OCR Text |
Show DISEASES OF THE ORGANS OF DIGESTION. TABLE VIII. FIGS. 1, 2.-Gelatiniform Cancer (Colloid). Fig. 1 represents an enormously infiltrated and exceedingly hypertrophic condition of the whole organ, cancerous masses forming nearly pa ‘allel ridges, made up of innumerable papilliform cxcrcscences crowded by the side of one another. They are nearly transparent and have a jeliylike look. The ca rcinoinatous process has here passed upon the lesser and greater omentum, and scattered upon them are very many nodular tumors having a fine vascular layer outside and consisting chiefly offatty detritus and cancerous infiltrations. The. stomach wall, chiefly in the ocsophageal region, is iiidu'atcd, and has an extraordinary thickness. Outside it is embossed with many *aneerous tumors. Fig. 2 represents a portion of the integumeiit covering the uinbilieus. Through the opaque white peritoneum there is a liernial protrusion of the oincntum (II 0). The. sac has an embossed exterior like the outer surface of the stomach. Above the umbilicus another sac of nearly llfotor IVt'll/‘Wt'N '{f the Stomach. When the muscular tissue has lost its contractility. or when the stomach becomesiimnovably attached to the abdouiinal walls,tliere is diminution of peristaltic action of the organ. 0n the con« trary, the peristaltic action is sometimes exceedingly increased. aml becomes visible and palpable through the abdominal walls. Kitssnzmil describes it as "lirristoll/c rcsilrs‘s‘ncm of the strmmch." This occurs in cases of very dilated stomach, with strong hypertrophy of its muscular coat, in stricture of the pylorus or the duodenum by closure of the pyloric orifice with malignant or non- malignant growtlis. This hypertrophy of the muscular tissue is compensatory (similar to compensating hypertrophy of either ventricle ot'the heart). It is gradually produced, in measure as the food meets with obstacles in its passage through the pyloric opening. In purely spasmodic contraction of the pylorus, even the normal muscular tissue will sometimes produce exaggerated l'iei'istaltic action, to overcome the pyloric re istancc,but of course it will not be as well pronounced as in muscular hypertrophy, Irritation of the stomach filaments of the pneumogastric nervehor even portions of the solar plexus which connect with the muscles of the stomach, further hypera-sthesia of the mucous membrane, mechanical. irritation, certain poisons, direct or refiex irritation within the nerve centers, etc., all produce this affection. Kussmaul, in describing this disorder (in the 181st Clinic chturc, Vol/rmmm's Collortion),yites a number of cases of the kind,and especiallymentions one of a. woman who became affected with almost incessant peristaltic action of the stomach to an insupportable degree, and giving her no rest even in her sleep. Only when her stomach was perfectly empty did she have afcwminutcs' peace. The primary cause of her disorder\ 'as poverty and domestic trouble. She recovered after two years' hygienic treatment. The same author thinks that peristaltic derangement may exist even when there is no pyloric stricture, but simply hypcrhincsis of the muscular tissue brought about by long use of drastic purgatives and other substances capable of irritating the peristaltic centers. Busch (in Virch. Arc/7., Vol. XIV, 1868, p. 130) describes a case of that kind where the peristaltic move- ment would last all day, but would stop in the night. Maycm/ic, .Lonyct, Schif, who have experimented upon dogs' SiOI'IIi‘tt‘hS, found that as long as any chyme was contained in the cavity the peristaltic action took place, but was perfectly quiet when it became empty. It has been found that many tumors and other neoplas- mata are capable of producing similar disturbances. As many cases of hyperplasia of the adjacent organs are capable of pr0» ducing stenosis of the pyloric opening or stricture in the duodenum and thereby dilatation and hypertrophy of the stomach, peristaltic derangements in such cases are very natural. Gastric Troublcfrani Causes in. thc Ncrrc-Ccntn‘s Direct aurl by Itcflrx Action. In his repeated experiments upon the nerve-centers which Schifi' has described (in Arc/hf. Phys. IIcilh/(nrlr, 1840, p. 077; Ucln'r. (I. Gejfacssncrccn, Arch. f. Phys. I[.. Vol. XIII, p. 30, 18:34; eriis sur Phys, Vol. II, 18457, Chap. XXX V) a number of gastric disturbances ensuing from severing the optic thatamus or the cerebral peduncle on one side. The gastric lesions produced by the injury of those portions of the brain consisted in haanorrhagic infiltration and softening of the coats of the stomach. The severance of the central conducting fibers of the vasomotor centra produced neuro- paralytie hyperiemia of the mucous coat of the organ. Cutting through the pons Varoli on one side, as Well as one half of the medulla oblongata (especially downward toward the lower point of the columns crime/arts). the same etfcct upon the stomach was pro- duced. Farther down in the spinal marrow he could not produce any stomach trouble by a section of the conducting fibers. He concluded that the vasomotor fibers of that viscus must enter the spinal marrow above the dorsal portion. He was farther led to the conclusion that (Ill peripheral branches of the sympathetic contained vasomotor filaments of the stomach, for when be destroyed a few of these only and not all, there was no disturbance. or at least but very little vascular derangement in the organ. (In the other hand, when he irritated any of these splanchnic fibers. and especially those from the coeliac ganglion, contraction of the vessels of the mucous and serous membranes was produced. W'. Ehstcin states that when be injured the anterior tubercula quadri-geiniua. even in a very circumscribed manner, he found the following changes in the‘ animal‘s stomach immediately after killing it. seven days after the operation: "The mucous membrane was covered with mucus, of grayish-white color in the pyloric region, brownish in other portions. In the fundns there was a shallow erosion; the sharp edges and l'undus were pale. Tlic ulcer was irregular in shape. Quite a number of ecchymoses of [SECTION VI. similar appearance is observed (II L D). The sac (C) is more of the form of a cyst. The serous membrnae (S) in the umbilical ring is also covered with tumors. Fio. 3.