stomach. Thus it has been found in women who died of convulsions after delivery,—in children who died convulsed or of hydrocephalus,—after death from suppuration of the brain, both natural and the result of violence,—from coma following an old ulcer of the back, which communicated with the spinal canal,—from diseased mesenteric glands,—from phthisis,—from nervous fever,—and after sudden death from fracture of the skull or hanging:[1] and in all of these circumstances it has occurred without any previous symptom referrible to a disorder in the stomach.
The opinions of pathologists are divided as to its nature. The French conceive it arises from a morbid corrosive action, which, however, may extend after death, in consequence of the fluids acquiring a solvent power. Hunter ascribed it entirely to the solvent power of the gastric juice after death. There are difficulties in the way of both doctrines. A full examination of the whole inquiry, which is one of much interest and considerable complexity, would be misplaced in this work; but some remarks are called for, by reason of the important medico-legal relations of the subject, and the uncertainty in which it is at present involved.
In the first place, then, it appears difficult, if not impossible, to comprehend how a vital erosive action can account for the perforations observed after death from diseases wholly unconnected with the stomach, and unattended during life by any symptom of disorder in that organ. For, not to dwell on other less weighty arguments,—on the one hand, there is during life no symptom of perforation, an accident which if deep stupor be not present at the same time is always attended with violent symptoms when it arises from any cause but gelatinization,—and on the other hand, there is frequently no escape of the contents of the stomach into the cavity of the abdomen, though the hole is of enormous size, and its edge not adherent to the adjoining organs.—All such perforations, however, are perfectly well accounted for, on the other theory, by what is now known of the properties of the gastric juice. This will appear from the following exposition.
The power of the gastric juice to dissolve the stomach and other soft animal textures was long thought to be fully proved by the well-known researches of Spallanzani,[2] Stevens,[3] and Gosse.[4] In later times doubts were entertained on the subject in consequence of negative results having been obtained by other experimentalists, more especially by Montégre.[5] But these apparently discrepant facts and opinions have been reconciled by the ulterior experiments of Tiedemann and Gmelin on digestion;[6] who found that the nature and
- ↑ The last cases were observed by Hunter. See Philos. Transactions, lxii. 452.
- ↑ Fisica Animale e Vegetabile. Dissertazione quinta, § ccxxiii.-ccxxxi. T. ii. 86-89, Edit. Venezia, 1782.
- ↑ De Alimentorum Concoctione. Diss. Inaug. Edinburgh 1777.
- ↑ Experiments on Digestion. Appendix to Spallanzani's Dissertations relative to the Natural History of Animals and Vegetables. London Edition, 1784, i. 317.
- ↑ Expériences sur la Digestion dans l'homme. Paris, 1814, pp. 20, et seq.
- ↑ Die Verdauung nach Versuchen, &c. Heidelberg, 1825, or the French Edition, Recherches Expérimentales Physiologiques et Chimiques sur la Digestion, 1826, passim.
