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Show DISEASES OF THE ORGABS OF DIG TARTE IV. F11" 1.-Aeule Iffl'rllON/HIf/IC (1115117115, PI'mI/III/ D11generation of 11111 I)(II/)l(‘//1/)IZ(I. 11111t1'11113 Jim/101m F1111. flumlate 11111111 1'1I14 1%I11flfll‘. (1'.\511'. - \ 21ii'ltVV'elV'e year.5 old. [11.51.111'll/ 111111 .2.¥1/III/1111III5'. -.\he VV'a5 taken VV ith pharV't152'eal diph|theriti5| about tVV'o VVe11115 bel'ore 11111 death. ()11 the tcntl1 day 11 'h1r 5i1'11ne55 5l1e Vo111it1d blood 1opiou51V and 112111 b'loody' 5tool5. l'he 1111l'ee2'1tion5 1ont1nu111 V1"1V lie- quent. until 111"1 11 ath. ()n the day 111' 11111' death 51111 112111 very 511V'ere. no5e-bleedin5_1;. 11i11d t'rom exl121u5tion. The body W215 examined the third day al'ter death and 5hoVV'11d po5t-lethal dark 5pot5 in 111211 V' pla1'e5. 11211111111'1'11212115 in all serou5 111en1brane5 and 1'aV'itie5. (1'11'eat' alteration in myocardium and kidnem Spleen normal 51Il't' palate ton5il5 11V 111.1. and adjacentti5511e5. the root ot' the tongue V11'V' much 5VV'1)llen. T heir 511pe'1'li1' i211 5t1'1111'1t1n15 opa1|ue.dirt_V gray color. in plaee5 green. and reduced to 21 51111 pulp. co115i5tii12'ot' debri5 ot' the ti55ue 21nd enormou5 1111111111115 ol'ditl'erent-5ha|Ied 11111111 and baeteria. The 1leeperti55ue5. in con5equenee ol' prol'u5e inliltration5, are deep 11111.211111 eontain many eon52'erie5 ol' 7I/I'(‘I‘(H‘()(‘(‘l'. .\ll ti.5'.5'ue5 ol' the larynx. the lymph-212111115ot' the 11111111. ete.. in :1 111211 5tat'11 ot' 112111111121tou5 infiltration, .5o1ne hyperzemie. 51I1ne 2111211mie. .TION. [SECTon VI. It. seems t11e~ga5tric juice has not acted cV' erVVV 1111111 alike in thent and duration. The Vello" 1511red portion5 ol the 112211111111'112111115 are due to a combination of bloody 211111 cell- 111211' in filtration. They VVere plodueed bV irritant emboli, VVhieh turned into 112en1o1'rha11e5. home of 11111511 eontain 111ie1oc-oe1i, some do not. but all 5hoVV ed 21 deep 1li5tu1'ban1e of nutrition. The content5 ot' the inte.5'tine5 VV1'"11- 211.50 111111;]; led with blood, eV'identh' deriV'ed [111111 the 5ton1aeh. 11'112.._.-1\11I11111,'1'1'1'II1I (11111 11'»II/1 (:‘1/51I'I'1I'5. [lawn/11'- I'1111_I/11.'.12".I115'IIIII5'.111511 JI'IT'IIIII/ [III11I"'111/I11II 1'11 1111.1 1101/511:] 11111 lIIfI1,5'/III11 ('\.511- .\ liV'e-year-old boy. [11.51/1III/ 1III1/ I\I/III/It1IIII5. ~'.\hont tVVo VVeek5 bel'ole 1115 1121th he b1eame u11VV1ll. r115tle55. 211111 lo5t hi5 appetite 211111 hi5 ordinary 51'ood humor. \\215 pee1Vi5h. 211111 at ti1n115. 1'hi1th' in the i1i11'11t.1'eV'eri.511.1"1111111daV51111111111111121thhi5 511in beeame int1n5elV' 1'1'11. and he toiiiplained ot' thir5t. TV1-V1ntV' l'our 110111'5 111111111 d1ath he took 51111111 t'ood. and Very 5oon began V'11111itin52' 211111 pnr51'in11'. VV'hieh. VV'ith 11x1'115- .5iV'e VV'ealtne55 211111 pain in the 112.111 l'e'1'V11 and 111'2e1t thir5t. 121.5ted until hi5 death. 1'1I5t-n1o1'ten1 examination forty-eight 110111'5 after death. '1'1111511'in. the ctranial 211111 thoraeie o1'51'an5 oll'er1d nothinh' abnormal. 