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Show SECTION VI.] DISEA 9 OF THE ORGANS OF DIGESTION. TABLE V. FIG. 1.-]rli01)(u‘,/1[c Phlegmoaous Gastritis. C.\sE.-.\ robust man of fifty. IIzszforg/ (III/l Symptoms-After returning from a trip in the country with his family, where he partook of ordinary food, he was suddenly seized with Violent pains in the stomach and vomiting. Pulse mode ‘ately frequent, tongue slightly charged, conjunctiva a little yellow. Epigastriiun very tender. No pain on pressing the abdomen. No blood in the vomited masses. Somewhat constipated. Administered a saline laxative, which opened the bowels. Morphia sulph. and sub-nitrate of bismuth relieved the vomiting. Two days later he complained of severe dyspn ia, and had to sit up in bed, became very restless, pulse exceedingly fre- quent; the extremities became cold. abdomen very tender to the touch. Died in collapse. Autopsy forty hours after death. The intestines found much distended with gases; they adhered to each other and to the abdominal v‘alls. The Whole peritoneal surface was opaque, and covered here and there with fibroid membranes, which could be readily detached. In thc'pelvic cavity about three hundred 00111. of a yellowish liquid, containing considerable fibrous fioculi and pus. \Vithiu the cavity of the little-dilated stomach a small quantity of reddish-brown liquid and some blood coagula. Externally the organ is of a dark purple color, and all its membranes are thickened and infiltrated, particularly in the pyloric region. The sub-mucous tissue is partly opaque-yellow, partly reddish from hyper:emia, in many places infiltrated with pus, and oedematous, its consistence like jelly. Owing to the great volume of the sub-mucous structure, the mucous membrane is smooth, slightly stretched, very shiny, and covered with yellow, gray, brown, and black spots, which in seine localities have clear outlines, in others diffuse. They are due to the action of the acid gastric juice upon the ext 'avasatcd blood. The muscula * and serous coats were less swollen, but very nmch infiltrated with pus. The alteration of all the structures indicates that the irritation and subsequent changes originated in the subszrh'onnl Disorders of the Stomach. These may be divided as follows: 1. Chant/rs of Altair/Nation. 2. Ill/:rlffimrion of Plume/[mot of D/f/rsz‘ion. 3. film/{ficut/on [n (In) I'roct'sws 'lf Secretion and Ercrefion. 4. JLizlifica/mn of Now I'lauomrmz in. My Gastric Functions, and its Shale of Sensz'liil/fy. CLASS 1.-- .Aililizentm‘y Clarity/rs-D/sfi(rbroir'rs in {710 Appetite.- Sensation of hunger may be enormously increased (boulz'mz'a), decreased (anorer/a), perverted (pint), or totally destroyed. The inordinate desire for food was formerly ascribed to enormous dilatation of the stomach, and lack of power in the pylorus to close, pyloric omnittmener; termination of the ductus chaledochus into the stomach; hyperseeretion of the gastric juice; an unusually 5 mucous tissue and spread from there upward and down- ward, and differs lrom changes taking place in the mucous membrane primarily. Flo. 2.- U'Mtc Softening offlm Simone]; and I'm-form‘ion of [1‘s Walls. A, (‘.\sE._.\ babe of eighteen months. 111'storyum/ Symptoms-llad measles about three weeks ago and suffered ever since with hoarsencss and slight cough. As a number of children in the same house were affected with scarlet fever, it was supposed that this child was also affected thereby, and a physician called in, who took hold of its tongue in order to examine the cavity of the pharynx, when the child suddenly expired. Autopsy three days later. The brain and ifs membranes quite normal. The aryepiglottal ligaments slightly swollen, and in a state ofcatarrhal inflammation. The saute was the arse with the larynx. trachea, and bronchi; in their cavities a quantity of tough mucus existed. The left lower lobe of the lung was inllamcd. The peritoneum in the region of the stomach was covered with a layer of very souti milk, which escaped from the organ by a fissure through all the coats, of about, six centimeters in length, extending along the great curvature. This extensive perforation must have been the cause of the sudden death. Fios. 3, 4.- Perforation of the esophagus and great atrophy of the eardial portion ofthe stomach, from chronic ulcerations in their walls. FIG. 5.- Simple circular ulcers of the stomach. They are very shallow, and only involve the mucous membrane. The dark color of the ulce‘ated part and the injected tissue show that there was very circumscribed lo ‘al disturbances of the circulation in each affected part. The filled vessels are. visible near the ulcers only. C G, great curvature. I]. l :emorrhage. ]' 71), .P 1', perforations. 0 E, (esophagus. E, erosion of the mucous membrane. [1 U, hzemorrhagie ulceration. (LY, nervous vagus. I), duodenum. _fl[ 1) 31, softened mucous membrane. P,pylorus. Pregnant women, ehlorotie young persons, liysteric individuals, and many persons affected with mental diseases often manifest the strangest desires for food or drink. The dirt-caters in Africa and South Ameriai exemplify such ethnic perversity of appetite. In great losses of blood, during the shock from mechanical injuries, in fevers, and fatigues with exhaustion there is always an intense desire for drink, not to speak of the craving for pungent and highly stimulating substances, which in the very fewest ot'icases only can be attributed to direct gastric lesions. ' intestine. To the anatomical peculiarities of those individuals were of course ascribed, in those non-critical days, their ravenous appetites. Still, there is one interesting fact connected with th s matter, that all exceedingly voracious carnivorous fishes have enormously-developed stomachs and but very short intestines. Ravenous appetite in man is undoubtedly due more to a state of incomplete nutrition, assimilation, and nervous disturbance than to any peculiarity of the stomach. Gastric irritation may sometimes produce boulimia, especially in CLASS 2.