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until, if the animal remains alive long enough, perforation occurs. Probably the
peritoneum becomes involved in the general atrophy, but I have not seen a single
case in which it has shown signs of inflammation opposite the ulcers. (In Tonghoo
one case was noted.) Here and there a stellate congestion of the corium may be
detected by means of a magnifying glass. Condensation of the areolar tissue connect-
ing the muscular with the mucous coat and sometimes thickening of the former takes
place, and later the three coats of the stomach may become united by consolidation of
their connective tissue. Perforation may result from extension of the ulceration and is
generally a minute opening through the peritoneum, its length corresponding to the
direction of the outer layer of muscular fibres. It is sometimes seen in the cuticular
portion, sometimes in the villous. Where the muscular layer is exposed, its blood-
vessels are often distinguishable as black lines between the fibres; they are filled with
coagula. This leads us to the important question of whether the blood organisms are the
producers of the ulceration, and gives a clue to the manner in which they might produce
that effect. The villous portion is less adapted to show the lesions above described,
but it presents them, one and all, in different cases. We frequently find that part of
its substance is dense and thicker than the rest, but not uniformly so, for here and
there are thin spots resembling ulcers, or we may find lines of ulceration looking very
much like rents converging towards the pylorus, or the membrane may be merely
congested and present blood-spots. In some cases there are changes going on at the
line of junction of the two portions which look like (and probably are) a normal
change of nature of the membrane, an increase in size of the villous at the expense of
the cuticular, especially wherever the latter normally projects into the former. I have
also seen cases in which the ulcers were apparently undergoing gradual, but not very
advanced, repair. Various forms of parasites are to be found, but this is nothing
unusual. The abodes of sclerostomes and the gelatinous mucus in which those on
the mucous membrane are embedded are constantly alluded to in the post-mortem
records, but apparently have no direct relation to the disease. Bots leave behind
them marks resembling some of the smaller ulcers on the cuticular part, but these
will not be confounded with the extensive removals of tissue found in true cases of
gastric ulcer. Dr. Romanis has found, on microscopical examinations of the ulcers,
low organisms and tissue debris—in fact such matters as we find in the gastric
contents. My results are the same with well-marked and advanced ulcers, but in the
earliest stage of epithelial change in the cuticular portion I have noted no organisms,
simple breaking up of the cells, which seems generally to commence about the orifices
of the follicles which open into the stomach. Thus from post-mortem inquiry we obtain
some important items of information of which we may note especially (1) that the
ulcers are specially frequent in certain definite situations; (2) that they may
originate in the deep-seated epithelial cells as well as the superficial; and (3) that
sometimes they are in direct association with plugged vessels. To these we may add
that (4) similar ulcers are observed in the nose and mouth during the progress of a
few cases. To the first matter we must not attach special significance because it is
also noted in simple ulceration of stomach in man and probably depends on the manner
in which the blood-vessels are distributed to the organ. Items (2) and (4) tend to
prove that the ulceration is a consequence of disease of the body in general, arising
from within and not from the direct action of irritants taken into the stomach, and
item (3) gives us a feasible explanation of how this might take place in the course
of an attack of relapsing fever, the parasites plugging the small vessels of the gastric
coats and thus causing circumscribed ulcerations of them. We must remember, on
the other hand, that ulceration of the stomach was not found by Dr. Evans in his surra
cases and is not noted in relapsing fever of man (it seemed also to be absent from the
stomach of my dog,* which succumbed to the disease as artificially induced), and that we
have ample evidence of the use of paddy, uncrushed gram, and rice straw as food having
been long-continued—irritant substances which might possibly give rise to rents and
ulcers of the gastric mucous membrane, as also might the sharp-edged cutting grass,
which is often given as fodder. We have a certain amount of evidence that the use of
uncrushed paddy is liable to cause stomach lesions. The native horse-owners at
* And was not found in my experimental monkey.