11115111115 5ome p.11111n1'hym2 1ton5 alteration ol the 11idn1V5 oan 5on1e poition5 ()1 the i11te5tinal tiact VV'"11e 2111'111ted. l'he ton5i15 and pharVnV VVeie 5VVollen and V11'V' red; the tongue and 11151I|111212115 pale. but not at 2111 211111111111. 'l'he 5tom21eh 51In111VV'hat eontra1te11. it5 51'11'0115 C(IV'erinO' 111 the eon5iderably dilated 5ton1aeh. there i5 21 blaelti5h. 5ol't. pulpy 1112155. The 1nueon5 11111mbrane. i5 11oV'ered 2111 over with a layer 01' thi1'11' 1111111115. \V'hieh 11:15 pre511r\'ed it5 ori2'i112112'1o55y appearanee. 111 the pylorie region 211111 in some. other loealitie5 the 111111'115i5 5tained by an admixture ot' blood. The 52'1'1121te5t portion ol' the 1nu11u5 i5 here rep1'1151111ted 215 remoV'ed. 211111 5hoVV'5 the .5u1'l'a1'e ot' the 11aV'it_V' in a thiekened and 5li2htly turbid condition. .\ great many 11:11111111'1'1121521111 point5 11ontr215t with the 51i2'htly 2111211111i1' general 5url'aee. The. eolor and extent 111' the t'oei ditl'er V'erV' mueh. Some are 11ir1 111.11'. 5o1ne oV'al .5-o1n11 haV'e 21 VerV inuht red color. 51111111 21 deep eherry r1.1d .5ome are per't'eetly 11121111. 1)e'pth o1 (011)1‘ 15 in ratio to the amount 1li5te1nd1d VVith dark. liquid blood. The 11111111115 snrl'ate VV215 111Ve1ed with tough. 5111155V 1111111115. inten5111V' stained yellow with bile. lt.5 511pe1'lieial 121V'er5. with few exeep- tion5. are all ot' .1 _V‘(‘ll()\\' 11olor; the l'old5 are most i11ten5elV' 5o. The pyloric region 11215 retained most 01' it5 natural hue. 111 5011111 ot' it5 part5 there are 21 t'eVV' inject111 V'e55el5 Some 5|Iot5 are pale or 5t'ained V'ell1'IVV'.("lhe letter5 in the5e li2ure5 eorre5pond to tho5e found 011 the ot 1'11du1tion ot'112111111I2'111bi11. 11'1111111" pa2'e.) surface ol' the organ (Sedion \1 Table \'111. 1"12'. 1). or 5in52'le 1<not5. Deeay ot' the 1e11tral 11122551-5 produee5 ul1'er5 \V'ith rai5ed e112e51'1t' 21 yelloVV'i5h-VV'hite eolor. Thi5 eaneer i5 developed l'rom the 22L5trie 212111115. 11i5tologieally it i5 eharaeterized by Very 11115 merou5 eaneer 1111115 in the little-deV'ehIped 5trun121. Beneath the decayed po1'tio115 there i5 produeed librou5 induration and 1'21111'111'1In5 infiltration in the gastric VV'alls. T1115 1'111'111 111<I5t ti'e11uently 1121115115 Inet225tatie depo5it5. 2. [1.'/111/1111'11II11I. 1t t'orm5 5ot't. knotty tuinor5, VV'hieh 21t'terVV'ard become uleerated. It 1111115t'itute5 tubular V'112et21t1on5 (Seetion \'I, Table V11, Fi25 4. :3). VV'hieh are provided with 21.5i1nple. eylindrieal lining, V'ery 111111111 1'115111nblin2' tubular 212111115. They V'ery 511011 111511 their glandular appearanee. The neopla5m i5 u5ually .5oon de5troyed by nleeration. and eareinomatous 21nd eonneetiVe-ti55ue inliltration take5 place at the bottom (11' the. uleer5. 3 15'1'11'1'111115111' 11'/braid (.'/II'1‘/'1HH/1.1(. T1115 form '15 1151121lly formed 115ually followed by very 1115225tron5 1111115111111111111115 to the patient (.‘ontinued pre55ur1: upon the 5to1naeh bV' elothe5 01' aeeontrement5 V'oluntaiV' oi 111V'olunta"1V unnatural po5ition (It the ble, e5p11eial|y ot' the thoraVl and abdomen. tumoi5 in the 5ton1a1h 01 111 the adiaeent or_2'an5'21puts, all ot VVhi111 are liable to prth-nt timely 1'11111oV'al ot'the t'o'od from the stomaeh into the other intestine, the 52111111. 