he organ suffer;
peristaltic movement is weakened; expulsion of the contents through the
pylorus hindered; and, aggravated by these effects, the condition
becomes worse, atonic dyspepsia in its most pronounced form results,
with or without dilatation. Chronic vascular congestion may occasion in
process of time similar signs and symptoms.

Duodenal catarrh is constantly associated with jaundice, indeed is most
probably the commonest cause of catarrhal jaundice; often it is
accompanied by catarrh of the common bile-duct. Chronic inflammation of
the small intestine gives rise to less prominent symptoms than in the
stomach. It generally arises from more than one cause; or rather
secondary causes rapidly become as important as the primary in its
incidence. Chronic congestion and prolonged irritation lead to deficient
secretion and sluggish peristalsis; these effects encourage intestinal
putrefaction and auto-intoxication; and these latter, in turn, increase
the local unrest.

Infective lesions.

The intestinal mucous membrane, the peritoneum and the mesenteric glands
are the chief sites of tubercular infection in the digestive organs.
Rarely met with in the gullet and stomach, and comparatively seldom in
the mouth and lips, tubercular inflammation of the small intestine and
peritoneum is common. Tubercular enteritis is a frequent accompaniment
of phthisis, but may occur apart from tubercle of other organs. Children
are especially subject to the primary form. Tubercular peritonitis often
is present also. 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 tubercles spread over the surface
of the serous membrane, and if small and not very numerous may give rise
in chronic cases to few symptoms; if larger, and especially when they
involve and obstruct the lymph- and blood-vessels, ascites follows. It
is hardly possible that tubercular invasion of the mesenteric glands can
ever occur unaccompanied by peri