-Excessivcly contracted and deformed stomach from cancerous ulceration and atrophy of the tissues. The spleen (R) is attached laterally to the cardiac portion, and has drawn the organ in that direction out of its position. The (esophageal opening is very narrow (0 C . The greate‘ and lesser omcnta (E 1', E G) are thickened and covered with cancerous tumors. F ms. 4, 5.-Fil)r0us Carcinoma (Scirrhus). . Fig. 4 presents the pyloric region in a state of diffuse induration and increase of volume of all the tunics of the organ. The internal surface is covered with hvpertrophic tissue and partly sub-mucous tough fibrous bands or lamina. All the coats are still recognizable, but show enormous increase of volume from abundant infiltration. Fig. 5, a. section showing the cancerous masses imbedded in the sub-mucous tissue. small size were found in the rest of the membrane." Ebstcin further states that quite a number of experiments have proved that one-sided injuries of the cervical medulla produced far greater changes in the circulation of the stomach than those of portions of the brain. But where he severed the "ail/ole spinal marrow in the (‘CI‘Vlt‘ili region, those changes were either very insignificant or did not take place at all. This author and Grucz‘znrr have also produced hemorrhages and hmmorrhagic infiltration into the coats of the stomachs of animals by irritating the lingual or Sciatic nerve several minutes in succession with intervals of a few minutes. \thn they injured the labyrinth or destroyed the semi-circular canals of small animals (without injuring the cerebellum, according to the method of Guttstc/n), the same gastric lesions were produced. It seems that almost any severe, painful injury of any sensitive surface or of a sensory nerve stump produces the same gastric phenomena. When all the circumstances are examined under which those changes of the tissues of the stomach are brought about, it will be found that the vessels, both arteries and veins, of the walls of the organ, are enormously dilated and turgid with blood, and the volume of the structures enormously increased. Very few lymph corpuscles, but enormous numbers of blood corpuscles are extra 'asated. The pyloric region is thus mostly affected. Upon such congested tissue the gastric juice very soon produces its corrosive action. If such a condition continues for some time, perforation of the organ takes place, and death tollows. All those phenomena. can be reduced to the single cause, crccctlinyly high m‘tcrial press-inc, which products the mast (lclctcrimts effect upon. an organ. normally prone to hi/prrtcmio. For in all those nervous derangements experimentally produced there were exceeding irrita- tions effected upon the vasomotor centra, and disturbance of the respiratory ecntra, circumstances which always lead to enormous arterial pressure. When the whole medulla spinalis is severed in the cervical region, there is such sudden and quick fall of the blood pressure that no liyperzcmia is produced, and may be compared to that state where very profuse hmmorrhagcs have greatly reduced the volume of blood in the body. Comparing the above experimental data With many wcci'oseupic findings in the stomachs of persons affected during life with mental and nervous diseases, the very legitimate inference might be drawn that connection of the gastric lesions with disturbances of the trophic or vasomotor centra were those of cause and effect. Further clinical observations are made daily that persons suffering from many forms of neuroses, especially of such organs to which are distributed nerves from the medulla oblongata, cerv- ical and upper thoracic portions of the spinal marrow, suffer nearly always from severe gastric and gastro-cnteric disturbances. The older pathologists, such as Andra], Bright, and many more who were at the same time pathological anatomists, have readily eoniiected gastric lesions with mental and nervous diseases, through the instrunicntality of disturbances of circulation. Displuccmcnt and Chaiiyi? of Form of the Stomach. \thn this organ is perfectly empty it is uniformly contracted and loses much of its curved form, and its caliber is then not much greater than that of the colon. The mucous membrane is then folded in a nearly longitudinal direction. During long abstinence from food or after copious vomiting it assumes the same form. In many diseases it takes a perfectly horizontal position. \Vlien mechanically much injured, or when affected with cancer in its middle portion it usually increases in size. Destruction of the fundus, of the pyloric portion, or stricture of the pyloric orifice, produce more or less dilatation of the whole organ. Its position niav. under such circumstances, be changed, as well as its relation to the other organ enormously altered. In excessive contraction from cancer it is placed behind the ensiforni cartilage, and presses the diaphragm into the thoracic cavity. "'licn 'thc cancer spreads from the stomach upon the mesocolon and colon it is drawn downward bv the latter viscera, and then occupies a place l1l111l(‘~ diatelv below the ensiforni cartilage and above the navel. In exec ‘i've dilatatioiis it may descend so low that the fundus either prescs the transverse colon down into the. pelvis or the greater portion occupies a position below the umbilicus and presses the smaller intestine downward and outward on each side. The most peculiar displacement is I'irodiiccd by large-sized tumors in the lesser omentiim and mcscntcry, These tumors occupy the smaller curvature. become firmly attached to the wall of the stomach. press it down and to. the lett. and cause the organ to occupy an almost vertical position. Under such circumstances it becomes enormously atroph‘icd, reduced in size, and assumes the form of a large tumor. The compressed condition of the organ will prevent any vomiting from taking place. |