ULCERS OF THE STOMACH AND INTESTINE. 



187 



If these two varieties of stomachal and intestinal ulcerations 

 sometimes give rise to particular Symptoms which permit us to 

 distinguish one from the other, yet it is by no means easy to do so, 

 and the observations on record testify that the two kinds have 

 frequently been confounded. Thus there is a neceesity for a more 

 precise anatomical description of gastric ulcer than that hitherto 

 outlined by different authors. 



At the Berlin slanghter-house E,. Ostertag found in the calf six 

 cases of peptic ulcer of the abomasum ; in several the stomach was 

 perforated, and he could detect an intense catarrh of the mucous 

 membrane in all. The macroscopic and microscopic examination 

 indicated that none of these cases were of thrombotic origin. 

 The form of the ulcers, however, showed clearly that the process 

 had its starting-point in vascular troubles. Ostertag, while point- 

 ing out that the pathology of stomachal ulcers is as yet little known, 

 estimates their close relation to catarrh and to nutritive disturbances 

 produced by this cause. 



Cohnheim asserts that the numerous anastomoses existing in the 

 gastric mucous membrane are sufficient to prevent thrombi and 

 ulceration. According to him, the circulatory troubles could not 

 by themselves produce a true persisting ulcer, for in cases where 

 local artificial thrombi produce ulcers, the latter lieal very quickly. 



Introduction of a large proportion of acid into the stomach 

 has given negative results. Id man it has been established that 

 ulcers of the stomach often correspond to a diminution of acidity of 

 the gastric juice. These few facts are sufficient to bring out the 

 vague points of our actual knowledge upon the pathology of 

 peptic ulcer. 



Pathological anatomy. Catarrhal ulcerations of the stomach 

 are developed from the erosions which accompany intense mucous 

 hyperemias and phlegmasias complicated by hemorrhage. These 

 erosions are ordinarily observed in the right compartment of the 

 stomach, especially in the neighborhood of the pylorus ; they 

 appear in the shape of small solutions of continuity of the super- 

 ficial layer of the mucous membrane, are round, with sharp and 

 soft edges, with an irregular and bloody ground. In the intestine 

 the catarrhal ulcerations are developed preferably at the expense 

 of the follicular ulcers ; these latter are themselves the result of 

 an abundant cellular infiltration of the lymphatic follicles, ending 

 in molecular gangrene of the affected tissue. At the outset they 



