Crampton;[1] and Mr. Alfred Taylor has referred to several others, the stomachs of which are preserved in Guy's Hospital Museum, and gives the particulars of some which had occurred in the practice of that institution or to his friends.[2] Occasionally no symptom exists prior to the perforation, as in an instance related by Dr. Kelly of a stout healthy servant, who was suddenly seized with excruciating pain in the stomach and expired in eighteen hours, and in whose body the stomach was found perforated in the middle of an extensive thickening and induration of the villous coat.[3]
The second variety of perforation takes place by simple ulceration without previous scirrhus. In one of Dr. Crampton's papers will be found some remarks by Mr. Travers, along with a case of this kind. The subject of it was a man of a strumous habit, who enjoyed good health, till one day at dinner he was suddenly attacked with acute pain in the pit of the stomach, and died in thirteen hours. The stomach was found perforated in the centre of a superficial ulcer of the mucous coat, occupying two-thirds of the ring of the pylorus.[4] This case shows that the present variety of perforation may take place without the preliminary organic disease being indicated by any symptom. The circumstances under which it commenced are peculiarly important in relation to the medical jurisprudence of poisoning. Another case which has been lately described with great exactness by M. Duparcque, was preceded only by very trivial dyspeptic symptoms. Here the whole mischief arose from a small ulcer eight lines long and five in breadth on the inside of the stomach, and not more than a line and a half in diameter at the perforation through the peritonæum.[5] Several excellent examples of the same disease have been related by Dr. Abercrombie.[6] In one of these the ulcer in the centre of which the perforation had been formed, was not bigger than a shilling, and the rest of the stomach quite healthy. A very instructive case of a similar nature, but of unusual duration, has been related by Mr. Alfred Taylor. A young woman, after suffering for some time from nausea and constant craving for food, but inability to indulge it, and occasionally from pain in the stomach, was attacked suddenly with the usual symptoms of perforation, and died forty-two hours afterwards. The villous coat of the stomach, though generally healthy, presented at the lesser curvature several small elevated points, and in the middle of two of these a sharply-defined ulcer, one affecting the mucous coat only, while the other, which was half an inch in diameter where it affected the mucous coat, perforated the muscular and peritonæal coats by a hole no bigger than a crow-quill.[7] A case still more remarkable has
- ↑ Trans. of the Dublin College of Physicians, i. 2, and London Medico-Chirurgical Transactions, viii. 228.
- ↑ Guy's Hospital Reports, 1839, iv. 20.
- ↑ Abercrombie on Diseases of the Stomach, 41.
- ↑ London Medico-Chirurg. Transactions, viii. 233.
- ↑ Archives Générales de Médecine, xxvi. 123.
- ↑ On Diseases of the Stomach, pp. 35, 37.
- ↑ Guy's Hospital Reports, 1839, iv. 16.