--Allrratirm in flux Prom of Dan‘s/fan-I)ysprpm'a.-- It is unnecessary to state that dyspepsia is one of the chief symptoms of actual gastric lesions, and even irritations. Yet, like the abovedescribed derangements, dyspepsia may be due to disturbances lying outside of the stomach. Clinical histories have often enough re- vealed the apparently singular fact that in very many cases of severe dyspepsia of long standing no important anatomical changes in the organ have been found after death, while very deep altera- tions in the tissues have produced very insignificant disturbances of digestion during life. Even in those cases where distinct ltsions of the organ were found, it could not always be proved that the lesion and dyspepsia during life stood to each other in direct relation of cause to effect. For clinical purposes alterations of the processes of stomach digestion are classified according to the discernible causes producing them. These are : 1. Such as have actual acute or chronic alterations of the parenehyma of the organ. 2. Those in which there are derangements in the secretions of the organ from irrita- tion, such as liypermmia, etc. 3. Those caused by asthenia. either a. chronic state, and often furnishes a valuable symptom, when the from insufficient circulation, insufficient innervation, or mechanical great desire for food is soon followed by anorexia, or distaste, for it. Very many dyspeptics have a peculiar gnawing sensation in the epigastrium. which they mistake for intense desire for food. Growing children, convalescents from exhaustive diseases and pregnant women furnish examples of boulimia with which gastric irritation has nothing to do. Anorexia is the most common phenomenon associated with all sorts of gastric derangements. There are a number of very grave obstacles. 4. Strictly nervous derangement, either of the organ itself, or by reflex from other organs or from the centra. Nervous t'lyspepsia, the most common form of dyspepsia, is that which is either caused by direct irritation of the several tissues of the stomach, or by partial or total atony of the organ. Such atony is liable to be produced by any exhaustive process going on in the body. In asthenie dyspepsia there is usually no thirst; the tongue is pale and very lax. After taking food the patient experiences a sensation of fullness and weight in the ga>trie region, often a feeling of great tension. The pulse is usually not irritable, but is sometimes apparently full but, very eomprcssibie. from the great loss of elasticity in the arterial coats and low degree of blood pressure. Vomiting seldom exists, and then only when the organ is overloaded or distended by liquids or gases. short intestine, worms, etc. Vesalius has, for instance, found the bile duct ending in the stomach of a certain glutton. Another celebrated great eater was found by Percy to have an enormous sized stomach. Cabral found in a certain polyphagist, his former patient, an enormous stomach, followed by an exceedingly short diseases of the stomach, such as softening. ulceration, and indura- tion of the subanueous tissue, in which there are no other symptoms than total loss of appetite. Anorexia sometimes exists in very insignificant diseases of the organ, as post-mortcm examina- tions, made by very competent persons, have proved that the causes of this loss of appetite may be due to disturbances outside of the stomach. In fact, it is always found as a constant factor in severe acute and chronic inflammation of nearly every important Organ of the body, more especially in such derangemcnts which give rise to disturbance of circulation in the organs of the body. There are depressed conditions of the body when every function is S/t'o/V‘S/‘s/i't (-Etfo/oy/r Ill/(l I'uf/«of/o/«sr, 1h )r/gswlirf/‘I, "TIM-Minn) divides the causes ofasthenic dyspepsia into three classes: 1. Such as produce direct irritation upon the mucous membrane. 2. Dyserasis and anomalies in the blood. 3. (‘entral nervous disturbances. (if the latter varieties of disturbance of digestion. he observed sixty-four clinical cases, thirty-tinir of which owed their origin to an ebb that no metamorphosis of the tissues takes place, nor does , psychical derangemeuts, twelve to uterine atieetions, three to even their nutrition go on; insuch a condition, complete anorexia l onanism, and three to elilorosis. To prove the connection ot those disturbances with gastric atony. he bases his explanation upon exists. This constitutes the state of [muff/mt. Pica. perverse appetite, is very common in many diseases, and is , ph‘ 'iologieal grounds, claiming that they act upon the Isplanehnic t nerves in such a manner that they produce contraction of the Only indirectly connected with the stomach. almost at a standstill, and when the processes of life are at so low |