CHAPTER II.

DISEASES OF THE DIGESTIVE SYSTEM.

IN studying the local diseases of mankind we cannot do better than take them in order as affecting the different systems of organic parts we have just considered. The local diseases, the reader may be once more reminded, are, for the most part, but repetitions of the conditions of disease and of the general diseases, locally situated. We commence, therefore, following our physiological outline, with the diseases of the alimentary or digestive system of organs.

The different parts of the alimentary system are, as we have seen, (a) The lips, mouth, tongue, fauces or back of the throat, and palate, with the uvula and tonsils. (b) The pharynx, or dilated pouch at the back of the throat, ending in the oesophagus or gullet, the tube extending from the pharynx to the stomach. (c) The stomach, or first digesting receptacle, in which the albuminous or flesh-forming foods are transformed into chyme, primary digestion, to be passed through the pylorus or exit gate of the stomach, into the duodenum. (d) The duodenum, or first portion of small intestine into which the liver pours its bile and the pancreas its emulsifying juice, under which the fatty and starchy portions of the food are digested, secondary digestion,-before being carried into the small intestines. (e) The small intestines, jejunum and ileum, in which digestion is completed, and from which the prepared food is absorbed into the blood. (ƒ) The large intestine springing from a pouch, the cæcum, for receiving the débris, undigested or useless part of food substances, and the gases arising during digestion, the colon. (g) The straight intestine, with the outlet of which the canal is terminated. (h) The mucous membrane lining the whole of the canal internally. (¿) The peritoneum or serous membrane of the abdominal cavity, in

which the intestines and other abdominal organs are in great part enfolded, and which lines also the walls of the cavity.

All these parts are seats of local disease.

DISEASES OF THE LIPS.

Ulcer of the Lip.-A small round ulcer by which the mucous membrane is destroyed in a circular manner so cleanly that it looks as if a portion had been punched out, the cellular tissue beneath forming the lower part or base. The ulcer is often exceedingly painful, and frequently recurs in those who are liable to it.

Fissure. A cleft in the mucous membrane of the lips running longitudinally, often occurring in the middle of one lip, and most frequently in the lower lip. As a rule the fissure is painful, slow to heal, and apt to recur.

Cancer. Cancer usually of the form called epithelial, occurring mostly in the lower lip, and excited in many cases in those who are addicted to smoking by irritation from the stem of the pipe. The disease not unfrequently affects men, but so rarely affects women, that in thirty years of medical observation I have not seen one instance of it.

Cysts. Small cystic or hollow tumors attached to the mucous surface of the lips.

Harelip.-A malformation in which the upper lip has not been developed in such way as to unite in the centre previous to birth, so that there is a deep cleft down the lip. The malformation is now remediable by surgical art.

DISEASES OF THE MOUTH AND TONGUE.

Stomatitis.-A diseased condition of the mouth to which infants or young children are most subject, in which the mucous membrane is more or less covered with whitish flaky-looking spots or patches.

Follicular Stomatitis.-A catarrhal inflammatory state of the follicles or little sacs of the mucous surface.

Ulcerative Stomatitis.-A series of small ulcerations of the mucous surface involving the follicles.

Thrush. Vesicular Stomatitis.-Stomatitis in which there is

a vesicular eruption of thrush on the mucous surface.

Parasitic Thrush.-Thrush in which there is present the parasite called oidium albicans, or thrush fungus.

Cancrum Oris, Canker of the Mouth.-A form of stomatitis in which there is death or mortification of the mucous membrane. The disease is sometimes called gangrenous stomatitis.

In all these local forms of disease there is some pre-existing general disease and weakness of the body, the common cause of which is improper feeding. Thrush most generally precedes death in exhausting diseases, and is, as a rule, a fatal symptom.

Abscess. A circumscribed accumulation of matter or pus in the structure of the cheek, the result of inflammation.

Cyst.-Growth of a hollow or cystic tumor beneath or upon the mucous surface of the cheek.

Ranula.-A cystic tumor beneath the tongue, sometimes, but not always, connected with destruction of one of the ducts which convey the saliva from the salivary gland into the mouth. It is occasionally attended with a deposit of phosphatic concretion or calculus, derived from the saliva.

DISEASES OF THE GUMS.

Inflammation.-Inflammation of the firm structure which, covered with mucous membrane, extends over the alveolar part, -socket part,—of the jawbone up to the commencement of the crowns of the teeth. When the inflammation is caused by a decayed tooth, and involves the periosteum of the fang of the tooth, the term gum boil is employed to express the disease.

