188 DISEASES OF THE DIGESTIVE APPARATUS. 



constitute small crateriform cavities, due to loss of substance. In 

 the end they may acquire dimensions varying from the diameter of 

 a ten-cent silver piece to that of a small saucer. The necrobiotic 

 process affects successively the submucous connective tissue, the 

 muscular tunic, and sometimes also the serous. More or less 

 abundant hemorrhages are produced through the destroyed blood- 

 vessels, peritoneal adhesions are formed upon the level of the 

 ulcerations, and in some cases these lead to a complete perforation 

 of the intestine. 



Near lesions in which the destructive process is well marked 

 there may be found others showing a tendency to healing ; others,, 

 again, are in a more or less advanced stage of repair, and we may 

 even detect star-shaped cicatrices resulting from healed ulcerations. 

 The great losses of substance are never entirely repaired, their 

 edges become thickened and form a swelling of a cartilaginous 

 consistence ; the submucous connective tissue and the destroyed 

 muscles are replaced by a fibrous neoformation, and the neighbor- 

 ing mucous membrane shows streaked folds. We also observe all 

 the alterations of chronic catarrh. 



Peptic ulcers have rarely been observed. They are found ex- 

 clusively in the stomach and duodenum, which localization is 

 sufficient to establish the difference between these and catarrhal 

 ulcerations. Their form is regular, round or elliptic; the edges 

 are smooth and cut sharp, as if stamped out ; their depth is vari- 

 able. They may become quite healed, leaving a radiating cicatrix; 

 they often produce hemorrhages or peritoneal adhesions; sometimes 

 they end in perforation of the gastric or intestinal walls. 



Among the cases of ulcers described in our special literature, 

 those of Siedamgrotzky, Grad, and Zippelius were of a catarrhal 

 hemorrhagic nature ; Bruckmuller, Roloff, and Frohner have 

 studied round peptic ulcers ; the lesions described by Gotteswinter 

 and Mlinich were probably also peptic ulcers. In a case related 

 by Roloff, an obliterated arteriole ended in ulceration. 



Symptoms. It is impossible to distinguish the clinical differ- 

 ences of these two varieties of ulcers, the existence of which is 

 demonstrated by the pathological anatomy. Indeed, the symptoms 

 are obscure, and are confounded with those of chronic gastro- 

 intestinal catarrh. Siedamgrotzky has only observed emaciation 

 and a progressive weakening. Grad and Zippelius have noticed 

 symptoms of chronic catarrh of the abomasum of the ox ; also 



