Observations on the Vascular Appearance in' the Human Stomach, which is frequently mistaken for Inflammation of that Organ. By JOHN YELLOLY, M. D. Physician to the London Hospital.

[From the London Medico-Chirurgical Transactions for 1813.] IT must have happened to every one accustomed to the examination of morbid bodies, to see appearances of vascular fulness in the villous coat of the stomach. Such appearances have very frequently been referred to inflammation; but they have probably been but little studied; because, in dissections, the stomach is seldom opened, unless the attention be particularly directed to that organ, either from something remarkable in its external appearance, or some particular symptom affecting it, which may have been the subject of observation during life. I have several times been present at the examination of bodies, where the vascularity of the villous coat of the stomach was considerable, as even to give rise to suspicions, that VOL. V. No. 17.

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this appearance had been produced by the agency of something deleterious. In some remarkable cases, too, which fell under my own immediate inspection, (particularly one of apoplexy, and another of hydrothorax,) the phenomena now mentioned, existed to a very considerable degree, without there having been present, during life, any symptom which could make an affection of the stomach looked for.

I was therefore induced to embrace frequent opportunities of viewing the state of the inner surface of the stomach; and I so often found in it the appearances alluded to, as to incline me to imagine, that the opinion which is commonly entertained, of their being marks of disease, is not well founded. I thought it, however, desirable to make a continued series of examinations as to this point, in subjects taken indiscriminately, and therefore without any reference to the disease of which they might have died; hoping, by this means, to obtain such a portion of evidence, as might warrant some deduction, as to the ordinary appearances of the villous coat of the human stomach, in the dead body. I shall therefore lay before the Society, an account of twenty successive dissections, made by me, with a more particular view to the state of the stomach: and shall then give the appearances which that organ presented, in the bodies of five criminals, who forfeited their lives to public justice, and where there might be expected to be as little deviation as possible, from natural and healthy structure, and appearance.* The twenty dissections were principally made in cases which occurred at the London Hospital, under the care of my colleagues, (the physicians and surgeons of that establishment,) or myself; and the appearances were generally noted down by me at the time of inspection. I shall give one of them separately; but as I am aware that a detail of cases, where there is no material diversity in the individual particulars, is very tedious, I shall reduce the others to a tabular form.

It may be proper to remark, that in removing the stomachs,

It will be obvious, from the dates, that several of the cases and observations have been added since this paper was communicated to the Society.

for the purpose of examination, a ligature was made at each extremity, and a portion of the esophagus and duodenum included within it; and in order that no unnecessary pressure should be made on the tender villous coat in the inversion, an incision was made in the anterior part of the stomach, from the extremity of the duodenum, through the pylorus, of sufficient size to admit of its being readily inverted.

John Bate, aged thirty-six, porter, was admitted into the London Hospital on Feb. 23, 1813, with general dropsy; and after the unsuccessful employment of various means for his relief, he gradually sunk, and died on May 11. There had been no affection of the stomach. He was opened on the day of his death.

In both cavities of the thorax, there was a considerable quantity of bloody serum, and some also in the pericardium. The heart was large and firm; and there was a small and slight adhesion of it to the pericardium. Some bloody serum was found in the abdomen; and a strong band attached the lower part of the ilium to the peritoneum contiguous to it. The spleen was considerably larger than usual; and it adhered extensively and strongly to the diaphragm, and slightly to the colon. Its substance was firm; and the whole of its external surface (that towards the ribs) was covered with a thin layer of white, smooth, cartilage.* The liver was natural in appearance; but the cystic bile was very pale. Nearly the whole of the great end of the stomach, on the posterior part, including a surface of somewhat a round form, and of about five inches by four in dimension, was of a bright crimson colour, which arose from very numerous points, as if of extravasation, very near the internal surface of the villous coat, and a slight regular vascularity. Similar points, well defined, and of various sizes, were seen in other parts of the stomach, particularly near the pylorus. The plice were numerous, near the pylorus, and towards the left inferior extremity of the greater

curvature.

• A similar affection of the spleen is described in Baillie's Morbid Anatomy, p. 256.