Page:EB1911 - Volume 08.djvu/280

 notwithstanding constant variations in the work set them. 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. Any form of unphysiological diet, each failure to cater for the wants of any special tissue engaged in, or of any processes of, metabolism, carry with them pathological signs. Perhaps in greater degree than elsewhere are the individual sections of the digestive system dependent upon, and closely correlated with, one another. 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. The digestive system includes every organ, function and process concerned with the utilization of food-stuffs, from the moment of their entrance into the mouth, their preparation in the canal, assimilation with the tissues, their employment therein, up to their excretion or expulsion in the form of waste. Each portion resembles a link of a continuous chain; each link depends upon the integrity of the others, the weakening or breaking of one straining or making impotent the chain as a whole.

The mucous membrane lining the alimentary tract is the part most subject to pathological alterations, and in this connexion it should be remembered that this membrane differs both in structure and functions throughout the tract. Chiefly protective from the mouth to the cardia, it is secretory and absorbent in the stomach and bowel; while the glandular cells forming part of it secrete both acid and alkaline fluids, several ferments or mucus. Over the dorsum of the tongue its modified cells subserve the sense of taste. Without, connected with it by the submucous connective tissue, is placed the muscular coat, and externally over the greater portion of its length the peritoneal serous membrane. All parts are supplied with blood-vessels, lymph-ducts and nerves, the last belonging either to local or to central circuits. Associated with the tract are the salivary glands, the liver and the pancreas; while, in addition, lymphoid tissue is met with diffusely scattered throughout the lining membranes in the tonsils, appendix, solitary glands and Peyer’s patches, and the mesenteric glands. The functions of the various parts of the system in whose lesions we are here interested are many in number, and can only be summarized here. (For the physiology of digestion see .) Broadly, they maybe given as: (1) Ingestion and swallowing of food, transmission of it through the tract, and expulsion of the waste material; (2) secretion of acids and alkalis for the performance of digestive processes, aided by (3) elaboration and addition of complex bodies, termed enzymes or ferments; (4) secretion of mucus; (5) protection of the body against organismal infection, and against toxic products; (6) absorption of food elements and reconstitution of them into complex substances fitted for metabolic application; and (7) excretion of the waste products of protoplasmic action. These functions may be altered by disease, singly or in conjunction; it is rare, however, to find but one affected, while an apparently identical disturbance of function may often arise from totally different organic lesions. Another point of importance is seen in the close interdependence which exists between the secretions of acid and those of alkaline reaction. The difference in reaction seems to act mutatis mutandis as a stimulant in each instance.

General Diseases.

In all sections of the alimentary canal actively engaged in the digestion of food, a well-marked local engorgement of the blood-vessels supplying the walls occurs. The hyperaemia abates soon after completion of the special duties of the individual sections. This normal condition may be abnormally exaggerated by overstimulation from irritant poisons introduced into the canal; from too rich, too copious or indigestible articles of diet; or from too prolonged an experience of some unvaried kind of food-stuff, especially if large quantities of it are necessary for metabolic needs; entering into the first stage of inflammation, acute hyperaemia. More important, because productive of less tractable lesions, is passive congestion of the digestive organs. Whenever the flow of blood into the right side of the heart is hindered, whether it arise from disease of the heart itself, or of the lungs, or proceed from obstruction in some part of the portal system, the damming-back of the venous circulation speedily produces a more or less pronounced stasis of the blood in the walls of the alimentary canal and in the associated abdominal glands. 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. 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. 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 the latter position these dilated veins constitute what are known as haemorrhoids or piles, internal or external as their site lies within or outside the anal aperture.

The mucous and serous membranes of the canal and the glandular elements of the associated organs are the parts most subject to inflammatory affections. Among the several sections of the digestive tract itself, the oesophagus and jejunum are singularly exempt from inflammatory processes; the fauces, stomach, caecum and appendix, ileum, mouth and duodenum (including the opening of the common bile-duct), are more commonly involved. Stomatitis, or inflammation of the mouth, has many predisposing factors, but it has now been definitely determined that its exciting cause is always some form of micro-organism. Any condition favouring oral sepsis, as carious teeth, pyorrhoea alveolaris (a discharge of pus due to inflamed granulations round carious teeth), granulations beneath thick crusts of tartar, or an irritating tooth plate, favours the growth of pyogenic organisms and hence of stomatitis. Many varieties of this disease have been described, but all are forms of “pyogenic” or “septic stomatitis.” This in its mildest form is catarrhal or erythematous, and is attended only by slight swelling tenderness and salivation. In its next stage of acuteness it is known as “membranous,” as a false membrane is produced somewhat resembling that due to diphtheria, though caused by a staphylococcus only. A still more acute form is “ulcerative,” which may go on to the formation of an abscess beneath the tongue. Scarlet fever usually gives rise to a slight inflammation of the mouth followed by desquamation, but more rarely it is accompanied by a most severe oedematous stomatitis with glossitis and tonsillitis. Erysipelas on the face may infect the mouth, and an acute stomatitis due to the diphtheria bacillus, Klebs-Loeffler bacillus, has been described. A distinct and very dangerous form of stomatitis in infants and young children is known as “aphthous stomatitis” or “thrush.” This is caused by the growth of Oidium albicans. It is always preceded by a gastro-enteritis and dry mouth, and if this is not attended to, soon attracts attention by the little white raised patches surrounded by a dusky red zone