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CHAPTER V.

CHRONIC GASTRITIS.

THE most common disease to which the stomach is liable is chronic gastritis, and it is one which lays the foundation of many of the other affections of this organ. In addition to this, we shall find that it is as generally an accompaniment of chronic diseases in other important viscera, as we before found subacute gastritis to be in fevers. There can be no doubt that it often results from the same causes as the other affections it accompanies, and that, by impeding nutrition, it hinders or protracts the recovery of those cases in which it may be present.

There are various morbid changes produced by chronic inflammation in the gastric mucous membrane, the exact nature of which has produced much discussion. We may, however, generally refer the differences of opinion upon this as on other diseases of the stomach, either to the fact that the microscope has not been employed in their investigation, or to the use of imperfect methods of preparing the specimen for examination.

The morbid appearances visible to the naked eye in the mucous membrane of the stomach are, an increased quantity of mucus, congestion of the blood

MORBID CHANGES IN THE STOMACH.

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vessels, changes of colour, thickening, and an uneven appearance of the surface, termed "mammillation."

We often find the lining membrane of a stomach affected with chronic gastritis studded with minute holes, and, on employing the microscope, we perceive that these are due to enlargement of the little pits into which the secreting tubes open, and that each pit is surrounded by a zone of congested blood-vessels. On making sections of the membrane, the blood-vessels between and below the tubes are also found to be increased in size, and not unfrequently in a thickened or fatty condition. In some cases the smaller arteries are chiefly affected, but where long-continued congestion has been kept up, the veins are usually thickened and their calibre increased.

The changes in colour are mostly connected with the deposition of a black or grey pigment, between and within the gastric tubes. This pigment is chiefly observed in the shape of granular matter, and there can be no doubt, as stated by Dr. H. Jones, that it arises from altered hæmatine.

We can with the microscope trace two kinds of morbid changes affecting the secreting tubes; one of which may be named chronic intertubular, and the other chronic tubular gastritis. Both forms may be accompanied by increased thickness of the basement membrane.

The amount of thickness varies much in different cases, but in all it is greatest at the closed ends of

the tubes.

In chronic intertubular gastritis the tubes are firmly adherent to each other, the spaces between and below

PLATE V.

THE APPEARANCES PRESENTED IN CHRONIC GASTRITIS.

FIG. 1. Chronic intertubular gastritis.

t. The tubes filled with cells and granular matter.

co. Increased connective tissue between and below the tubes.

FIG. 2. First stage of chronic tubular gastritis.

t. The tubes irregularly filled with cells and granular

matters.

v. Enlarged and thickened blood-vessels.

FIG. 3. Second stage of chronic tubular gastritis.

t. The remains of the tubes wrinkled and almost empty. d. Dark cells scattered here and there between the tubes. v. Enlarged and thickened blood-vessels.

Figs. 2 and 3 were drawn from specimens taken from near the edges of chronic ulcerations of the stomach.

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