21.5 e1on5tri1tion or 1ont1a1tion ot' the pyloric 01'ifi1e ot' the 2'.15tri11. end ot' the duode.num VV ill produce dilatation of the Olgan. \\ hen toodis not properly 1li51'e5t1d1n the sto1na1h it remains a long while111 its cavity and the vast VaiietV' ot n1i1r-0-organi5ms VVill deV'elop 2111 t111ir activity upon the stagnant and de101nposing mass and produte a 0'reat number 01' 1111'1111111t--'-plo(1111ts, VVhi111 V1111 in the. region ot' the pylor. where. the VV'all5 beeonie indurated and inerea5 in volume. The pV'lo1i1 opening thereby 1111110111115 11111111 le55 eontraeted. l'he. inner 51111'21eeot' the inilurated p2nt i5 either eon-red VV'ith manV' hV"'pe1pla.5tie t'old5 ot' the 111111ou5 membrane (Se1t1on \1.Tal'Ile \111. F1 5. 4 5,) or the touU'h and enla 'U'ed 511b- 111111 11115 ti.55ue protru1le5 t'hrou'52'h the mueou5 mem- brat. .. A 5e1tiont1110112'11t1111VVall5 5till shon 5 them to be separate but very mueh infiltrated with conneetiV'e-ti55ne. eell5. 4. (JUNO/'1] or (11'/11117117111711. ('1/1'11I‘III'IIIIIz. Thi5 pre5ent5 itself in the form ot'tnbereulou5 5in52'le. tumor5. or 21.5 2111i11'u5e.inliltration in the wall5ot'the5t1'1maeh. 111 both the neopla51nata eontain ajelly-like substance may tr21n5p21rent and V"e1V'5ot't.1t i5 ot'ten 11Vtended upon the p1'1it'1'11n1un1 t'orminfr V'e1V't1a115lu1ent iellV- like more or 1e55 V'a5eular 1112155115 (Seetion VI T able. \11 11101.1). The jelly 15 derived 1'1'0111 both the (cancer and 11nn1eetiV'e-ti55ue 110115. ('olloid ol'ten appear5 very early in lite, while the other 1,11151ribed t'orms att'eet people in adV'aneed age. 5.1'III'I'IIII'III‘ Epit/II'ZI'II/ (.‘11/2111'1'. T1115 is the rarest. of all forms in the 5ton1211111. 1t'5 usual 51'at 15 in the eardia and it5 5111'1'011111111125. Myoma, 5211112011121, 21111111111'011121211'1', V'erV' 5e.1do1'11 formed in that organ. pale. delieate. 211111 51111Ioth. the 51111-5-111'0115 Vein5 extensiwlv i111re2 1.511 and t'11uther 2122121V'ate the 111511115111 10ndition 01 the o1gan. In a morbidly dilated 5t01n2|el1t111"1e15 to be 10111111 a vast (ollection 01' .5'pora. and more 01'11155 1111'1V1loped 01'1gani5m5 plodndng laet'ie. butV'rie, aeetie, and 2111111101ie 11111111111t21ti0115. Their 13101111115 exert exceedingly i11‘jnrion5 ett'eet5 upon the walls ot' the stomach, 112111521 hyperaania, 11V|Ier5eeretion. and often a continued state ot' 1111112115tive irritation, protraeting 1li511215es ot' the organ indefinitely and turning aeute eatarrhal 2215triti5 into chronic. lieekl11121121115151 has 11111111I11511'ated that s1:hi'/.1.n1V'eetes often pene- trate into the. Lieberliuhn'5 erV'pts, and from those pass into the parenth'ma ot' the organ, producing 11115111111115 enlargements in the 11111111115 111embl.1ne (Virehow'5 Areh.. \'111.XXX.) \111V many 1121511501 1ny1'ot'i1 ga5triti5' V'V'hieh1112111,.5'0011111 01 later to the death ('11 the 11'1e1ted per5on5.111111111'1-11011'1'12-11-i11'e symptoms, have been reported. 