presented on the internal surface of the stomach. Sometimes a great number of granulations are extended over the whole surface, of various sizes, white, grey, red, or brown, in the centres of which it is often possible to perceive a small orifice surrounded by a small red or black circle. Sometimes these crypts are so greatly magnified, that they have a nipple-like appearance, which would induce one, at first view, to suppose there was a morbid structure of the mucous membrane itself; which may sometimes be the case; but, on attentive examination, it will generally be found that the phenomenon is owing to enlargement of the follicles. This mammillary appearance is usually accompanied by a grey or brown colour of the mucous membrane, and, during life, these are the symptoms of chronic gastritis. More than once our author has found only this mammillary structure, when there had been every reason to believe that cancer of the stomach existed, from the symptoms, such as lancinating pain in the epigastrium, yellowish tint of countenance, marasmus, vomiting of food, and also of black matters, &c.

In the horse's stomach certain appearances sometimes present themselves, which M. Andral thinks deserving of notice. They are roundish tumours on the mucous membrane, from the size of a cherry or a walnut, to that of a large orange. The mucous membrane passes over these turnours, and in the centre of each is an orifice capable of admitting a probe, which passes readily into the interior. This interior is found not to be of solid structure, but a pouch filled with a liquid of varying kind and consistence--sometimes resembling mucus-sometimes pusand sometimes of a grumous character, or resembling honey, or that which is squeezed from melicerous tumours of the skin. The parietes of these tumours are as variable as their contents. In some tumours they are very thin, and appear to be merely prolongations of the inucous membrane, covered outwardly by a layer of dense cellular tissue. In other tumours, this layer assumes a fibrous, and even a cartilaginous appearance. In these tumours, M. Andral has often found a great number of the ENTOZOA, having all the characters of the nématodes of Rúdolphi, being of a beautiful white colour, one or two lines in length, the thickness of a hair, and possessing great agility in their motions. These animals have been observed issuing from the central aperture, and spreading themselves over the interior of the stomach. They were not the products of any putrefactive process, since they were observed in horses opened the very instant after they were slaughtered. The constancy and regularity of the orifices in the centres of these tumours leave little doubt that they are the mouths of dilated follicles. This would be presumed from the examination of the larger ones-but, when they are traced through their various gradations, all doubt vanishes, as we come at last to the follicles themselves in scarcely a state of enlargement. From these and other facts, our author is led to conclude that many of those tumours and other morbid growths which are considered as adventitious or heterogeneous structures, are only excessive or morbid developments of natural tissues. In his Clinique Medicale (vol. 3)' M. Andral has endeavoured to shew that this is the case in pulmonary

granulations, or incipient tubercles; and at the close of this memoir, the same will be attempted in respect to the principles of formation in certain diseases of the stomach, especially scirrhus.

The fluids secreted by a healthy stomach may be very much altered from their natural condition during chronic gastritis. An individual entered the CHARITÉ with all the symptoms of this disease, having daily vomitings of some pints of a glairy white mucus, resembling the white of egg. There was this remarkable circumstance, that the patient never threw up any of the food or drink which was taken into the stomach. On dissection, nothing was found but a thickening (hypertrophie générale) of the mucous membrane, with a brownish tint in colour, and a strong development of the follicles.

Among the matters found in the stomach after death, (in chronic inflammation,) and of which prodigious quantities are sometimes thrown up during life, we may remark on the black or coffee-ground looking fluid, which has so often engaged the attention of pathologists. What is the nature of this fluid? Is it connected with any, and what special lesion of the stomach itself? Lately our author sent a quantity of this black matter, thrown up by a female in the quantity of a pint daily, to his friend, M. Lassaigne. It was found to contain much water, albumen, a free acid, of an organic nature, and to hold in suspension a colouring matter, insoluble in water, soluble in sulphuric acid, and presenting, when thus dissolved, a beautiful blood-red appearance. Submitted to calcination, it burned without swelling, and left a slight residue of a brick-colour, composed of oxide of iron, and traces of phosphate of lime, the same as is furnished by the colouring matter of the blood. Hence M. A. concludes, that the black matters ejected from the stomach in certain diseases, are owing to the presence of an organic element, having a great analogy to the colouring matter of the blood. Such is the conclusion come to also by M. Breschet, in his work on Melanosis. In the 18th volume of the Dictionnaire de Medecine (Art. Melanose) M. Andral has adduced fresh proof in support of M. Breschet's opinion. In a stomach which he recently examined, this colouring matter was found under two forms-one, in which it existed free in the stomach; the other, in which it was combined, in several places, with the mucous membrane, giving that tissue a beautiful jet black colour. The black matter, then, which is vomited in cancerous affections (for example) of the stomach, is to be considered, M. Andral thinks, as identical with the matter of melanosis, and like that to be constituted of a colouring principle analogous to the colouring matter of the blood.

