40
it is remarkable how an animal in a state of semi-coma will continue to eat grass
almost without ceasing. In one case the patient seemed very keen for his gram,
but after the first mouthful, either from pain or distaste, refused to take any more
and turned away eagerly to his grass. in the human subject, pain, especially after
ingestion of food and persisting until completion of digestion (or until vomition
occurs), is found when the stomach is ulcerated. Sometimes, as in the case of senile
ulcers of the limbs, so in gastric ulcer there is little or no pain; when present, the
pain is noted as occurring in one spot u It is not uncommon for the pain to increase
for a few days and then gradually to subside. These exacerbations the writer has
chiefly observed in very chronic cases. They probably point to an extension of the
ulceration, for they not unfrequently precede haemorrhage or perforation." There is
appetite, but the patient dreads the pain resulting from feeding; there is copious flow
of saliva prior to vomition ; loss of strength and energy in chronic cases; pain between
the last lumbar and first dorsal (?)vertebrae generally more on the left side than on the
right; the bowels are constipated, there being mucus sometimes in the stools. The
urine is clear and passed frequently and in considerable quantities (Fenwick). The
above precis of the symptoms of gastric ulcer in man, as taken from Quain's Dictionary
of Medicine, is well worthy of perusal as justifying the diagnosis of the mules' disease
as ulceration of the stomach which used to be made prior to the establishment of its
nature as relapsing fever. Before I proved its periodicity, demonstrated its distin-
guishing parasites, and proved that ulceration of the stomach is absent in some
undoubted cases, I examined carefully this diagnosis of my predecessors. I found in
our patients depraved appetite, the copious flow of saliva from the mouth, loss of
strength and condition, and the pain on pressure over the loins and over the sciatic
nerves on either side of the sacrum. The breath also was in some cases very
offensive. I came to the conclusion that, although these symptoms would justify
diagnosis of gastric ulcer, something else had to be dealt with, that something being
blood derangement, as proved actually the case. We have already seen the bearings
of ulceration of the stomach on the main disease. The urine varies in quality and
quantity in different cases and, to an extent, in accordance with the phases of the
disease. Sometimes it is very viscid, its specific gravity being as high as 10,40. I
am not sure what is the cause of the viscidity; it is not directly associated with the
presence of albumen, nor have I been able to determine its special occurrence at any
one phase of the disease or in association with congestion or other disease of the
kidneys. In other cases the reverse condition is found and a certain degree of
polyuria is present, the urine being limpid, of a very pale yellow, and low specific
gravity (10,05—10,15) and passed frequently and in considerable quantities. This also
I have not been able to associate with any special pathological state. The color was
not always high; on the contrary it is extremely exceptional to find it above the normal,
although it is often very much paler. In almost every case the freshly-passed urine is
quite clear and distinctly acid. Sometimes albumen,is present, a condition I am inclined
to associate in direct ratio with the breaking up of the red corpuscles as being specially
present in the decline of lever, but it is by no means constantly present. I have never
been able to detect sugar, bile-coloring, casts, or parasites in the urine, but rather
frequently had occasion to record excess of urates and phosphates, probably inconsequence
of the amount of disorganisation brought about in the blood by actions of the parasites.
The faeces affords no indication of disorder. I have noticed the red slime on the
surface of the dung-balls mentioned by Dr. Evans, but it is not of frequent occurrence
and is of minor import either in relation to diagnosis or pathology. As a rule, the
dung is normal in appearance and in quantity, presenting only occasionally a reddish
or chocolate color, until the last day of the disease, when it sometimes becomes pulta-
ceous, chocolate-colored, and of most foul odour; this I am inclined to associate
with the presence of circumscribed congestions of the small intestines. The state of
the skin indicates the general malnutrition ; it is in most cases completely devoid of
the soft, bright appearance of the healthy coat, being dry, tense, dull, and harsh from
an early stage of the disorder. It at length becomes "like that of a dead animal."
There is then a great liability to bed-sores, and they sometimes exhibit great tardiness
in healing in those animals which, having " been down," resume the standing position,
the bruised portion of skin persisting in the centre of the ulcer. The skin eruption
already mentioned, as seen in some cases, seems similar to that on the nasal membrane,