706 
(ESOPHAGITIS IN THE PIOliSE. 
ness and flaccidity, and its diameter was more than triple its natural 
dimensions. It was opened throughout its whole extent, and there 
escaped a liquid melange of water — the farina of barley — -mucosity 
and blood ; and we were compelled to use a great deal of water, 
in order to see the exceedingly remarkable changes of the mucous 
membrane*, particularly in the thoracic portion of it. 
The epithelium, white and thick, which covers the whole of the 
internal face of the mucous membrane of the oesophagus, was al- 
most entirely destroyed in this portion of the oesophagus. Where 
it still remained, it was disposed in longitudinal striae — a kind of 
whitened protrusions, disposed in salient and parallel lines, and 
occupying the summits of the plicae, of which the mucous mem- 
brane is naturally formed. It was thick and friable, detaching 
itself from the body of the membrane with the greatest facility. 
Between these straight bands of the preserved epithelium, and on 
the large surfaces where it had been destroyed, appeared the mu- 
cous membrane, the red-brown colour and the deep injection of 
which formed a striking contrast by the side of the dead white of 
the epidermic bands. Here and there, the mucous membrane itself 
appeared to be destroyed, and the eye distinguished the denuded 
fibres of the muscular membrane, in the spots corresponding with 
that destruction. There were certain points where numerous ec- 
chymoses between the fasciae of the muscular membrane could be 
discovered. These ecchymoses, of a deep tint, were especially 
evident in the white portion of the membrane in the neighbourhood 
of the cardia. 
The adhesion was so slight between the two oesophagean mem- 
branes, that, in the portions of its extent where the mucous mem- 
brane still preserved some consistence, it required only a very slight 
pull to separate it from the muscular membrane. The cellular 
tissue, usually so lax, which united them, represented a thick 
bloody net- work; so great was the injection of the vessels which 
permeated them. 
In proportion as we approached the superior part of the oeso- 
phagus, these changes, although sufficiently evident, were not so 
marked. The denuded portions of the epithelium were not so ex- 
tensive. It was destroyed only in circumscribed spots, assuming 
the appearance of superficial ulcers of variable size, from that of a 
one-sol to that of a five-sols piece. The mucous membrane which 
formed the bottom of these erosions had the same appearance and 
* The Professor here, as throughout the whole of his able history of this 
case, calls the cuticular membrane of the oesophagus the mucous membrane, 
because it is the lining membrane of this tube, and thus occupies the situa- 
tion of mucous membrane, and because it is, in fact, furnished with a mucous 
secretion from the follicular glands beneath. — Y. 