It is highly probable, however, that this colouring matter is the product of a peculiar secretion, like some of the numerous colouring matters, blue, green, yellow, &c. which so richly tint the skins and coverings of various animals.

It is supposed that black vomiting is a characteristic sign of a cancerous state of the stomach, and that ejected black matters come from the ulcer. This is clearly a mistake; for similar vomitings have been met with where no such ulcer existed. Our author has observed this phe

nomenon in people whose stomachs presented, on dissection, tumours of the sub-mucous cellular texture, (the scirrhus of systematic writers,) without any breach of structure. In other instances, where black vomitings had obtained, during life, he has found merely a thickening of the mucous membrane, or a mammillary configuration of its surface, with some alteration from its natural colour. In one case only, a woman, aged 39 years, who had vomited, while in the hospital, a fluid sometimes brown, sometimes black; who had complete anorexia, laborious digestion, diarrhoea, and habitual cough, there were found, on dissection, ulcerations of the ileum, cœcum, and colon, and some tubercles in the lungs. The mucous membrane of the stomach was pale and blanched throughout, except near the great cul de sac, where there were three or four red spots, occasioned by capillary injection. All the coats of the stomach were otherwise apparently sound, though, but two days before her death, this woman vomited a large quantity of black matters.

Into the composition of the gastric parietes two layers of cellular membrane enter-one between the mucous membrane and the muscular coat-the other between this last and the peritoneum. Both of these are connected by means of cellular prolongations which pass through the interstices of the muscular fibres of the middle coat. These layers often become the seat of inflammation, and consequently changed in their structure. These membranes are rarely altered in texture by acute inflammation of the organ-and very often escape the effects of chronic phlogosis. At other times, these tissues undergo the same fate as contiguous parts, and become the seats of various changes of structure. There are cases in which these cellular layers are attenuated, and finally even disappear-in other instances, they become softened into a liquid pulp, and also disappear. In such conditions, the parietes of the stomach lose a great proportion of their natural strength, and are sometimes ruptured in the action of vomiting. But augmentation of thickness and density is the most common effect of chronic inflammation in these tissues, and this is the morbid anatomy of what is generally described as scirrhus of the stomach. In proportion as these effects take place, these cellular layers differ from their natural appearance, and present numerous and remarkable transformations. The most usual appearance is that of a grey, bluish, or dead white homogeneous membrane, without any trace of vascularity, and both dense and friable under the scalpel. This is called scirrhus, par excellence, and to this denomination there is no great objection, provided we bear in mind its real nature-namely, a thickening and induration of natural structure, devoid of any specific distinction from thickening and induration of the cellular membrane in any other part of the body. Thus, in a great number of chronic diarrhoeas the submucous cellular membrane of the large intestines, becomes much more developed than in health-in fact, it becomes hard, white, and homogeneous. If this change be general in the said intestines, and to no great extent, it is called a thickening of the coats of the colon or rectum; but if it be partial, and to a greater extent of density and thickness, then it is called

a scirrhous tumour, which is a palpable error-for there is no other difference between the two states than degree.

In some cases the induration of this tissue in the stomach goes on to an actual transformation into cartilage, of that soft and elastic kind, however, which we find in the fœtus.

If, instead of being white, homogeneous, and devoid of vascularity, it becomes full of vessels, it is no longer of a scirrhous nature, but takes the title of a cerebriform or encephaloid tissue, said to be developed in the parietes of the stomach. Formerly, our author admitted this distinction between scirrhous and cerebriform degenerations; but more minute investigations induce him to view them as only varieties of the same thing. He has seen them run into each other by insensible degrees, till all distinction was lost.

