too says he is acquainted with an instance where, in a medical inspection on account of a suspicion of poisoning, the villous coat of the stomach was found lined with a white granular substance which presented the properties of a fat and contained no mineral admixture;[1] and in the case of Warden I remarked a similar appearance, which, as arsenic was found in the stomach, I was disposed to consider a sprinkling of that poison, until the contrary was ascertained by analysis. The present caution, therefore, is not superfluous.
In a few cases the stomach is the only situation where morbid appearances are visible, even though life has been prolonged for so much as two days. This state of matters is well exemplified by a French case of death in forty-three hours, where the stomach presented much redness and extravasated patches, but where the intestines, the larynx and the contents of the head and chest were in a natural condition.[2] Such limitation, however, of the diseased appearances are rare.
Redness of the mucous membrane of the intestines is often present when the stomach is much inflamed. Dissolution of the mucous coat is much less frequent in the intestines than in the stomach. Ulceration occasionally occurs in lingering cases. In the case of Mitchell, which has been several times alluded to, the inner coat of the duodenum was dark-red, pulpy, thickened, easily separable; and on a spot as big as a crown-piece, both the inner and the muscular coats were wanting.[3] Perforation of the small intestine was found in a case communicated to me by Mr. Sandell, and detailed at page 277. But as the person survived only eight hours, and had laboured under symptoms of disease in the bowels for some days before taking the arsenic, it is unlikely that this appearance, which has not been observed, to my knowledge, in any other instance, arose from the action of the poison.
The signs of inflammation are seldom distinct in the small intestines much lower down than the extremity of the duodenum; and they do not often affect the colon. But the rectum is sometimes much inflamed, though the colon, and more particularly the small intestines, are not. Dr. Male mentions, than in man he has found the rectum abraded, ulcerated, and even redder than the stomach itself;[4] and Dr. Baillie also notices two cases in which the lower end of the rectum was ulcerated.[5] A common appearance in lingering cases is excoriation of the anus,[6] and it is said that even gangrene has been produced.[7]
A late writer draws attention to the fact that in the only two fatal cases he had seen the whole colon was contracted to an extraordinary degree;[8] and this state is mentioned in other cases. The appear-*
- ↑ Repertorium für die Pharmacie, xxiv. 144.
- ↑ Archives Gen. de Méd ii. 58.
- ↑ Edin. Med. and Surg. Journal, xviii. 171.
- ↑ Elements of Juridical Medicine, 76.
- ↑ Morbid Anatomy, p. 128.
- ↑ Case of Mr. Blandy, State Trials, xviii.
- ↑ Bachmann's Essay (see p. 259)
- ↑ Houlton in London Med. Gazette, xiv. 712.
