there was no free acid either in the matter discharged from the stomach before death after the free administration of antacids, or in the contents of the stomach obtained at the examination of the dead body.
The stomach, if not perforated, is commonly distended with gases. It contains a quantity of yellowish-brown or black matter, and is sometimes lined with a thick paste composed of disorganized tissue, blood and mucus. The pylorus is contracted.
The mucous membrane is not always corroded. If the acid was taken diluted, the coats may escape corrosion; but there is excessive injection, gorging, and blackness of the vessels, general blackness of the membrane, sometimes even without softening, as in a case related by Pyl of a woman who first took aqua-fortis and then stabbed herself.[1] More commonly, however, along with the blackness there is softening of the rugæ or actual removal of the villous coat, and occasionally regular granulated ulceration with puriform matter on it.[2] The stomach is not always perforated. But if it is, the holes are commonly roundish, and the coats thin at the margin, coloured, disintegrated, and surrounded by vascularity and black extravasation. In some rare cases there is no mark of vital re-action except in the neighbourhood of the aperture. A case of this kind is related by Mertzdorff: The margin of the hole was surrounded to the distance of half an inch with apparent charring of the coats, and this areola was surrounded by redness; but the rest of the stomach was grayish-white.[3] I examined with the late Dr. Latta of Leith a similar case, where the limitation of the injury was evidently owing to the stomach having been at the time filled with porridge. The patient, a child two years old, died in twelve hours; and on the posterior surface of the fundus of the stomach, towards the pylorus, there was a hole as big as a half-crown, which was surrounded to the distance of an inch with a black mass formed of the disorganized coats, and of incorporated charred blood. But the rest of the stomach was quite healthy. The most remarkable instance of chemical destruction of the coats yet known to me is a case mentioned by Mr. Watson of this city, where suicide was effected by cutting the throat about half an hour after two ounces of sulphuric acid had been swallowed. The individual was at first thought to have died simply of the wound of the throat. But on dissection the usual signs of acid poisoning were found; and among other effects, it was observed that nearly three-fourths of the stomach had been entirely destroyed.[4] The perforation, if the patient lives long enough, is generally accompanied with a copious effusion into the belly of the usual muddy liquor of peritonitis; and the outer surface of the viscera feels unctuous, as if from a slight chemical action of the acid on them. The acid has