Ulceration.-A destruction, by ulceration, of the surface of the gum from irritation or inflammation.

Hypertrophy.-An excessive growth or thickening of the structure of the gum.

Atrophy.-Wasting of the structure, often called, in advanced life, shrinking of the gums.

Induration.-Hardness of the structure of the gum; a condition which, occurring in infancy, causes much pain and difficulty in the process of cutting the teeth.

Tumors.-Growths, malignant or non-malignant, attached to or springing from the structure of the gum. The cancerous or malignant growths are usually epithelial. The simple or nonmalignant are of four kinds. (a) Polypoid. (b) Cartilaginous. (e) Vascular. (d) Fibrous, called sometimes epulis.

Perforation of the Palate.-The palate, the bony structure forming the roof of the mouth and, in the natural state, covered

with mucous membrane, is said to be cleft or perforated when from irregular development before birth the two parts of which it is composed have not come together. The condition is sometimes accompanied with cleft or harelip.

DISEASES OF THE TONGUE.

Glossitis.-Inflammation of the structure of the tongue, an acute disease of rare occurrence.

Ulceration.-An ulceration of the mucous surface of the tongue assuming different forms. (a) Small round ulcers like those seen on the lips, or taking the form of a cleft. (b) Wider spread, more irregular shaped, deeper ulcers. (c) Aphthous ulcers, ulcers accompanied with aphthæ, often of parasitic char

acter.

Abscess. A circumscribed accumulation of matter or pus in the structure of the tongue, the result of inflammation. A disease of comparatively rare occurrence.

Hypertrophy.-A partial or general enlargement of the tongue, the organ sometimes assuming a great size from interstitial deposit between the muscular fibres of which it is composed.

Cancer.-Malignant disease commencing in the tongue, usually in the epithelial form of the malady, but taking, sometimes, the hard or scirrhous type.

Vascular Tumors.--Various forms of tumors, made up mainly of arterial and venous vessels, and attached to the tongue from its cellular or connective structure.

Cellular Infiltration.--A condition I have observed and described, in which the whole cellular structure of the tongue has become infiltrated with diseased serous fluid as the result of inoculation, through a wound in the tongue, of decomposing animal substance taken as food. The tongue is greatly enlarged so as to protrude from the mouth, is of soft spongy consistency, and completely infiltrated with a serous, milky-looking decomposing fluid.

Paralysis. The tongue often shares with the lips and other parts of the body in paralysis. In rare instances it is subjected to paralysis of motion independently of the rest of the body.

Tongue Tie.-A malformation in which, from prolongation of the little central band called the frænum, the tongue is tied down to the lower jaw.

Exfoliation of the Mucous Membrane.-In some dyspeptics, especially in persons who smoke excessively, the tongue is sometimes coated with a thick white fur, which peels off, carrying with it the epithelial surface and leaving an irritable red surface beneath.

DISEASES OF THE THROAT.

The part of the mouth called the fauces, the back of the throat, is commonly injected, inflamed, and ulcerated in the course of some acute febrile affections, such as scarlet fever. It is also subject to several purely local affections. The following are the more important:

Sore Throat.-A diffuse injection of the mucous membrane of the throat, with raised points, accompanied by a sense of soreness, heat, and dryness, but without exudation of any membranous substance. The affection is a frequent attendant of a common cold, cold and sore throat, and may be associated with some degree of temporary deafness and feeling of pressure on the drum of the ear. The Eustachian tube, which extends from the throat into the middle ear, is then also affected.

Relaxed Throat.--A state of the mucous membrane of the fauces in which, with redness and irritation, there is a relaxed condition of the mucous membrane, with projecting folds of membrane which are often, at the same time, large and relaxed. The condition follows usually upon cold and sore throat, but it may be induced by mechanical causes, such as severe hoarse cough, screaming, shouting, frequent reading in one harsh tone, and overstrain in singing. It is induced also, in persons who are susceptible to it, by no means an inconsiderable number, by smoking tobacco. It is more frequent in men than in women, and specially in men who are engaged in occupations in which the voice is employed in one strain. Thus to one chronic form of this affection the term "clergyman's throat" is applied, because it affects numbers of the clergy who, while in indifferent health, read the services of the Church and preach too frequently.

Ulcerated Throat.-A condition in which the mucous membrane of the throat is in parts destroyed so deeply in bad cases, that the connective tissue beneath it may be seen. It is the result, as a rule, of inflammation of the mucous membrane or of specific disease.