526 



DISEASES OF THE STOMACH. 



are entirely decomposed, and the stomach is perforated. These 

 changes are usually limited to a few longitudinal folds of the mu- 

 cous ^membrane, running from the cardiac end toward the pylorus, 

 while the rest of the membrane is reddened by hyperzemia and 

 ecchymosis, and swollen by serous infiltration ; the blood in the 

 vessels of the stomach, and often even in the neighboring large 

 vascular trunks, is transformed into a black, smeary, tar-like sub- 

 stance. Only the milder cases recover, for the parts destroyed 

 slough off, and the loss of tissue is replaced by callous cicatricial 

 substance. The caustic alkalies change the epithelium and the 

 superficial, or even the deeper layers of the mucous membrane, into 

 a pulpy, discolored mass. In these cases, more frequently than in 

 cases of poisoning from acids, the destruction extends to the mus- 

 cular and serous tissues, and so leads to perforation. When the 

 destruction is superficial, cure may result even in such 'cases, after 

 the sloughing of the necrosed parts. 



Brown or black sloughs are formed by the action of corrosive 

 sublimate, copper, or other metallic salts ; these are surrounded by 

 active injection and serous swelling of the mucous membrane. 

 Phosphorus excites similar changes. 



If gastritis occurs after poisoning from arsenic, we find one or 

 more spots of the mucous membrane covered with a powdered 

 white substance, swollen, reddened, and softened to a pulp, or 

 transformed to a yellowish or greenish-brown slough. From these 

 sloughs extend reddened folds of mucous membrane, between which 

 the walls of the stomach are often unaltered. 



After the action of ethereal oils, or acrid vegetable or animal 

 poisons, the remains of severe catarrhal, croupous, or diphtheritic 

 inflammation are seen. 



SYMPTOMS AND COURSE. Gastritis from poisoning is peculiar, 

 because, even where the poison used has no directly paralyzing ef- 

 fect on the nervous system, besides the local symptoms, there is a 

 general depression, and particularly an almost complete arrest of 

 the circulation. These paralytic symptoms are also seen in other 

 severe injuries of the stomach or other abdominal viscera, but espe- 

 cially in perforation of the stomach from ulceration. 



If a previously healthy person be suddenly attacked with severe 

 pain, which spreads from the epigastrium over the abdomen ; if 

 this be accompanied by vomiting of mucus or bloody mucus ; if 

 there be also purging of mucus and blood, preceded by severe 

 colicky pains and tenesmus, and the patient be at the same time 

 collapsed, and his features distorted, his extremities cool, pulse 

 small, and skin covered with cold, clammy sweat ; there is strong 



