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Rangoon bruise the paddy before use with a view to breaking off the irritant sharp
points, which they think injurious to the stomach. The Tonghoo Committees noted the
occurrence in the stomach of unbroken paddy in several cases, and one Board suggested
" that paddy be no longer given and some light easily digestible substitute be made.''
In one of my experimental cases which died on the fortieth day of the disease, I find well
marked ulceration of both cuticular and villous coats bearing a fairly direct relation
to the known duration of the case. He has been fed with soft readily digestible food
since admission. In my experimental cases which succumbed subsequently to this
I always found gastric lesions, more or less intense. Altogether the evidence very
decidedly tends to the conclusion that gastric ulceration must be directly associated with
this outbreak of relapsing fever as a special feature of it and one materially aggra-
vating the symptoms. The latter point must not, however, be exaggerated; thus the
persistent acidity and occurrence of albumen in the urine must not be attributed
entirely to this lesion, for I have found them in a case where the lining membrane
of the stomach was proved to be normal after death, and the acidity of the stomach
contents is constantly diminished in fever, so would be less likely to affect the blood in
relapsing fever than in. health. Again marked pain in the region of the stomach,
indicated by the animal turning his head to the left side and biting the hypochondrium,
occurs sometimes, and in one instance of it I found no ulceration of the stomach.
Having thus decided that we must, at any rate provisionally, accept ulceration of the
stomach as a lesion of the disease, and not simply in the light of a cause or accidental
accompaniment, the next matter to be dealt with was whether the disease is an erup-
tive disorder having the local manifestations of the constitutional derangement in the
stomach.
5. I was at first inclined to accept this view. I find from my records that before
I detected the parasite in the blood, I thought the disease was malarious and decided
to, pro tern., term it gastric typhoid; there certainly was well-marked cachexia, fever
was a prominent symptom, one part of the alimentary canal (the stomach) was the
seat of ulceration presenting special features, and sometimes there were circumscribed
congestion of the mucous membrane of the small bowel, often somewhat most marked
on Peyer's patches. In some cases just before death the fæces became soft, reddish,
and most offensive to the smell. I think the following extract from my note-book of
an. entry made at this stage of the inquiry will be found sufficiently interesting to
warrant its insertion here :—" The theory of malaria in the production of this affection
must be accepted as by no means established because it is incapable of exact demons-
tration, and the majority of the conditions seen in this disease are referrible to local
states. But analyse the symptoms, post-mortem appearances, and (other) causes as we
may, there is still a something deficient, which ' something' may be considered as
specially acting on the blood, probably superadded to it. Its effects are remarkably
like those exerted by miasma on man, notably the periodic exacerbations of fever and
occurrence of crops of petechias, and the characteristic cachexia and embolic compli-
cations. We cannot attribute them to ordinary poisons ; they are not such as would
result from premature absorption of semi-digested albuminoids or acid secretions
through the gastric ulcers; they are something more than simple anaemia. To the
influence of miasma only can I attribute them with the remark that miasma is, in all
probability, parasitic in its nature, essentially consisting of minute organisms gene-
rated, or finding their most suitable nidus of growth in decaying organic matter, but
having a parasitic stage, during which they inhabit the bodies of mules, horses,
possibly also men. Whether these organisms be animal or vegetable cannot here
be discussed. Such argument would be premature !" Here I was manifestly verging
on determination of organisms in the blood. I had decided that the disease usually
found in the kidneys and brain is evidently, from its nature, secondary; its absence
in some cases also proves this, and although the disease in some respects resembles
uraemia, yet it presents very markedly different phenomena in others. The generally
diffused character of the lesions, the height and special relapsing nature of the
fever, the absence of any definite and well-defined local lesion invariably present in
association with the characteristic symptoms of the disease, the fact of different
cases assuming different forms and of petechias appearing on the mucous membranes
clearly pointed to its being a disease of the blood. This important fact having been