in the pyloric region — physiological ; hence 

 the ^' etat mamelonne" is at first only a quantitative excess. 

 It is only with the aid of the microscope, that we can draw the 

 line between quantitative and qualitative deviations from the 

 normal standard. The dilatation of the hypertrophied tubes, 

 which is usually very striking, serves as a reliable criterion of 

 the morbid nature of the alteration. Higher degrees of the 

 ^' etat mamelonne " pass directly into polyposis ventriculi. 

 We commonly find a number of transitional forms side by side 

 in the same stomach. The folds are subdivided into smaller 

 areas by furrows which cross them at right angles ; these are 

 best seen at some distance from the pylorus, about the middle 

 of the stomach : the overgrowth of the glandular layer pro- 

 gresses steadily within these areas. A flattened, roundish 

 tubercle soon projects above the surface. The higher it grows, 

 the more disproportionate is the enlargement of its free ex- 

 tremity ; it becomes fungoid and is finally converted into a 

 polypus, with a globular head rather larger than a pea, and a 

 very thin stalk. We occasionally find as many as thirty such 

 polypi upon the mucous membrane of the stomach, with which 

 moreover they ^'ividly contrast by their dark-red hue ; fi'om 

 four to six of them are often seated on a commoii base ; next to 

 cancerous products, they cause the greatest and most striking 

 alterations in form, to which the gastric mucous membrane is 



