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Show SECTION VI.] DISEASES. OF THE ORGANS OF DIG TABLE VII. FIG. l.-Sqff LV/II'NIc/imm/ (filler/ul/urlq (mm/mm) '37. /]/I' Eton/(It'll. Fig. .1. shows this cancer, several inches in extent. and involving the pylorus and portion of the duodenum. The disease commenced in the lesser curvature and descended partly upon the anterior. partly upon the posterior aspect. ot‘ the organ. 'l‘akiiig its origin in the epithelial covering of hoth the glandular and iiitcrglaiidular structures. it formed a iiiiiiiher ot' ['ungil'orni tumors. some soft. some hard, and intiltrated not: only the mucous. hut also the suh-iiiueous tissue. causing. hy the great pressure it ex- erted upon the tissues.destruction ot‘ hoth. The histology of this cancer is desci'ihed hy Til/'r'rf'rlr/cr as follows: "The lihrous strings of the stroll/I1 contain great iiumhers ol' splieroid and spindle-shaped coiiiiective-tissue cells. and form tuhular sacs in which are contained the polygonal cancer cells. composed ol' a very granular and fatty proto- plasni. and supplied with a large, very distinct nucleus. They remind one of the cells of the peptic glands. yet it can not he proved that the latter originate the former." There are a iiiiinher ol' small hlood vessels traversing the iieoplasinata. After it has reached a certain size it underg.)es ulcerative destruction. leaving hehind a iiuinher of hinges which still adlieie tothe ['uiidiisol'the ulcer. They are remnants of the si‘rom/l ot the cancer. which resists destruction far longer than the cancer cells. By the action of the gastric juice they hecome gradually detached in pieces from their hases. and produce. hy exposing the vascular layer. those hzeinorrhages characteristic ot' solt cancer; that is. the hlood will he vomited in soft clots, having a more or less honeyeoinhed arrangement and of the color of Colli‘c-g‘l‘tilllltls or dark chocolate. A section ot'the papillit‘orni growth in Fig. 5 ol'this Tahle shows the raised mucous memhraiie. the enormously hyper- trophied structure and [ihrous arrangement of the stronia. studded on top with epithelial spikes visihle to the naked eye. Fig. G of this Tahle shows a section ol' the wall strong to produce contraction of the muscular wall was applied hoth high arterial pressure and a slow pulse were produced. The splanchnie nerves Were not at all allected. Neither the influence of these \':l.\‘tist't)llil'itt‘itil's nor ol‘ the contracted Vessels ol' the contracted muscles could here he the cause of the arterial pressure. 13y pinching the gastric walls with a forceps the same phenomena of circulation was produced." " ln order to produce a retlex ettect t'roni irritation ot' the walls ot the stomach similar to that which might he produced hy distiirhance ot' digestion, the stomach was dilated to an excessive degree hy means of a sot't i'uhher hall which was dilated in the organ hy introduction of air into it through a catheter in any desirahle quantity. l)istentioii ot' the stomach hy this means yielded. in a clearly-defined manner. a great rise ot‘artcrial pressure and a slow pulse. These experiments prove that the rellex upon the, heart and circulation from the stomach are hrought ahout hy the nervous centers. These retlex actions reseinhle those which are produced hy irritations of sensory nerves. existing either on sensitive surtiices or in the muscular tisstie ., . From these experiments we are justitied in concluding that the nerve-tilaments from which retlex action upon the heart and circulation can he exerted are situated in the muscular and serous coats ot' the stomach." A practical lesson from theseexperiments can he drawn in this way: That distention ot' the stomach produced hy partlydigested tood. overtilling ot' the stomach with too much and too hastily taken l'ood or with indigestihle material. is capahle of producing so slow a pulse as to intert'ere with the steady aeration of the hlood. and producing so high a pressure as to cause hyper» :eniia and