This may ensue either as a direct or as an indirect result of syphilis. The latter variety is by far the more common, and is due either to embarrassment of the gastric circulation from disease of the liver or spleen, to lardaceous degeneration of the vessels of the stomach, to secondary disease of the kidneys, or to the specific cachexia. This gastritis does not differ histologically from the ordinary varieties, and, like them, usually subsides when its exciting cause has been removed. Chronic inflammation of the stomach directly dependent upon the systemic infection occasionally results from repeated attacks of an acute character during the early phases of the complaint, such as have been described by Jullien and Fournier; but as a rule it appears only at an advanced stage of the disease, and is often associated with gummatous lesions of the bones, liver, or testes. To the naked eye the mucous membrane either is dull white and peculiarly opaque, or appears to be thickened and irregularly congested, with a surface like velvet pile. On microscopical examination the superficial roughness of the tissue is found to be due to an absence of the normal columnar epithelium and to a hyperplasia of the connective tissue between the mouths of the glands, which give the section the appearance of being covered with fine papillae. The capillary vessels which ramify between the glands are dilated and filled with corpuscles; but here and there their outlines are obscured by an accumulation of the small round cells, which pervade the whole of the connective tissue and form thick layers around the mouths and fundi of the glands. The lymphoid follicles are enormously enlarged, and their cellular elements frequently penetrate the muscularis mucosas and invade the submucosa. The gastric glands vary in appearance at different parts of the section, at one spot being comparatively healthy, while at another they are twisted, distorted, or disorganised by the round-cell infiltration. These general features are common to all forms of interstitial gastritis, from whatever cause they arise, but in the present case two special phenomena exist which indicate the syphilitic origin of the disease. The first of these takes the form of miliary granulations, which occupy the whole thickness of the mucosa and may even invade the submucous tissue or project slightly above the free surface. These nodules, which are really minute gummata, consist for the most part of a homogeneous granular non-staining material, and where several have coalesced a large portion of the section may consist entirely of this cheesy material. The other characteristic feature of a syphilitic gastritis is a hyperplasia of the inner coats of the small arterioles situated in the submucosa, which produces considerable narrowing of their lumina and not infrequently leads to thrombosis. These arterial changes may be observed in any part of the section, but are always most noticeable in the vicinity of the miliary gummata.