14
and myself :—In one of Dr. Evans' cases the stomach was much ulcerated in two patches
—one small, the other very large ; the small one presented a " bloody slough " and the
stomach contained black fluid of a very foetid odour. There was yellow discoloration
of the cuticular portion in this case, and it seems from the record of symptoms to
have been a true case of relapsing fever. In another, which, when examined, gave no
evidence of being affected with the fever, he found a patch (1 inch by ¾ inch), irregular
in shape, on the cuticular portion, of a brownish leathery appearance, not detached nor
presenting any tendency to separate, thinner than the normal membrane. There was
neither congestion nor inflammation of the parts around this patch of what Dr. Evans
considers " degenerated membrane which probably would become a slough." He found
in almost all cases yellow pigmentation of the lining membrane and " dry sloughing "
without inflammation along the line of meeting of the cuticular and villous parts. In the
Tonghoo death returns the yellow coloration is mentioned as bile-staining, and the patho-
logical states of the stomach are noted as extensive ulceration, erosion in patches, inflam-
mation, and congestion ; sometimes the ulcers are noted as superficial and shallow,
at others they are " evidently of old standing " or " large and irregular." One case is
specially worthy of record, for in it there was a " large ragged ulcer on the cardiac
extremity " and the organ " contained a large hard mass of undigested paddy and
grass, one side of which, i.e., that in contact with the ulcer, was covered with blood."
In Dr. Evans' case of gastric hæmorrhage he also noted the presence of rough,
indigestible matter in the form of a bunch of unmasticated straw. In my post-mortem
researches I have found ample evidence that, as Veterinary Surgeon (First-class) Frost
observed and recorded, both the cuticular and villous portions of the gastric mucous mem-
brane may be involved in the disease, but the former actually is involved more frequently
than the latter. I find that sometimes the cuticular may be the sole seat of disease,
sometimes the villous, and sometimes both are simultaneously diseased or both healthy.
I also observe that there are, so to speak, favorite positions for the occurrence of the
lesions (as Inspecting Veterinary Surgeon Shaw indicated) at the junction of the two
portions and also at the lesser curvature rather than at the greater, and at either side
of the middle line. Further, I find that the lesions of the villous coat differ from
those of the cuticular only in minor respects, such as may fairly be attributed to their
anatomical differences. As the lesions of the cuticular are more frequent than those
of the villous portion, I will deal with them first. The bright yellow color presented
when the stomach is opened at once attracts attention, for it contrasts remarkably with
the normal whiteness of the epithelium. In the Tonghoo reports the stomach is
mentioned as extensively bile-stained, but we have no evidence that the coloring is due
to bile ; on microscopical examination we find that it results from degeneration
of epithelium and other tissues. Careful examination very soon makes it clear
that there are several different ways in which the degeneration
commences—(a) An irregular thickening of the epithelium takes
place in lines with generally a tendency to radiate from the oesophageal opening, or to
extend along the line of junction of the cuticular with the villous portion. This is
due to a proliferation of the epithelium and at first results in increased opacity, but later
the epithelial cells begin to break up into yellow débris from those parts which have
attained a certain thickness ; thus yellow superficial ulcers are formed which run together
along the disease ridges and extend laterally, so that a tendency to linear arrange-
ment of the ulcers is generally marked in this diseased state. (b) At definite spots
the epithelium becomes depressed and semi-transparent from the loss of its deeper cells
which have commenced to degenerate. Next the superficial cells give way and small
ulcers—circular, shallow, and yellowish—result. These in time run together ; they do
not show any tendency to linear arrangement, but by their extension and confluence
frequently isolate irregularly-shaped portions of the healthy epithelium from their
surroundings, and these healthy parts separate from their margins and gradually
curl up until they are shed. (c) Sometimes a small, generally circular, loss of the
glistening dense outer layer of epithelium is the first noticeable change. The effect
of either of these processes of degeneration of the epithelial layer is to expose the
corium, which in its turn undergoes degenerative changes which have probably
already advanced considerably by the time the epithelium is thoroughly removed.
Sooner or later the corium disappears and the white muscular fibre is exposed, only
in its turn to undergo the yellow degenerative change becoming thinner and thinner
Vide diagram.