hypersecretii>ii in the stomach. (tn the other hand. the contraction of the small hlood vessels during the high arterial pressure may prmluee such aiiiemia ot' the hraiii as to greatly impair its t'unctions. especially the innervation of the intestinal canal. lleadache. vertigo. a t'ecling ot' coldness in the upper and lower extremities. and many lltitt't‘ie'ttt‘li symptoms of distui'hance ot' the nerve centers. are very common in t'uiictional disturhances. especially in distention ot' the stomach. Regarding the slight seiisihility otthe gastric mucous memhrane very many examples can he produced where the meinhraiic was highly injected. sot'tened or indnrated.or even ulcerated. without any l'eeling of pain heyoiid a slight colic or insignificant sensation ot' inaleasc. The ahdoininal wall may he roughly passed over or ruhhed without producing any pain in the severelywatlected intestine. Only when the ulceration has penetrated into the muscular and serous coats and is on the point ol‘ pertoratioii. is intense pain produced. l'ain t'roin nervous irritation may sometimes exist in the stomach without the least alteration ot‘ the tissues ot'the walls tgastra "1a). lt‘orinstaiice. people, who are. hy their calling or otherw .e. siihiect to very sudden changes 01' temperature olien sutt'er intense pain in the stomach without any pei'ceptihle cause existing in the walls ot' the organ. Gastralgie attacks. descrihed hy ltelamarre and (‘hai'cot as crises I/«tslrfc. are Very common in dorsal tahes. Such patients are ol‘leii attacked with intense gastralgia. associated with vomiting. strangling. nausea. dizziness. and sometimes with diarrluea. liltli usually: with very ohstiiiate constipation: sometimes even swelling ot1 the :ilnlomeii: rigors of the severest kinds. convulsion. ti‘enihling‘. vomiting of mucus, hlood. or hile: very t'reilucnt pulse. Such attacks inav last a dav or two.mav return weekly or even dilil."~ and gradiiallv reduce the 'tlesh and the health of the zll‘li‘cl'ctl person.s." deserilies a t'oriu ot‘ Iti/pr/"n's/lilso! and paintiil contraction ot the ahdoniinal muscles. which simulate eertain phenomena t'ound «soon. 7 surrounding a carciiioniatoiis ulcer from which the cancer cells have heeii removed hy destruction. leaving only the spongy stroina. which has its hasis on the hasement menihraiic. while only dehris ot' the atrophied glandular layer represent degenerated and deformed mucous tissue. Fits. 2 represents the l'undus and the walls ot‘ a carcinoiiiatous ulcer in the region ot‘ the. coecum. The surface ot‘the l'undus is hlack (the color is due to the action of the enterie. juice upon the tissue), the walls are jagged. and a iiuniher ot‘ l'ringes are projected and tloat 11])tmiil10 surface of the ulcer. The deeper layers of the edges of the wall 7 are darker than the more external. Fins. 3. ~L-Arlr/r‘nomr/ ])I'sI‘/‘/Icns. This form ot' cancer. although developed in the mucous memhraiie. does not produce its hyperplastic action upon the outer surface ot the iiieinhi'aiie, as in the inner strata, upon the suh-inucous tissue. the muscular and the serous tunies. \Yithin these. and even upon the outer surl'ace ol' the tihroiis coat, it develops into iiiiiunierahle solitary nodules-v ery rarely aggregated-whicli follow the cours ot' the internal and external lymphatics, To the tree. sur- l'aee ol' the mucous iiiemhrane within the cavity it imparts a pitted and honeyeoinhed appearance. with here and there a few raised vegetatioiis. All the walls of the organ are, thoroughly intiltrated; the mucous iiieinhraiie especiallv is thickened and much increased in volume. The pyloric region is peculiarly enlarged. The great inclination of this form to produce metastatic deposits is here shown by the hroadcast carcinoinatous nodules upon and within all the structures. Along the great curvature and within the pyloric region the veins are tilled with cancerous thromhi. I' (I. small curvature. (1' (,1. great curvature. 0 1), oritice ot‘ the pylorus. 1' L. lymphatic vessels. 