The malignant tumours of the intestine arc almost without exception cancerous. Their most frequent sites are the colon and the rectum, but they are sometimes found also in the small intestine. They may reach the size of a man's fist, and may lead to extensive adhesions between the intes tinal coils and the surrounding regions. These tumours are hard, present an uneven or nodular surface, and may often be palpated through the abdominal wall, when they may be felt to be more or less movable. Under certain circumstances these tumours may not give rise to any marked symp toms for months ; and the first signs of trouble do not appear until they have grown to such a size that they exert pressure on neighbouring organs, or produce a narrowing of the lumen of the gut. This results in pain, repeated attacks of intestinal colic, hcemorrhages from the bowel, and diarrhcea. The patient becomes pale and markedly emaciated. If a permanent occlu sion of the gut has resulted, which interferes with the passage of the intes tinal contents, the movements of the intestine, as well as the distended loops of gut, may become visible on the surface of the abdomen. These appear ances are due to the stoppage of the intestinal contents at the point of con striction, where the peristaltic action ceases because further propulsion is no longer possible. Where the occlusion takes place suddenly, faecal vomiting results, and death may come on very quickly. When obstinate constipation occurs in middle - aged people whose evacuations have formerly been perfectly regular, suspicion should always be directed to the possibility of an intestinal tumour being present. This state of constipation may be inter rupted from time to time by periods of but this is merely due to a transitory restoration of the 'latency of the lumen of the bowel. The intes tinal tumours of most frequent occurrence are cancers of the RECTUM (which see). Growths which have their site at the beginning of the colon, especially if they are small, may give rise to symptoms resembling those due to chronic appendicitis.
The only effective remedy for intestinal tumours is their removal by the surgeon's knife. Success, however, can he hoped for only in the cases of smaller tumours, where no adhesion to the surrounding structures has occurred, and where no cancerous deposits have taken place in other portions of the body. Operation must not be delayed until the patients have become emaciated, but should be carried out at the appearance of the first definite evidences of the disease.
Intestinal Ulcers.—These occur on the inner surface of the gut, and are of varying sizes and shapes. At first they are no larger than a pin-head, but gradually they may become as large as a sixpence. In shape they are circu lar or oval, and rarely irregular in outline. They are always developed in the mucous membrane, and usually remain restricted to this. Sometimes, however, they penetrate the muscular coats and finally the peritoneal cover ing of the intestine. Whenever the serous coat of the gut is involved, there
is constant danger of perforation into the peritoneal cavity. The entrance of frecal matter into this cavity brings about a purulent peritonitis, NVIliCh rapidly proves fatal. This accident, however, is often prevented by the fact that the irritation produced by the gradually deepening ulcer causes an inflammatory deposit at the site of the threatening perforation ; and this deposit forms a close adhesion between the peritoneum and the ulcerous spot. These adhesions are the natural means of protection for the peritoneum.
The following types of intestinal ulcers may be distinguished : (I) Tuberculous ulcers which form part of the pathological process described under intestinal tuberculosis (which see) ; (2) typhoid ulcers ; (3) dysenteric ulcers, which arc usually found in the large intestine, whereas the two former types are met with almost exclusively in the small intestine ; (4) syphilitic ulcers ; (5) gonorrhoeal ulcers, which arc produced by a transmis sion of gonococci from the genitals ; (6) carcinomatous ulcers, due to the disintegration of cancerous growths ; and (7) ulcers resulting from urinary intoxication in the presence of chronic inflammation of the kidneys. Syph ilitic and gonorrhoeal ulcers usually develop in the rectum. All these ulcers, particularly the syphilitic and the gonorrhoeal forms, have a tendency to produce a cicatricial contraction of the lumen of the gut. They also keep up, for weeks and months, a purulent, blood-mixed discharge which greatly weakens the patient. Very often there is present also a chronic diarrhoea.
In typhoid the small intestine from ten to twenty or thirty ulcers in various stages of development. In each case the symptoms vary with the cause and variety of the intestinal ulcers present. Either suppu ration, hmmorrhage, or diarrhoea may be the most prominent symptom ; or these symptoms may be combined in various ways. Sometimes the abdo men is tender and painful to the touch. If intestinal occlusion be present in addition to the ulcers, the symptoms of this condition are superadded.
From what has been said in the foregoing, it is very evident that no one set of rules can be formulated for the treatment of intestinal ulcers. The physician must be governed entirely by the circumstances associated with each particular case. Some of these ulcerations, for example those found in typhoid, may heal without leaving any trace of their existence ; but the majority either fail to heal, or do so with the formation of scars. The original disease which caused the formation of the ulcers often results fatally, as in tuberculosis or cancer. In these cases the ulcers remain unchanged until the termination of the disease.
INTOXICATION.—See ALconousm. INTUSSUSCEPTION.—See INTESTINES, DISEASES or.