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jaundice is the consequence.

These instances occur

independently of the excitement from stimulants, and sometimes are very alarming in their character. The febrile condition is accompanied with cerebral oppression, with a semi-comatose state, or with violent delirium. This brain complication may perhaps be due to the glandular structure of the liver becoming involved, and the depuration of the blood being consequently interfered with.

The pain in these cases is much less than in gallstone; and they differ from ordinary inflammatory jaundice in the mode of commencement, the symptoms being at first those of intestinal or gastric irritation.

The prognosis is generally a favourable one, unless the cerebral symptoms become inordinately severe. In some instances general hepatic disease has been induced.

The treatment must be directed to quiet the irritation of the stomach, and to relieve the hyperemia of the affected parts. As to the former, scarcely anything must be administered by the mouth. Soda water and milk, arrow-root, broth, and similar forms of diet, are alone admissible. Alkalies, as lime water, effervescing citrate of magnesia, carbonate of soda with hydrocyanic acid, also serve in some degree to soothe the stomach. A free mercurial purgative is very desirable in these cases, as five grains of calomel or grey powder, followed by a saline aperient; and hot fomentations may be applied externally.

CHAPTER XVI.

DEGENERATION OF THE STOMACH.

THE stomach is not independent of the general law, that when one part of the body is affected with disease, other parts also become implicated either in a primary or secondary manner. Purely local disease is of very rare occurrence, and this is still more manifest when we regard degenerative changes; thus, degeneration of the stomach is not unfrequently observed, but, it is only a part of other more general morbid conditions. We find the stomach affected with—

1. Atrophic degeneration or wasting. 2. With fatty degeneration.

3. With lardaceous disease.

4. With fibroid disease, implicating especially the pylorus.

1. Atrophy.-The mucous membrane and the other coats of the stomach are sometimes found in chronic disease to be exceedingly thin and pale, as if, with the gradual decline of the general nutritive power, the organ of primary assimilative function had also proportionately wasted; the glandular follicles are less distended with

cells, the muscular coat is indistinct, and the coats are semi-transparent.

2. Fatty wasting.-Sometimes the cells of the follicles, instead of presenting a simple nucleus, contain a great number of highly refracting particles, and almost resemble an inflammatory granule cell, while the appearance of the stomach itself indicates an otherwise healthy condition. At other times, the stomach is found to be pale, and studded with white points, somewhat resembling solitary glands, but not at all elevated above the surface. A section of the membrane at this part shows that around the crypts are collected highly refracting granules and fatty particles, giving to the vertical section the appearance of a dark border. This form of degeneration has been observed in phthisis, in struma, in exhausting suppuration, and is often associated with a fatty condition of the liver. A more advanced condition of atrophy shews the follicles to be entirely destitute of secreting cells, only containing granules of fat.

3.-Lardaceous disease.-In ordinary cases this form of albuminous degeneration is found to affect the liver, the spleen, the kidneys, &c., but the mucous membrane of the stomach is also similarly affected. With the iodine test, the mucous membrane becomes deeply coloured, and under the microscope, the section shews that the minute capillaries have undergone remarkable change; their walls are greatly thickened, they appear

of a homogeneous consistency, and the free circulation of the blood is greatly impeded.

Beyond loss of appetite, exhaustion, prostration, and the inability to take food, or if taken by constraint to digest it, we are not acquainted with any symptom which indicates these states of degenerative change. They are part of a general state of exhaustion, and are indications, that pari passu with disease in other structures, the stomach takes part.

4. Fibroid degeneration.-After chronic inflammation of the mucous membrane, the structure appears thickened, dense, and the mere rudiments of gastric follicles remain. This appearance arises from fibroid degeneration which gradually extends so as to induce follicular atrophy; and it is from the contraction of this fibroid deposit, that true "mammillation" of the surface of the membrane is produced. We would call this true mammillation in contradistinction to that which is observed in a healthy stomach, from the contraction of the muscular layer.

Beside this general condition of fibroid degeneration, there is one perhaps of greater importance, although of a local character, we refer to fibroid disease of the pylorus. This state has by some pathologists been considered as a form of cancerous disease; if, however, the diseased structure be carefully examined, no evidence of cancer will be found in it, or in the adjoining parts. The disease apparently commences in the submucous cellular

tissue, which undergoes fibrous thickening, while the mucous coat is in many cases unacted upon. This deposit leads to obstruction of the valve; the muscular coat then becomes hypertrophied, and the amount of that hypertrophy is an indication of the degree of obstruction.

The growth beneath the mucous membrane is whitish in colour; it is firm, sometimes almost cartilaginous in hardness, but without any "juice" as cancer; it consists of elongated or wavy fibres, resembling a fibroid tumour, and with acetic acid it presents numerous elongated nuclei; bands of similar tissue pass between portions of involuntary muscular fibre, and externally the omentum may be contracted, and adhesions may have been formed with adjoining structures. The mucous membrane of the stomach may present a grey and thickened appearance, and simple chronic ulcer or the cicatrix of one, are occasionally present. At the pylorus the mucous membrane may be quite healthy, having distinct or even hypertrophied gastric follicles; but the irritation may have excited secondary disease and ulceration. The glands near the pancreas are not usually affected.

The symptoms closely resemble those of cancerous obstruction, and they consist in chronic dyspepsia, followed by emaciation; vomiting occurs several hours after food, preceded by pain; distension of the stomach, eructation, fermentation, and the development of sarcina. ventriculi are also symptomatic; the bowels are gene

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