Andrew Lockhart Gillespie and Michael Foster

“ The small intestine is rarely attacked by cancer; the large intestine frequently. The rectum, sigmoid flexure, caecum and colon are affected, and in this order, the cylindrical-celled form being the most common. Carcinoma of the peritoneum is generally colloid in character, and is often secondary to growths in other organs. Cancer of the liver follows cancer of the stomach and rectum in frequency of occurrence, and is relatively more common in females than males. Secondary invasion of the liver is a frequent sequel to gastric cancer. The pancreas occasionally is the seat of cancerous growth. ”

“ As a general rule, the more marked the involvement of the large bowel, the severer and more fluid is the resultant diarrhoea. Inflammation of the stomach may be due to mechanical injury, thermal or chemical irritants or invasion by micro-organisms. Also all the symptoms of gastric catarrh may be brought on by any acute emotion. The commonest mechanical injury is that due to an excess of food, especially when following on a fast; poisons act as irritants, and also the weevils of cheese and the larvae of insects. ”

“ Obstruction to the flow of blood from the liver leads to dilatation of its blood-vessels, consequent pressure upon the hepatic cells adjoining them, and their gradual loss of function, or even atrophy and degeneration. In addition to the results of such passive congestion exhibited by the stomach and bowel as noted above, passive congestion of the liver is often accompanied by varicose enlargement of the abdominal veins, in particular of those which surround the lower end of the oesophagus, the lowest part of the rectum and anus. ”

“ In catarrhal jaundice it is in most cases the bowel that is at fault, the liver acting properly, but unable to get rid of all the bile produced. The liver suffers, however, from several diseases of its own. Its fibrous or connective tissue is very apt to increase at the expense of the cellular elements, destroying their functions. This cirrhotic process usually follows long-continued irritation, such as is produced by too much alcohol absorbed from the bowel habitually, the organ gradually becoming harder in texture and smaller in bulk. ”

“ In females the pelvic organs are often the true source of emesis. Haematemesis accompanies gastric ulcer, cancer, chronic congestion with haemorrhagic erosion, congestion of the liver, or may follow violent acts of vomiting. In cases of ulcer the blood is usually bright and in considerable amount; in cancer, darker, like coffee-grounds; and in cases of erosion, in smaller quantity and of bright colour. The reaction of the stomach contents, if the cause be doubtful, yields valuable aid towards a diagnosis. ”

“ The inflammatory process readily tends towards ulcer formation, with haemorrhage and sometimes perforation. If in the large bowel, the symptoms are usually less acute than those characterizing tubercular inflammation of the small intestine. The appendix has been found to be the seat of tubercular processes; in the rectum they form the general cause of the fistulae and abscesses so commonly met with here. Tubercular peritonitis may be primary or secondary, acute or chronic; occasionally very acute cases are seen running a rapid course; the majority are chronic in type. ”

“ The two common pyogenetic organisms, Staphylococcus albus and brevis, show no virulence. Also the pneumococcus, though often present, must be raised in virulence before it can produce untoward results. The foulness of the mouth is supposed to be due to the colon bacillus and its allies, but those obtained from the mouth are innocuous. Also to enable the Oidium albicans to attack the mucous membrane there must be some slight inflammation or injury. The micro-organisms found in the stomach gain access to that organ in the food or by regurgitation from the small intestine. ”

“ Acute catarrh of the stomach is associated with intense hyperaemia of its lining coats, with visible engorgement and swelling of the mucous membrane, and an excessive secretion of mucus. The formation of active gastric juice is arrested, digestion ceases, peristaltic movements are sluggish or absent, unless so over-stimulated that they act in a direction the reverse of the normal, and induce expulsion of the gastric contents by vomiting. ”

“ The mucous membrane of the stomach and bowel, less able to withstand the effects of irritation, even of a minor character, readily passes into a condition of chronic catarrh, while it frequently is the seat of small abrasions, haemorrhagic erosions, which may cause vomiting of blood and the appearance of blood in the stools. ”

“ Mouth breathing is the cause of many ills. As a result of this, the mucous membrane of the tongue, &c., becomes dry, micro-organisms multiply and the mouth becomes foul. Also from disease of the nose, the upper jaw, palate and teeth do not make proper progress in development. There is overgrowth of tonsils, and adenoids, with resulting deafness, and the child’s mental development suffers. An ordinary “sore throat” usually signifies acute catarrh of the fauces, and is of purely organismal origin, “catching cold” being only a secondary and minor cause. ”

“ The lack of a sufficiently vigorous flow of blood is followed by deficient secretion of digestive agents from the glandular elements involved, by decreased motility of the muscular coats of the stomach and bowel, and lessened adaptability throughout for dealing with even slight irregular demands on their powers. ”

“ Traction diverticula of the oesophagus not uncommonly occur as sequels to suppurative inflammation of cervical lymphatic glands. More frequently dilatation of a section is met with, due as a rule to the presence of a stricture. The stomach often diverges from the normal in size, shape and position. Normally capable in the adult of containing from fifty to sixty ounces, either by reason of organic disease, or as the result of functional disturbance, its capacity may vary enormously. ”

“ Ptoses of other abdominal organs are described; the liver, transverse colon, spleen and kidneys may be involved. Displacements downwards of the stomach and transverse colon, along with a movable right kidney and associated with dyspepsia and neurasthenia, form the malady termed by Glénard enteroptosis. A general visceroptosis often occurs in those patients who have some tuberculous lesion of the lungs or elsewhere, this disease causing a general weakening and subsequent stretching of all ligaments. ”

