84 



DISEASES OF THE DIGESTIVE APPARATUS, 



of an acorn to that of an apple. (Concerning common intestinal 

 worms in their relation to chronic intestinal catarrh, see the section 

 on Helminthiasis : Asearis megalocephala, Tœnia mamillana, T. 

 plicata, T. perfoliata.) 



Symptomatic chronic gastro- intestinal catarrh is also determined 

 by : ulcerations, dilatations, constrictions, displacements, new for- 

 mations, and foreign bodies ; and besides by calculi of the stomach 

 and intestine, bezoars of animal or vegetable nature, abnormal accu- 

 mulations of alimentary matters, and finally the diseases of the 

 pancreas (Martens). 



Among the numerous affections which may provoke gastro- 

 intestinal catarrh, let us particularly mention : Bright's disease, 

 rhachitis, anemia, hydremia, leukemia, and chronic muscular rheu- 

 matism. 



Pathological anatomy. 1. In chronic catarrh of the stomachy 

 the alterations are generally located upon the mucous membrane of 

 the right pouch, especially at the large curvature and in the neigh- 

 borhood of the pylorus. We find there a thick and adherent layer 

 of whitish-gray mucus, containing a considerable number of epi- 

 thelial cells. 



The coloration of the mucous membrane is variable and often 

 shows nothing characteristic. It is usually of a dark or dirty 

 brownish-red; quite frequently we observe a slaty pigmentation or 

 spots of this color, giving the membrane a marble-like appearance. 

 This pigmentation is produced through infiltration of black pig- 

 mented corpuscles, derived from the coloring matter of extra vasated 

 blood, or from small bloody collections due to capillary hemorrhages. 

 In other cases the mucous membrane is of a uniform yellowish-gray, 

 or pale, whitish, with a few much-distended bloodvessels upon its 

 surface ; sometimes this is regular and smooth, or, again, anfractuous, 

 mammillated, or corrugated ; polypous new formations are very 

 rarely found in it (polypous gastritis ; polyposis). 



Microscopic examination has shown us but one case of atrophy ; 

 hypertrophy is the rule ; in the mammillated and polypous forms 

 the thickening may be from three to five times greater than normal. 

 The changed tissues are hard and inelastic, like cicatricial tissue; 

 a sharp instrument can hardly make an incision in them; they 

 creak under its action, the section surfaces are very rigid, and 

 do not present the least retractility. The thickening of the sub- 

 mucous connective tissue and muscular hypertrophy, which is 



