98 DISEASES OF THE STOMACH. 



given (Jatger), and we often meet with cases answering the descrip- 

 tion. Nevertheless, there can be no doubt (Elsaesser) that gastroma- 

 lacia is always a, post-mortem appearance. The description of soften- 

 ing of the stomach is precisely that of cholera infantum, and thus there 

 is a simple explanation of the apparent confirmation of the diagnosis 

 by the autopsy. For, if a child dies who has had vomiting and 

 purging from abnormal fermentation in the stomach, and if there are 

 still fermenting substances left there, the fermentation will not be 

 arrested by the gradual cooling of the body. When the circulation 

 ceases, the stomach can no longer resist the decomposition, which then 

 extends to it also, just as the stomach, that has been cut out of an ani- 

 mal and filled with milk, softens if left only for a short time in a warm 

 place. Hence physicians, who consider softening of the stomach as a 

 post-mortem appearance, may also predict it with certainty, when a 

 child that has died of cholera infantum had eaten milk, 'or any other 

 easily-decomposed substance, shortly before death. 



Rokitansky^ who does not consider softening of the stomach as a 

 post-mortem appearance in all cases, distinguishes two forms, the 

 gelatinous and the Hack. According to his description, the former 

 almost always begins at the fundus of the stomach, and gradually ex- 

 tends along the greater curvature ; the mucous membrane is first soft- 

 ened, but the softening soon extends to the muscular coat, and finally 

 to the peritonaeum. The membranes altogether change to a grayish 

 or yellowish-red translucent gelatin, which occasionally has some 

 blackish-brown striae through it ; these are the blood-vessels that are 

 also softened. When the softened inner layer is detached, the fundus 

 consists of a thin, easily-torn peritonaeum. The softened stomach tears 

 on the slightest touch, and comes to pieces between the fingers, or 

 else we find that rupture has already occurred, and the contents have 

 escaped into the abdomen. The process is not always limited to the 

 stomach, but may attack the neighboring organs, especially the dia- 

 phragm ; this may even be perforated, and the contents of the stomach 

 may pass into the left side of the thorax. In the black softening of 

 the stomach, the walls are not changed to a translucent gelatin, but 

 to a blackish brown or black pulp. This modification occurs if the cap- 

 illaries of the stomach are overfilled when the softening begins. The 

 blackish-brown striae in the gelatinous softening represent the same 

 changes of the large vessels and of the blood contained in them, which, 

 in this case, aflfect the capillaries and then* contents. 



The theory that gastromalacia does not occur till after death, or, at 

 least, till a short time before it, when the circulation and the change 

 Df tissue in the walls cf the stomach have almost ceased, is supported 

 I, by the fact that the softening is almost always found in the fundus 