“ Often the nervous cause can be traced back farther,—in females, frequently to the pelvic organs; in both sexes, to the condition of the blood, the brain or the bowel. Unhealthy conditions related to evacuation of the bowel-contents commonly induce reflex nervous manifestations of abnormal character referred to the stomach and liver. ”

“ Hepatic abscess may follow on an attack of amoebic dysentery, and is produced either by infection through the portal vein, or by direct infection from the adjacent colon. In general pyaemia multiple small abscesses may occur in the liver.
The Gall-Bladder.—The formation of biliary calculi in the gall-bladder is the chief point of interest here. At least 75% of such cases occur in women, especially in those who have borne children. Tight-lacing has been stated to act as an exciting cause, owing to the consequent retardation of the flow of bile. ”

“ The products of either class are inimical to the free growth of members of the other. The species which produce acids are more resistant to the action of acids. Thus, when the contents of the stomach possess a normal or excessive proportion of free hydrochloric acid, a much larger number of putrefactive and pathogenic organisms in the food are destroyed or inhibited than of the bacteria of acid fermentation. ”

“ A similar reversed action serves in merycism, or rumination, occasionally found in man, to raise part of the food, lately ingested, from the stomach to the mouth. Vomiting also is aided by reversed peristaltic action, both of the stomach and the oesophagus, with the help of the diaphragm and the muscles of the anterior abdominal wall. Emesis may be caused both by local nervous influence, and through the central nervous mechanism either reflexly or from the direct action of substances circulating in the blood. ”

“ The lungs can only yield oxygen to the blood when the oxygen is uncombined; no compounds are of use. The digestive organs have to deal with an enormous variety of compound bodies, from which to obtain the elements necessary for protoplasmic upkeep and activity. ”

“ Morbid lesions of the respiratory and circulatory systems are frequently capable of compensation through increased activity elsewhere, and the symptoms they give rise to follow chiefly along one line; diseases of the digestive organs are more liable to occasion disorders elsewhere than to excite compensatory actions. ”

“ A foreign body is the exciting cause in many cases, though less commonly so than was formerly imagined. The inflammation in the appendix varies in intensity from a very slight catarrhal or simple form to an ulcerative variety, and much more rarely to the acute fulminating appendicitis in which necrosis of the appendix with abscess formation occurs. ”

“ It is hardly possible that tubercular invasion of the mesenteric glands can ever occur unaccompanied by peritoneal infection; but when the infection of the glands constitutes the most prominent sign, the term tabes mesenterica is sometimes employed. Here the glands, enlarged, form a doughy mass in the abdomen, leading to marked protrusion of the abdominal walls, with wasting elsewhere and diarrhoea.
The liver is seldom attacked by tubercle, unless in cases of general miliary tuberculosis. ”

“ The eggs of the Trichina spiralis, when introduced with the food, develop in the bowel into larval forms which invade the tissues of the body, to find in the muscles congenial spots wherein to reach maturity. Similarly, the eggs of the Echinococcus are hatched in the bowel, and the embryos proceed to take up their abode in the tissues of the body, developing into cysts capable of growth into mature worms after their ingestion by dogs. ”

“ The crude articles of diet offered them vary immensely in nature, bulk and utility, from which they must elaborate simple food-elements for absorption, incorporate them after absorption into complex organic substances properly designed to supply the constant needs of cellular activity, of growth and repair, and fitly harmonized to fulfil the many requirements of very divergent processes and functions. ”

“ Irritation of the sensory nerve-endings in the stomach wall from the presence of an increased proportion of acid, organic or mineral, in the stomach contents is accountable for the well known symptom heartburn. Water-brash is a term applied to eructation of a colourless, almost tasteless fluid, probably saliva, which has collected in the lower part of the oesophagus from failure of the cardiac sphincter of the stomach to relax ”

“ Idiosyncrasy, past and present gastric education, penury or plethora, actual digestive power, motility, bodily requirements and conditions, environment, mental influences, local or adjacent organic lesions, and, not least, reflex impressions from other organs, all contribute to the variance. ”

“ The oesophagus may be the seat of a diverticulum, or blind pouch, usually situated in its lower half, which in most instances is probably partly acquired Physical abnormalities.and partly congenital; a local weakness succumbing to pressure. Hypertrophy of the muscular coat of the pyloric region is an infrequent congenital gastric anomaly in infants, preventing the passage of food into the bowel, and causing death in a short time. ”

“ In “relaxed throats” there is a chronic catarrhal state of the lining membrane, with some passive congestion. The tonsils are peculiarly liable to catarrhal attacks, as might a priori be expected by reason of their Cerberus-like function with regard to bacterial intruders. Still, acute attacks of tonsillitis appear on good evidence to be more common among individuals predisposed constitutionally to rheumatic manifestations. ”

“ Acute inflammatory appendicitis appears to be increasing in frequency, and is associated by many with the modern deterioration in the teeth. Constipation certainly predisposes to it, and it appears to be more prevalent among medical men, commercial travellers, or any engaged in arduous callings, subjected to irregular meals, fatigue and exposure. ”

“ In severe cases the muscular coat is exposed, and perforation may ensue. The number of ulcers varies from a few to many dozen, and in size from a pea to a five-shilling piece. Like all chronic intestinal ulcers they show a tendency to become transverse. ”

“ As a large proportion of the sufferers from this disease have been butchers, and the epidemics have occurred in the hot season of the year, it probably arises from contact with decomposing animal matter. ”

“ They render the medium they grow in alkaline, produce different gases and elaborate more or less virulent toxins. Other species set up an acid fermentation, seldom accompanied by gas or toxin formation. ”