I have mentioned a case (Observation 36), in which a large ulceration had formed in the stomach in a person suffering from cancer of the uterus, and it will be observed that a similar lesion occurred in a patient affected with cancer of the tongue. In both, the connective tissue below the muscular coat was greatly thickened, and this condition was also present in another case of cancer of the bladder, in which, although no ulceration had taken place, pus cells were found in the mucous membrane.

The class in which disease of the stomach has been most rare is that composed of cancerous affections of the skin, bones, and lymphatic glands.

As the changes in the stomach are most frequent in cancer of the breast, the organ in which scirrhus is most common, and least frequent in cancer of those organs which are especially liable to the attacks of the softer varieties of the disease, it is, I think, probable that the alterations in the gastric tubes will be found to co-exist only with the harder forms of malignant growth.

From the similarity of the intestine to the stomach in structure, we might expect to find anatomical changes in it also. In the earlier examinations I unfortunately neglected to investigate the condition of the intestine, but in the last twenty-three subjects, in which I have minutely examined it, I have usually found it diseased.

An increase in the quantity of nuclei in the intestinal villi was noticed in Observations 29, 30, and 33. When this form of disease was present, the mucous membrane was usually more firm than in its normal condition. The nuclei were very prominent and distinct,

STATE OF THE INTESTINAL VILLI IN CANCER. 281

there was generally a deficiency of granular matter, and the basement membrane was often thickened. Brunner's glands and the intestinal tubes often presented similar changes, their cells being intermixed with nuclei. In Observations 20 and 28, and in a case of cancer of the uterus, the villi were exceedingly fibrous, and looked wasted. The fibres were disposed in a direction parallel to the long axis of the villi, and between them were lines of prominent nuclei. In some instances the ducts of Brunner's glands were greatly thickened and enlarged.

In Case 34, and in two cases of diseased uterus, fatty degeneration of the mucous membrane was present. The appearance of fat was not the result of digestion, for Brunner's glands presented a similar condition. The villi were very thin and transparent, and so soft as to be crushed with the least pressure. Small globules of oil were diffused everywhere, and in many parts the intestinal tubes were either absent, or the remains only of their closed ends were visible. (See plate 6, fig. 4.)

The most common morbid appearance was a dark condition of the villi; indeed in only three cases out of seventeen where no disease of the stomach existed was this change absent, but where the stomach and villi were loaded with nuclei, it did not present itself except to a small extent in one case; in two out of the three exceptions the mucous. membrane was in a soft fatty condition. To the naked eye this appeared in many cases of a uniform dark hue, whilst in others the colour was more intense, and the villi could be readily distinguished as minute black spots. When examined by the

microscope, they were seen to be loaded with dark cells and nuclei, which were in greatest numbers at the free ends, but often extended the whole length. In some instances the villi were universally coloured by dark spots of an irregular form; occasionally they were loaded with a fine, dark, granular matter, and in two or three instances I detected minute crystals in their interior. (See plate 6, fig. 5.)

I need not add that this dark appearance of the villi is not peculiar to cancer; it has been described by other observers as occurring in other diseases. I have met with it chiefly in fever, but as I have never found it in persons killed by accidents, and once only in upwards of 100 dissections of wild animals, we may assume that it indicates an important alteration in the intestine.

I have often seen oil-globules in villi thus affected, so that, as far as the mere absorption of fat is concerned, their functions are not destroyed. We know, however, that the albumen of the chyle undergoes changes in its passage through the lacteal system; and as many of the softer forms of cancer seem to consist chiefly of albumen, it is, I think, probable that this morbid condition of the villi may be connected with functional changes of an important character.

It will be observed that out of fifty-seven cases of cancer the stomach was seriously diseased in twentyone, or in 37 per cent.; and that in nineteen cases in which the intestines were examined, and in which the gastric tubes were normal, morbid changes were detected in eighteen, so that we have reason to suppose that few cases of cancer die in which serious

CHANGES IN THE STRUCTURE OF THE UTERUS. 283

anatomical changes of a non-malignant nature are not present in some part of the digestive canal.

As the mucous membrane of the stomach in those who have died of malignant disease of the uterus so rarely presents morbid changes similar to those observed in persons affected with cancer of the breast, it will be interesting to ascertain what is the condition of the structures in the vicinity of the local disease.

When the sections are carried beyond the apparent limits of the cancer, we may generally observe that the muscular structure of the organ is in a state of degeneration. The fibres seem first to lose their sharp, clear appearance, and are fatty and opaque. Next, all distinction between them disappears, and as we approach the seat of the cancer, we find collections of fat, enclosed between layers of connective tissue, the only representatives of the former muscular structure. I have in some cases seen a few large cells in the midst of the degenerating muscle, as though a focus of cancerous growth was beginning to form in it.

Where the disease has affected the vagina, the voluntary muscles in the vicinity of the tumour sometimes present a remarkable appearance. They appear fatty, and in some parts no remains of the sarcolemma can be perceived; in others it looks like an empty case, the transverse markings being very clear and distinct, or it separates into rings, as in muscle in the process of digestion. (See plate 9, fig. 4.)

The connective tissue is not increased at the extreme edge of the tumour, but in some places it seems compressed into bands by the new growth.

PLATE IX.

SHOWS THE APPEARANCES PRESENTED BY DIFFERENT TISSUES

IN CANCER.

FIG. 1. Fatty degeneration of the heart in a case of cancer of the

rectum.

a. Muscular fibres.

FIG. 2. Fibroid degeneration of muscular fibrils near the edge of a cancer of the breast.

The

a. The muscular fibrils transversely wrinkled.
transverse markings are very indistinct, and the
sarcolemma is greatly increased in thickness.

b. Increased fibrous tissue surrounding the muscular
fibrils.

c. The increased thickness of the sarcolemma could be
seen at this opening.

FIG. 3. A muscular fibril filled with cancer cells. From the same
case of cancer as fig. 2.

b. An outgrowth of cells which has burst through the
sarcolemma.

FIG. 4. Degeneration of a muscular fibril near the edge of a cancer
of the vagina. It seems to consist only of a case, the
inner portion having perished.

a. Pieces of the sarcolemma which have separated from
each other.

FIG. 5. Cancerous growth from the lining membrane of a vein in a case of epithelial cancer of the uterus.

a little distance from the cancer.

v. The coats of the vein.

c. The cancerous growth.

It was situated at

FIG. 6. Fat cells in the vicinity of a cancer of the breast.

a. The fat cells.

b. The capsule of the cell greatly thickened.