CHAPTER XIV. ON THE MORBID CHANGES IN THE STOMACH AND INTES TINAL VILLI PRESENT IN PERSONS WHO HAVE DIED THE difficulty of accounting for the origin of cancer, and the want of success in all our efforts to arrest its progress or effect its cure, render investigations upon it of general interest. Of late years inquiries have been chiefly directed to obtaining clearer views as regards the development and anatomical structure of the tumour itself. As far as I am aware, no attempts have been made to ascertain whether the progress of the disease is accompanied by changes in other important parts; and yet an accurate knowledge of the condition of the various organs connected with the formation of the blood must be necessary to enable us to determine whether a malady, having chiefly a local manifestation, originates in an error of local or of general nutrition. Until, therefore, we have carefully scrutinised all the glandular structures, we cannot be certain that the predisposing causes of the so-called malignant action may not lurk in the imperfect or perverted actions of some of these organs. STATE OF THE STOMACH IN CANCER. 259 The microscope has hitherto shown us no local changes which precede the formation of cancer; consequently we are unable to foresee and powerless to prevent its invasion. If we could discover that anatomical or functional alterations take place in tissues other than those obviously affected, a careful observation of their conditions might warn us of the approach of the disease, and we might be enabled to avoid such circumstances as are likely to excite its development. In many cases of cancer we can scarcely account for the death of the patient. There is no secondary formation in any important organ, and the failure in strength has been out of proportion to the amount of local mischief, so that we are forced to admit either that the blood has been infected, or that some fatal change of a non-cancerous nature has occurred in the viscera. But if all the laborious investigations into the nature of cancerous tumours have left us still ignorant of their causes, and of any structural changes preceding their formation, and if in many cases the cause of death is not apparent, is it not probable that the medical practitioner will derive more advantage from a knowledge of the changes which may be found to take place in the other organs, than from further inquiries directed exclusively to the locally diseased tissues? I shall in the present chapter state the results obtained from the microscopic examination of the stomach in fifty-seven, and of the intestines in twentythree cases of cancer. I have to regret, however, that I am unable to give the history of each patient and a description of the peculiarities of the local disease, or to report the manner in which digestion was performed during life. I am therefore compelled to limit myself to detailing the changes I have observed in the mucous membrane of the stomach and intestines. CANCER OF THE BREAST. OBSERVATION 19.-A woman, æt. 62, died of cancer of the breast in the Middlesex Hospital,' February 7th, 1865. The mucous membrane of the stomach was everywhere thin, especially along the smaller curvature; it was smooth, but much injected in patches. Along the greater curvature it was rather thicker, adherent firmly to the subjacent coat, and mammilated. In this part the tubes were united together, and the spaces between and below them were loaded with nuclei and cells, nuclei also being everywhere visible in the muscular coat. The solitary glands were greatly enlarged, and mostly empty at the centre, but at their edges they presented thick layers of cells and nuclei. In the more wasted parts of the mucous membrane, the remains of the tubes appeared as bulbs, or as irregularly shaped masses of fat and broken-up gastric cells, or as lines of fatty matter so small as to resemble blood-vessels, whilst their interspaces were occupied by fatty and 1 To avoid repetition, it may be stated that all the observations mentioned in this chapter, were made upon patients who died in the cancer wards of the Middlesex Hospital. MORBID CHANGES IN THE STOMACH IN CANCER. 261 granular matters. In some places no remains of the solitary glands could be perceived; in others elongated cavities surrounded by thin layers of nuclei and cells marked their former position. The muscular coat seemed to consist of little else than fibres. The duodenum was large, but to the naked eye showed no appearance of disease. Examined microscopically, Brunner's glands were seen to be enlarged and loaded with nuclei and fatty cells. The intestinal villi were normal. OBSERVATION 21.-A woman, æt. 37, died June, 1863. The mucous membrane of the stomach was very thin, and much congested in parts. At the cardiac end, it was everywhere sprinkled over with small white spots about the size of a pin's head, that looked but did not feel as if raised above the surface. In this portion of the organ the membrane was converted into fibrous tissue, fat, and granular matters, whilst the tubes had disappeared or their remains only could be recognised as faint lines of fatty matter. The muscular tissue was thickened and fibrous, and the blood-vessels seemed very large and in many cases thickened and opaque. In a small portion of the organ the tubes could be distinguished, but they were firmly adherent to each other, and were filled with granular matter and a few large gastric cells. OBSERVATION 22.-A woman, ææt. 43, died in July, 1863. In one part of the middle region of the stomach, the mucous membrane seemed hard and fibrous. The solitary glands were in glands were in some parts enlarged and the tubes distorted or withered, as in Observation 20, but in other parts, although the solitary glands were not apparent, the tubes were firmly adherent to each other, their basement membrane was thickened, and the connective tissue between them and the muscular coat increased. The openings of the tubes on the free surface were larger than usual. OBSERVATION 23.-A woman died August, 1863; no post-mortem digestion had taken place. In the cardiac region the tubes were greatly wasted, and for the most part their closed ends only remained. They were firmly united in every other part of the stomach, their interspaces being occupied by nuclei, as in Observation 20. The gradual conversion of tubes into bundles of fibre was observable at many points. OBSERVATION 24.-A woman died August, 1863. In the smaller curvature of the stomach, no indication of tubes existed, excepting here and there a bulb surrounded by thick fibres; the whole of the structure being composed of cells, nuclei, and fibres. In the cardiac region the tubes were in a similar condition. The solitary glands were in many places very large, and loaded with cells and nuclei. OBSERVATION 25.-A woman, æt. 63, died December, 1863. The stomach contained torulæ in large quantities. The mucous membrane was remarkably thin, but much congested; along the lesser curvature were patches of a white opaque appearance. The |