186 DISEASES OF THE DIGESTIVE APPARATUS. 



point of view and from the troubles they provoke, we must recog- 

 nize the following two varieties : 



1. Ulcers of inflammatory origin (catarrhal ulcerations and 

 hemorrhagic erosions). 



2. Peptic ulcers of the stomach or duodenum, which are round 

 -or perforating (peptische Geschwilre). 



Etiology and patholog-y. 1. Ulcers of inflammatory 

 ORIGIN are developed when the phlegmatic infiltration is intense, 

 or when it is accompanied by hemorrhages in the substance of the 

 mucous membrane. As the inflammatory process weakens the 

 ulcers appear. In the stomach they may be found at various 

 points, while in the intestine they are located in preference upon 

 the lymph follicles {follicular ulcers). Whilst the principal con- 

 dition of their development is the existence of acute catarrh of the 

 mucous membrane they may nevertheless occur after wounds or 

 partial necrosis determined by insignificant causes. 



2. The '^peptic" vlcbb, (ulcus rotundum) is only seen upon the 

 surfaces bathed by the acid gastric juice— that is to say, in the 

 stomach and duodenum. Its genesis is quite different from that of 

 inflammatory ulcers : it is developed by a true gastric auto-digestion. 

 The causes of this circumscribed gastro-malacia produce local circu- 

 latory troubles, which prevent the alkaline blood from neutralizing 

 the acid gastric juice, and the mucous membrane is then exposed 

 to the destructive influence of this fluid. The following are among 

 the most important causes: thrombi and emboli of the arterioles 

 of the mucous membrane ; the atheromatous, fatty, fibrous, and 

 amyloid degenerations of the muscular walls, and also the vascular 

 spasm. In some cases the peptic ulcer is the consequence of an 

 exaggerated acidity of the gastric juice. If left to its action, the 

 slightest solutions of continuity of the mucous membrane are 

 transformed into ulcers, while in ordinary conditions they form a 

 cicatrix very rapidly. The general anemia and the venous hyper- 

 emia of the agastric mucous membrane act in the same manner ; 

 the weakened membrane, insufficiently irrigated by the arterial 

 alkaline blood, cannot resist the contact of the acid gastric juice.^ 

 But in the generality of cases a complex process determines the 

 formation of peptic ulcer. 



1 This theory, according to which the gastric juice is considered the principal factor 

 in the production of ulcer of the stomach, has lost many adherents since the reports 

 of chronic ulcers of the œsophagus in man. — n. d. t. 