11I5t 1no1te1'n. the stomaths ""010 111111111 1111012111111 and within the 1111:'e1.521n 11111111155 number ot'nii1r-0 o1Wa11i5n15,t111iV'ing upon the decompo5in2 and de1onipo5ed substan1e5' ot' the organs. \Vhen the quantity 0t and 15 Neatly 1111111151111 in the contents ot' the 5tomach and the eireulation in the 11111110115 11111111b1'ane is din1i11i5hed. there 15 t'ormed a 5tate ot' 111211101'ation and softening of 11ea5i115.r. but when it 1111110111115 V'itiated bV' di5ea5e 0r ceases to be se1reted altogether. then those t'ung'i Vi'ill become aetiV'e and the. 11111111111'21110 and it5 5e111'- div'e5tion Aeeordingr to the quantity of blood111 the otgan the 11e5t11IVed ti55111- 215511111115 a brown 01 a blatk color. and is eonVerted into a pnlpV. 2elat1110115. V"'e1V t'riabl 1: mass. This 1:11115titute5 the 511-112111111 .I/IM/I‘UI'I/(lldlla This form 01 501tenin2' i5 11105t frequent. in 11i511215115 ot' the brain and tubercnlar 1111111111111t15 [511.111V this de5tr uetiVee'pmcess goes on during death2101111_'.V termination many inteetiou5 and (-onta52'i0u5 di5e2151'5, 21150 when the a211nV' 15 11111111 protra1ted in f'orIneer' 111211 thV' 1"I11150115. (1.121111. [\12 . 1111/11,./IIIVI/1II\'1'II, /11I1/ZI2 ) SaIIIII/wII 111111bt5V'1"11V 11111111 that an increase ot' 211idity iii the gastric jniee is alone 121pable ot' produting'112L5trie 5elt'- di2e5tion; 211511 that 2111\2'11initV ot' the blood i5 the natural protection 212'ai115t the corro5iVe aetion ot' that set-tetion upon the 11111110115 11111111br.21111.11e 1ite5 a number 01 experi- 111ent5 he. made upon 2111i111al5 11V' prodtning 11\t1en1, 211iditV' ot' the 2:15t'ric juice in a V'a1iety ot VV.1V5, 211111 111VV11i1-h no 111:11211i21 was piodu1ed He 1on5i11e1'5 that there. 111115t be a pm1111211 distnlbame in 1ireulati1m to produee that 511t'teni112', 1'01 he had severed the 21215trie filaments ot' the \atrus nerve at'ter r'ende1ing the gastrn inere215e to an 0111111110115 extent. More e5peeiallV' i5 thi5' the ease W hen the 5tom21eh bee0111115 di5tended VV' ith t'ood \V' hieh cannot under seeretion V'ery mid. and found no 111211211ia following it in the stoma1h ot the 2111i1112115thl15 i11i111e11.lle. 1onsider5 that the cause the 1111111115t21111 e5 be digested, and remain5 5t212'nant in the cavity. ot'2215t101na1a1i21 d111inxr lit'e 11215 yet to be learned. A 5t.1te ot 111511fl121en1V' 01 inabilitV ot' the stomach1s ploduced by taking too much food and too fiequenth Such insufficiency is 1(7)g.IIl(Ll£{/.DZ.>‘.>'CI‘Z. Functional Dt'o'flU'ZJIUUV'e‘ of 1121' Stow/(012. Whenever the 0122111 1Ie1ome5 211111111011 by disease. there will inV'ariahly 111151101111110111155111111'11011211 di5t111b21nee5.VV111111 111.1V'al5o lead to t'u'rther neVV deran52'e1nent5, or to additional 11121112115'111 it5 ti55ue5. A5 the gastrie 5111'1'11tions produee definite. 111121112115 in the food taken. any nloditieation in the strueture VV'ill neee55arily prodnec abnornnd 111121112115 upon the eontents ot' the eaV'itV'. More 115|Ie5 cially i.5 thi5 brought. about by the pre5enec ot' 51,1111'2111111/12111‘115 (ti55ip21.1'0115 fungi). VV'hieh are constantly introduced into the stomaeh with the food. drink, and other sub5t21nees. Normally the gastric juice. pr'eVent5 these or221ni5n15 t'rom beto1nin2 active. and i11- Jana.) (bclbstccrdutt- |