- ance, and ascribes the thickening to gorging of vessels;[1] and in a
case related by Dr. Wood of Dumfries, where I had an opportunity of examining the stomach, this appearance was present in a remarkable degree, and it clearly arose from elevation of the villous coat by effusion of blood under it.[2] Remer, in his edition of Metzger's Medical Jurisprudence, says he once met with an instance where the stomach was shrivelled like a bladder subjected to boiling water.[3]
Sometimes the villous and also more rarely the other coats of the stomach are found actually destroyed and removed in scattered spots and patches. This loss of substance is occasionally owing to the same action which causes softening and brittleness of the villous coat,—the action, however, having been so intense as to cause gelatinization. That such is the nature of the process appears from the breach in the membrane being surrounded by gelatinized tissue, and not by an areola of inflammatory redness. Of this species of destruction of the coats I have seen a characteristic example.[4] But in other cases the loss of substance is owing to a process of ordinary ulceration, as is proved by the little cavities having a notched irregular shape, and being surrounded both by a red areola and a margin of firm tissue. This was the character of the ulcers in the case of Warden, which I have described elsewhere.[5] Destruction of the coats of the stomach by ulceration is not a very common consequence of poisoning with arsenic, as death frequently takes place before that process can be established. It does not often occur, unless the patient survive nearly two days. Mr. Alfred Taylor, however, mentions a case fatal in seventeen hours where he found ulceration of the stomach, and another fatal in ten hours where several small ulcers were seen on the lesser curvature, and two nearly circular ones as big as a sixpence.[6] Mr. Hewson too informs me he found many eroded spots even in his case which proved fatal in five hours (p. 56). I suspect, however, that spots of healthy membrane surrounded by vascular redness are sometimes mistaken for ulcers in such cases; for indeed nothing can more exactly resemble them. In many general works on Medical Jurisprudence, and in some express treatises on arsenic, it is stated that this poison may cause complete perforation of the stomach.[7] But this effect is exceedingly rare. I have related one distinct example of it;[8] Professor Foderé has briefly alluded to a case he witnessed which proved fatal in two days and a half;[9] I have likewise found in an account of a trial in North America, an instance in which the stomach was perforated by numerous small holes, so that when held before the light it appeared as if rid-*
- ↑ Aufsätze und Beobachtungen, i. 58.
- ↑ Edinburgh Med. and Surg. Journal, xxxiii. 66.
- ↑ Metzger's System der gerichtlichen Arzneikunde, von Remer, 1820, p. 257.
- ↑ Edin. Med. and Surg. Journal, xxix. 25.
- ↑ Edin. Med. and Surg. Journal, xxvii. 453.
- ↑ Guy's Hospital Reports, 1837, ii. 29, and 1841, vi. 266.
- ↑ Gmelin's Geschichte der Mineralischen Gifte, 124, Fodére, Médecine-Légale, iv. 127. Sallin, Journal Gén. de Médecine, iv.
- ↑ Edin. Med. and Surg. Journal, xxix. 25.
- ↑ Journal Complémentaire, i. 106.
