CHAPTER I. Preliminary Remarks on Topographic and (Part 2)

Klemensiewicz, and Heidenhain, who determined that the pyloric secretion was alkaline in reaction. Vacuoles have been observed in the border cells by Heidenhain, Stéhr, Sachs, Stintz- ing, Hamburger, and Bonnet. «All of these authors, excepting the latter, found the vacuoles near the nucleus, whereas Bonnet found them partly near by and partly at the site of the nucleus. ‘The explanation of this remarkable phenomenon is uncertain, but it appears likely that it is a manifestation of the process of secretion. Bonnet has furthermore deter- mined that a portion of the nuclei in the polynuclear border cells, which are rich in chromatin, belongs to leucocytes. ‘The latter may be observed in the border cells at all stages of invasion. The glands of the pylorus (Fig. 6) also consist of coils of tubules, which may occur singly or divided into many branches, Here, as in the ease of the gastric glands, the gastric follicle leads at first to the neck, which in turn is followed by the body and then the fundus of the gland. ‘The gastric follicle is lined with epithelium, which is of the character of the superficial epithelium, whereas the true glandular cells possess the characteristics of the chief cells of the glands of the fundus. Still other disseminated cells are noted, which in their structure and reaction tend to resemble the border cells (Nusshaum’s cells). ‘These, however, have more recently been looked upon by Stéhr and Hamburger as glandular cells which have become altered by compression from neighbouring cells. ‘The lab glands in the bordering zone between the pylorus and fundus of the stomach differ somewhat in appearance, inasmuch as they are shorter 16 Heidenhain, Schulze’s Archiv fiir mikroskopische Anatomie, 1870, Bd. 6, S. 363. 1 Griitzner, Archiv f. d. ges. Physiologie, 1879, Bd. 20, S. 410. 8 y, Swiecicki, Archiv f. d. ges. Physiologie, 1876, Bd. 13, 8. 452. Schrwald, Miinch. med. Wochenschr., 1888, No, 11. S, Friinkel, Pfliiger’s Archiv, 1890, Bd. 48, 8. 63. 2. F. Klug, Ungar. Archiv f. Medicin, 1892, Bd. I, 8. 35. ® Contejean, Archives de Physiologie 1892, Serie V., Bd. IV. 3, 8. 554-561. TOPOGRAPHIC AND HISTOLOGIC ANATOMY. 13 and more spiral in shape. In the neighbourhood of the cardia the border cells may be completely absent, according to Kupller2 ‘The single or forked gastric alveoli, which extend to one-half of the thickness of the mucous membrane, pass into wide, partly shorter, and partly longer spiral glandular tubules, which are paved only with a uniformly-low epithelium. Aside from the above-mentioned glands, we also note simple mucus glands, that is, glands, including lymphatic glands, which are wholly lined with cylindrical epithelium. ‘The lymphatic glands lic as little nodules in the tissue of the mucous membrane, and when intensely swollen may press the glandular tubules apart. During the process of digestion the glandular elements change their appearance in a characteristic manner. ‘The border cells become larger and swollen, but lessen in size as the end of digestion approaches. The chief cells likewise undergo enlargement and become darker and cloudy, but do not assume their former appearance and size until several hours after digestion. The so-called fatty granular cells (Mastzellen) oceur, according to Stintzing,* in large numbers in the fundus as well as in the pylorus, In the healthy stomach they are never seen outside of the connective tissue, but in pathologie conditions they appear between the tunica propria .and the glandular cells. They may penetrate between two glandular cells and reach as far as the lmmen, This process should not be confused with the passage of the leucocytes through the superficial epithelium. The connective tissue of the human stomach is very scanty in the fundus, The glands lie closely together, and are separated only here and there by a little connective tissue and muscle-fibres arising from the museu- laris mucosw, or by blood-vessels. ‘The pylorus is more richly supplied with connective tissue and smooth musculature, and exhibits a decided lencoeytie infiltration and numerous lymphatic nodules (Bonnet). The muscularis mucose is composed of two or three layers of smooth musele-bundles, extending in various directions. Offshoots from the mus- culature pass upward to the glandular portion of the mucous membrane. The submucosa consists of loose connective-tissue bundles alone, or combined with clastic fibres, forming a support for the mucosa. Smaller or greater collections of fat-cells are found occasionally in the connective tissue mass. The muscularis ventriculi presents in the pylorus two distinctly sepa- rate fibrous systems (Fig. 2): an inner circular and an outer longi- tudinal layer. Tn the other portions of the stomach the sadmixture of muscle-fibres from the csophagus presents a most. complicated picture, so ® Kupffer, Le. 4 Stintzing, Mtinch, med. Wochensehr., 1889, No. 8, 8, 121. 14 TOPOGRAPHIC AND HISTOLOGIC ANATOMY, that on cross-section the musculature exhibits a most varied arrangement. It is, however, of no practical interest to describe this subject here in detail. Blood-vessels and Nerves of the Stomach. The arteries of the stomach arise from the celiac artery. Of its branches, the left coronary artery, which arises dircetly from the coliae, and the right coronary artery, which arises from the hepatie artery, supply the lesser curvature. These two vessels form the superior ventricular arch. The greater curvature is likewise supplied by a branch from the hepatic artery, the left coronary gastrie artery, which is a branch from the splenie artery to the inferior ventricular arch. The veins run, as a rule, parallel to the course of the arteries. ‘Those arising from the left coronary artery empty into the splenic vein; those accompanying the right coronary artery end in the mesenteric or portal vein, into which, as a rule, the superior coronary vein also empties. An independent yenous trunk is found at the pylorus, the pyloric vein, which empties either into the inferior coronary yein or directly into the portal vein. ‘The vessels pass from the serosa through the muscularis to form a plexus in the submucosa. This plexus spreads out over a level plane, and emits fine capillaries, which, surrounding the glandular tubules, continue upwards to construct a second plexus at the.mouth of the gland. It, in turn, gives off other fine capillaries, which run in a circle around the exit. Minute veins arise from the capillaries, which, in a manner similar to the arteries, run downward to build a venous network in the tunica propria. The lymphatic vessels form large, tube-like spaces around the glandular tubules, which are bounded on the one side by the true membrane of the glands and on the other side by the endothelium of the interstitial connect- ive-tissue (Lowén). Lymph (chyle) capillaries, running between the individual tubules, connect with a widely-meshed network in the submucosa. The lymph-vessels, arising therefrom and supplied with valves, spread throughout the muscular coat; they also receive the many lymph-capillaries existing in the muscular strata. The lymph-vessels run beneath the serosa to the mesentery, between the layers of which they continue their course. ‘The nerves of the stomach originate partly in the vagus and partly in the solar plexus. The fibres, which are mostly non-medullated, form a net- work in the serosa, from which they penetrate the muscularis to build an extensive plexus between the longitudinal and circular layers, called the mesenterie plexus (plexus Auerbachii). Numerous multipolar ganglion- cells lie at the nodal points of this plexus. Nerve-fibres extend from this plexus to end either in the muscle-fibres or, penetrating into the submucosa, form a second plexus, called Meissner’s plexus. Small fibres run from this plexus between the glands to the glandular cells.