Page:EB1911 - Volume 08.djvu/283

Numbers of bacterial forms habitually infest the alimentary canal. Many of them are non-pathogenic; some develop pathogenic characters only under provocation or when a suitable environment induces them to act in such a manner; others may form the materies morbi of special Vegetable parasites.lesions, or be casual visitors capable of originating disease if opportunity occurs. Apart from those organisms associated with acute infective diseases, disturbances of function and physical lesions may be the result of abnormal bacterial activity in the canal; and these disturbances may be both local and general. Many of the bacteria commonly present produce putrefactive changes in the contents of the tract by their metabolic processes. 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. 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. Diminished gastric acidity allows of the entry of a greater number of putrefactive (and pathogenic) types, with, as a consequence, increased facilities for their growth and activity, and the appearance of intestinal derangements.

Table I.

Males.			Females.			Both Sexes.
Organ or Tissue in Order of Frequency.		Per- centage.	Organ or Tissue in Order of Frequency.		Per- centage.	Organ or Tissue in Order of Frequency.		Per- centage.
1 Stomach		22·56	1 Stomach		22·37	1 Stomach		22·49
2 Lip		12·94	2 Rectum		17·24	2 Rectum		13·12
3 Rectum		11·57	3 Liver		15·50	3 Liver		10·02
4 Tongue		11·36	4 Peritoneum		7·86	4 Lip		9·89
5 Oesophagus		10·90	5 Oesophagus		5·33	5 Oesophagus		9·29
6 Liver		7·80	6 Sigmoid		4·53	6 Tongue		8·96
7 Jaw		6·38	7 Pancreas		3·52	7 Jaw		5·65
8 Mouth		2·88	8 Tongue		3·12	8 Peritoneum		2·94
9 Tonsils		2·09	9 Omentum		2·98	9 Sigmoid		2·56
10 Sigmoid flexure		1·77	10 Lip		2·57	10 Mouth		2·40
11 Parotid	${\Big \}}$	1·10	11 Jaw		1·97	11 Pancreas		1·80
12 Pancreas			12 Colon	${\Big \}}$	1·84	12 Tonsils		1·35
13 Caecum	${\Big \}}$	0·94	13 Abdomen			13 Omentum		1·25
14 Peritoneum			14 Intestine		1·56	14 Parotid	${\Big \}}$	1·12
15 Colon		0·89	15 Caecum		1·37	15 Colon
16 Pharynx	${\Big \}}$	0·79	16 Mouth	${\Big \}}$	1·18	16 Caecum		1·08
17 Intestine (site unknown)			17 Parotid			17 Intestine	${\Big \}}$	1·00
18 Abdomen		0·71	18 Splenic flexure		0·98	18 Abdomen
19 Mesentery	${\Big \}}$	0·55	19 Jejunum and ileum		0·78	19 Pharynx		0·62
20 Omentum			20 Tonsils		0·68	20 Mesentery		0·52
21 Hepatic flexure		0·39	21 Pharynx	${\Bigg \}}$	0·40	21 Jejunum and ileum	${\Bigg \}}$	0·44
22 Submaxillary gland	${\Big \}}$	0·31	22 Hepatic flexure			22 Hepatic flexure
23 Jejunum and ileum			23 Mesentery			23 Splenic flexure
24 Duodenum		0·23	24 Submaxillary	${\Big \}}$	0·20	24 Submaxillary		0·28
25 Splenic flexure		0·15	25 Duodenum			25 Duodenum		0·22

Note.—The figures where several organs are bracketed apply to each organ separately.

In a healthy new-born infant the mouth is free from micro-organisms, and very few are found in a breast-fed baby, but Bacillus lactis may be found where the child is bottle fed. If there is trouble with the first dentition and food is allowed to collect, staphylococci, streptococci, pneumococci and colon bacilli may be present. Even in healthy babies Oidium albicans may be present, and in older children the pseudo-diphtheria bacillus. From carious teeth may be isolated streptothrix, leptothrix, spirilla and fusiform bacilli. Under conditions of health these micro-organisms live in the mouth as saprophytes, and show no virulence when cultivated and injected into animals. 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. Most are relatively inert, but some have a special fermentative action on the food (see Nutrition). Abelous isolated sixteen distinct species of organism from a healthy stomach, including Sarcinae, B. lactis, pyocyaneus, subtilis, lactis erythrogenes, amylobacter, megatherium, and Vibrio rugula.

Hare-lip, cleft palate, hernia and imperforate anus are physical abnormalities which are interesting to the surgeon rather than to the pathologist. 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. Incomplete closure of the vitelline duct results in the presence of a diverticulum—Meckel’s—generally connected with the ileum, mainly important by reason of the readiness with which it occasions intestinal obstruction. Idiopathic congenital dilatation of the colon has been described.

Table II.

Males.	Per-  centage.	Females.	Per-  centage.	Total.	Per-  centage.
1 Mouth and pharynx	37·85	1 Intestines	28·9	1 Oesophagus and stomach	31·78
2 Oesophagus and stomach	33·46	2 Oesophagus and stomach	27·7	2 Mouth and pharynx	30·27
3 Intestines	17·04	3 Liver	15·5	3 Intestines	20·42
4 Liver	7·8	4 Peritoneum	13·1	4 Liver	10·02
5 Peritoneum	2·75	5 Mouth and pharynx	11·3	5 Peritoneum	5·71
6 Pancreas	1·1	6 Pancreas	3·5	6 Pancreas	1·80

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. The writer has seen post mortem a stomach which held a gallon (160 ounces), and again one holding only two ounces. Cancer spread over a large area and cirrhosis of the stomach wall cause diminution in capacity; pyloric obstruction, weakness of the muscular coat, and nervous influences are associated with dilatation. A peculiar distortion of the shape of the stomach follows cicatrization of