In these bypertrophied conditions of the cellular tissue of the stomach, we sometimes find cells or pouches, containing different kinds of fluid, varying in consistence and colour-sometimes resembling jelly-sometimes honey, &c. These have been called softened down scirrhi, but they are assertions without proof. These secretions are either infiltrated, as it were, through a certain extent of the cellular membrane, or more circumscribed, and, as it were, in cysts. If the activity of the vessels be considerable if, in other words, the inflammatory action be in a certain degree, these cysts burst, and thus ulcerations are formed in the stomach, with discharges of puriform matter, or even fatal bæmorrhages. These secretions in the structure of the cellular membrane sometimes take on the tuberculous, sometimes the melanose character..

Hypertrophy of the gastric cellular membrane may be general, involving the whole parietes of the stomach, so that, when cut open, the organ does not collapse; but such is not a common event. Usually the hypertrophy is partial, and the pylorus is its ordinary seat. It is much more rarely found in the neighbourhood of the cardia. It seldom passes the limits of these openings to invade the structure of the duodenum or the œsophagus. In only two cases, our author has seen the disease spread to the lower third of the oesophagus, and there produce considerable stricture of the canal.

The muscular coat of the stomach generally escapes the disorganizing effects of chronic gastritis; but, occasionally, it becomes either hypertrophied, attenuated, or lost.

The blood-vessels also suffer considerable changes. Thus, beneath the softened mucous membrane, we often find very large veins, in a kind of varicose state. The same is seen in the neighbourhood of chronic ulcers of the lower extremities. This dilated state of the veins often continues long after inflammatory action has ceased, and, in several instances, our author found the parietes of the vessels themselves thickened by inflammation. M. Ribes has published some interesting observations on the part which phlebitis plays in certain cutaneous inflammations, and our author was led to investigate the same subject in regard to gastritis. The following phenomena presented themselves to him in two cases. On laying open the large and dilated veins which

ramified under the mucous membrane, which was red and soft, in one case, brown and hypertrophied in the other, be ascertained that the venous parietes were thickened, and opposed considerable resistance to the scalpel, feeling hard to the touch, and not collapsing after being cut into. In the other case, where the stomach was the seat of a large ulceration surrounded with vegetations, the enlarged veins were seen in great numbers around the disease, and one in particular was remarkably enlarged and indurated, and the venules or radicals which led to it from the ulcer were also thickened and indurated in the parietes. laying them open, they were found filled with a solid substance, of a dark red colour, mixed with a semi-liquid of a purulent character. The mouth of veins are not unfrequently found open at the bottoms of ulcerations in the stomach, although no hæmatemesis may have occurred during life.

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The lymphatic system of the stomach and intestines does not always escape the effects of chronic inflammation. They have been found by our author filled with a puriform fluid-their parietes friable, and of tuberculous character-in some cases the parietes are thickened, and have lost their transparency.

The pathological condition of the nerves, in various diseases, has hitherto almost entirely evaded our researches, and there seems but little chance of morbid anatomy throwing much light on this department. Disordered function in the nervous system is attended with so small a proportion of change of structure, that in some of the most painful diseases, as tic douloureux, there is nothing to be found, after death, in the nerve, which was the seat of such excruciating torments during life. So it is with the stomach. M. Andral has dissected, with the greatest care, the nerves leading to and distributed on this organ, where the patients had died of painful gastric affections, of organic diseases of the stomach, and where there had been no disease or pain in the stomach-yet the nerves had the same appearance in all! The following reflections, however, are very just.

"Nevertheless we cannot, for a moment, doubt that there are alterations produced by diseases in the nerves, although we are, as yet, unable to appreciate them by the evidence of our senses. There can be no doubt that the various sympathetic affections of different parts of the system, dependent on disorder of the stomach, are produced through the agency of its nerves, so remarkable for their distribution and numerous connexions. Neither can we doubt that, among the various disturbances of function which the stomach undergoes, there are many which imitate, more or less completely, acute and chronic gastritis, but which are, in reality, owing to a morbid state of the gastric nerves or the semilunar ganglia-hence, in some individuals, we have disordered digestion, in others, vomitings, and, in others, epigastric tenderness, pain, &c."

Gastritis, whether acute or chronic, rarely terminates in gangrene. When it does so, it is generally where there have been ulcerations and fungosities, around which gangrenous spots occasionally shew themselves, and which take place when the powers of life are prostrated in the last stages of illness.