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The condition of affairs met with in the alimentary canal in plague has been the subject of considerable dispute. Some observers state definitely that the digestive tract in this disease presents nothing of any great pathological importance. Other investigators, however, attach considerable weight to the presence of certain alimentary lesions, regard the changes present as more or less constant, but beyond this see no reason to ascribe to this system more than its participation as well as other organs in the series of general pathological phenomena of plague.
Few, if any, plague experts have brought the gastro-intestinal tract into relationship with the avenue of plague infection. The general consensus of opinion is against food infection and food conveyance as factors of importance in the spread of the disease. The weight attached to the inoculation method of infection has more or less swamped other possible channels of conveyance of the disease, so that the latter have almost entirely been disregarded by those supposed to be measuring out careful and well grounded scientific principles and prophylaxis of plague. WILM is almost the only observer who has brought forward the view that the alimentary canal is an important channel through which plague infection occurs. The evidence which he adduces is strongly in favour of such a mode of infection. Little importance seems to have been attached to the results which he obtained, results which are still considered by sientific congresses to be of great value, and requiring confirmation.
After a careful perusal of the results obtained by the various Plague Com- missions, amongst which one finds ample evidence of considerable pathological change in the alimentary canal, it is surprising that so little weight has been attached to these. My own results, coupled with the careful consideration of the clinical aspect of plague as well as the result of experimental research, e.g., insect spread of the disease, infected food, etc., have led me to the belief that from the point of view of plague prophylaxis the gastro-intestinal tract and what is administered to it, are of the highest importance.
The alimentary canal shows more or less always definite evidence of patho- logical change. In some cases, the lesions present may be slight, but in others, they are severe. In another part of this research, it has been shown, that symp- toms such as diarrhea and vomiting, referrable to some morbid condition of the gastro-intestinal tract, are present during the initial stages of all varieties of plague septicemia. These may be present only during the early part of the disease, but frequently one finds a persistence of some alimentary symptom, particularly a con- tinuance of diarrhea.
The following is a brief account of the results of my post-mortem examina- tions.
The mucous membrane of the mouth and pharynx is conjested, and frequently petechiæ are present. The condition of the tongue has already been given (Vide Symptoms).
The
The esophagus is usually hyperamic. Edema is also a frequent manifes- tation, and is often accompanied by scattered hæmorrhagic extravasations. latter are most numerous hear the opening of the tube into the stomach. cardine end of the esophagus is frequently surrounded with blood extravasation.
The
The stomach is usually hyperdemic, and petechiæ are scattered more or less generally throughout its walls. (Edema is frequent. The congestion and hamor- rhages are especially well marked about the apices of the folds of the mucous membrane.
All the changes found in the stomach, are usually most severe, at the cardiac end, the lesser curvature, and the pyloric aperture. Hæmorrhages of considerable size are occasionally found. Some of these may be present in the fundus, as large as a dollar piece.
The vessels in the stomach wall, and particularly the veins are usually found distended with blood.
Ulceration has also been found. It is rare however. The ulcers, if found, are small in size, varying from a pin's head to a pea, and arise in connection with foci of hæmorrhage. This condition is quite uncommon, and much of the aleerat- ed appearance is, on closer examination, produced by post-mortem digestion, the results of which are apt to lead one astray.
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