0 JL‘. I" 12'. raised vegetations. oesophagus. I). duodenum. F. liver. T C, transverse colon. (' (I. tiiiidus of ulcer. l' L (I coecal valve. A (f, ascending portion. .11 1'. pyloric portion. "ill ill. mucous membrane, C J] Jf. carl'. vegetations. cinoma ol' that inemhrane. in ilcns or peritonitis. and is ot'teii associated with actual distrrbaucc ol' the stomach digestion. which he called 1iscudii-gasti'algia. These are all produced hy general antenna. This hyperzesthesia seldom assumes a neuralgic term ()rdinarily there are muscular pains situated in the upper portion ot‘ the rectiis ahdominalis muscle in the epigastric region. ot'ten resulting in a permanent contraction of the muscle. and when the person is in a vertical attitude. or any tension upon the muscle he produced hy the distended wall ot' the stomach. the pain heeonies excruciating. The pain in that region. and especially when there is actual dis- tiirhaiice of digestion. will ot'ten mislead the physician in his diagnosis. liesseiiing ot' the pain when the tension is removed hy the person‘s lying down or relaxing ot the muscle will readily indicate the ditlereiitial points. l'ressure upon such painful inns- cles will H/u'io/s' increase the pain. while when the pain in the epigastriiini pl‘m‘eetl.‘ t‘roin a diseased stomach pressure will increase the pain only «lam/g (/rq'rs/fou. This muscular pain may. however. he the consequence ot a disease ot' the stomach. the same as diseasa' ot‘ the thoracic organs produce pain of the thoracic muscles. (it' course. the origin ot‘ the retlex action upon the muscles must necessarily he traced to its proper source. JJI /'H/H// mt wt of (inst/Vic [ti/It I‘M/hon. Although not as frequent as other nervous disturhaiices ot' digestion. there is a form ot' nervous dyspepsia characterized hy a nnmher of symptoms. chiet' among which is very severe pain in the stomach atter meals. The pain is sometimes so intense that. the aticcted persons ahstaiii from food tor l'ear or the intense sutl'ering that t'ollows eating At the same time there is a desire tor t'ood. tor the appetite is in such eases rather heightened than lessened. lioth starvation and intense siittcring are the alternate iiiisei‘ies' oil such zltllictcd people. and hotli or either reduce them TO a low aineiiiic state. The pains either follow the meal immediately or take place an hour or two later In the latter case the persons are seized with a sense ol' extremely painliil constriction or spasm in the gastric region, associated with a keen desire for limtl or a sense ol' emptiness in the stomach. Very rarely is the teed voni» ited immediately alter eating. When the disease assumes this form the person is threatened with a dangerous dyspeptic {woof/on. In malpositioii of the tietus and iii exceedingly sensitive and highly iri'itahle uterus of pregnant women. this t'orm ot dyspepsia usually causes very dangerous disturhance ot' nutrition. Anaemic persons are Usually atl'ectcd with this t'orm of disease. tor the insufficient quantity of nutrinient in their hlood readily tavors I/t/o/lrilfrm ot‘ the nervous svstcm. and gives rise to hypcrzestliesia or anicstlicsia ot' the dift'erent organs. In all cases of this kind there is hardly ever any important change in the gastric secretion. The irritation seeins‘to he exerted hy the t'ood upon the otherwise not very sensitive mucous nn-inhraiie otthe stomach. which now hecomes echetlingly hypera-sthctic. The irritation is carried hy the splanchnic tilainents to the spinal marrow and hraiii. and trout there i'ctlccted hy the motor tihers upon the muscular coat ol' the stomach hy the pneumogastric and phrenie. t'rom the stomach and diaphragm upon the muscles ol' the ahdomcn. produced. Cramps. spasms. and vomiting ilt't‘ thus As innervation has little to do directly with the quality otthe secretion ot'gastrn juice. there is thereti'tre no change in the lnpiid. and what food stays in the organ usuallv undergoes although slow yet perteet digestion. (See, Lego/is (It Pat/mloy. E11202) |