ACUTE TOXIC GASTRITIS. 367 



rounded by migrated leukocytes. At a later stage the leuko- 

 cytic migration becomes more, marked, either as a diffuse 

 round-celled infiltration of the mucosa, and often also of the 

 submucosa, or confined to more or less sharply circumscribed 

 patches. The lymph-follicles are often hyperplastic. 



PURULENT GASTRITIS. 



Purulent or phlegmonous gastritis is a rare and almost in- 

 variably fatal affection. It occurs in the course of puerperal 

 fever, pyaemia, smallpox and similar infections ; or it may be 

 a primary condition. The inflammatory process is either cir- 

 cumscribed or diffuse. In the former case there is generally 

 but one abscess most frequently situated near the pylorus, 

 and varying in size from that of a hazelnut to that of a goose 

 egg. In the latter case there is a diffuse purulent infiltration 

 most marked toward the pylorus, involving first the sub- 

 mucosa ; later the mucosa becomes riddled with perforations, 

 through which pus wells up. The muscle and serous coats 

 may be involved, and the serous surface covered with a puru- 

 lent exudation. 



ACUTE TOXIC GASTRITIS. 



Acute toxic gastritis, or gastritis venenata, results from the 

 ingestion of such poisons as alcohol, arsenic, phosphorus, 

 bichloride of mercury, organic and inorganic acids, and 

 caustic alkalies. 



The lesions produced vary with the kind and quantity of 

 the poison taken and the length of time elapsing before death ; 

 they are associated with similar changes in the esophagus, 

 and, below the stomach, in the small intestine, even to the 

 ileocrecal valve. 



The inflammatory process excited by dilute adds and alka- 

 lies may resemble that in simple acute gastritis. When con- 

 centrated they produce local death of the tissues ; and if the 

 patient survives, most serious deformities of the stomach 

 may result. The slough involves the mucosa and often also 

 the other coats of the stomach, frequently producing a perfo- 

 ration. Adjacent organs, especially the liver and spleen, are 

 often corroded and discolored in a like manner. 



