_Fourth._ _Exfoliation of Epithelium._ The stomach of young adults, dying of some acute disease, not unfrequently is found to have thrown off the epithelial layer of its mucous lining, even when the examination is made soon after death, and in cold weather. In many of the healthiest animals slaughtered for food, the same change has been noticed as early as two hours after death. The detached cells are found floating in a thick mucus, the microscope also showing that the gastric follicles have thrown off their epithelial lining, with their pepsinous contents. With this change commences the post-mortem digestion of the stomach, to be soon noticed. The younger and healthier the subject, and the more acute the disease causing death, as a general rule, the more rapidly and effectively does this exfoliation take place. It may affect only the summit of the folds into which the mucous membrane is thrown by the contraction of the muscular coat, or it may uniformly involve the whole mucous surface. _Fifth._ _Softening and Perforation._ It is an interesting fact, that while the tissues of the stomach during life are unaffected by the gastric juice—the vitality of the tissues enabling them to resist its solvent power—after death, they immediately yield to its influence, and hence results a greater or less degree of softening of the coats, or even in some instances, complete perforation of the walls, the extent of the change depending upon the quantity of gastric fluid in the stomach at the time of death. In these cases there is, of course, no evidence of inflammation, while the tissues present a pulpy, gelatinous appearance, the walls being greatly thinned, and breaking down under the slightest force. In most instances, probably the _actual perforation_ is the result of the force employed in lifting the stomach from its position. The opening in these cases is an irregular ragged hole, with soft, pulpy margins, and will more frequently be found at the large or cardiac extremity of the organ. In some extreme cases, the process of softening has not been confined to the _walls_ of the stomach, but has extended to the adjoining organs, as the spleen, liver, or diaphragm. The whitish-gray and gelatinous appearances of these cases, will enable us to distinguish them from ordinary cases of softening and perforation from ulceration. This form of softening is especially observed in cases of sudden death immediately after a meal, while the stomach contains a large quantity of gastric juice. It is also seen much more frequently in children and young persons than in the aged, or those dying from chronic forms of disease. It has often been noticed in cases of consumption, however, which is to be accounted for upon the fact that many of these patients retain a good appetite to the last.