EFFECTS OF POISONS ON THE STOMACH. 525 



pus, which collects in its distended meshes ; more rarely there are 

 circumscribed abscesses in the submucous connective tissue. The 

 undermined mucous membrane is thinned, and subsequently it 

 has numerous small openings, from which the pus trickles out as 

 through a sieve. The inflammation soon extends to the muscular 

 layer, the submucous tissue, and peritonaeum. If the patient re- 

 covers, cicatricial tissue may form in the meshes of the submucous, 

 and strictures may thus result, as is shown by specimens in the 

 Erlangen Museum. 



The most important symptoms of the disease are severe pain in 

 the epigastrium, vomiting, great anxiety, high fever ; later, there 

 are symptoms of peritonitis, the patient collapses, and usually dies 

 in a few days. Of course, a diagnosis can only be certainly made 

 in a few cases, where, with the above symptoms and vomiting of 

 pus, we are able to exclude other forms of gastritis, particularly 

 those caused by poisons. The treatment can only be sympto- 

 matic. 



CHAPTER Y. 



INFLAMMATIONS AND OTHER CHANGES IN THE STOMACH FKOM CAUS- 

 TICS AND POISONS. 



ETIOLOGY. The changes in the stomach caused by the action 

 of concentrated acids, caustic alkalies, and some metallic salts, de- 

 pend on the fact that these substances unite chemically with the 

 tissue of the walls of the stomach, whose organic structure is con- 

 sequently destroyed. The changes that vegetable or animal poisons 

 excite in the gastric mucous membrane, on the contrary, cannot be 

 traced to chemical processes. 



Poisoning by carelessness is most frequently induced by copper- 

 salts, sulphuric acid, or vegetable poisons being taken into the stom- 

 ach ; while intentional poisoning occurs most frequently from ar- 

 senic or sulphuric acid. 



ANATOMICAL APPEARANCES. If dilute mineral acids have acted 

 on the mucous membrane, only the epithelial and superficial mucous 

 layers are changed to a soft brownish or black slough. If a quan- 

 tity of concentrated acid has reached the stomach, all the layers of 

 the mucous membrane are converted into a soft black mass, which 

 may become several lines thick from imbibition with bloody wa- 

 tery fluid. The muscular tissue becomes softened or gelatinous, 

 and very friable ; more rarely both it and the serous membrane 



