Treatise on Poisons: In relation to medical jurisprudence, physiology, and the practice of physicChristison, Robert, Sir
Science
Treatise on Poisons: In relation to medical jurisprudence, physiology, and the practice of physic
Christison, Robert, Sir
Medical jurisprudence; Toxicology
The outer surface of the abdominal viscera is commonly either very
vascular or livid, or bears even more unequivocal signs of inflammation,
namely, effusion of fibrin and adhesions among the different turns of
intestine; and these appearances may take place although the stomach is
not perforated.[285] The cause of this appearance, which is seldom
observed in poisoning with other irritants, more especially with the
metallic irritants, is that the acid passes through the membranes of the
stomach by transudation during life,—as will be proved immediately. It
must be observed, that the peritonæum is sometimes quite natural after
death from sulphuric acid, even although the stomach was perforated. I
have seen this in a case which proved fatal in twelve hours. An
important appearance in the abdomen, to which less attention has been
hitherto paid than it deserves, is gorging of the vessels beneath the
peritonæal membrane of the stomach and adjoining organs with dark,
firmly coagulated blood, arising from the acid having transuded through
the membranes and acted on the blood chemically. My attention was first
turned to this appearance by an interesting case, which I saw in 1840 in
the Royal Infirmary of this city, and of which an able account has been
published by Dr. Craigie.[286] The whole vessels of the stomach were
seen externally to be most minutely injected and gorged, and the blood
in them was coagulated into firmly-cohering cylindrical masses, as if
the vessels had been successfully filled with the matter of an
anatomical injection. This appearance was also observed in the superior
mesenteric arteries, in the omental vessels, and over the greater part
of the mesentery. It was occasioned by the chemical action of the acid
coagulating the colouring matter and albumen; for the clotted blood was
strongly acid to litmus-paper. So too was the peritoneal surface of the
stomach, omentum and intestines. And the acid had transuded through the
stomach and into the omentum and tissues of the intestines during life;
for in the first place, there was no perforation of the stomach, and
secondly, I ascertained that 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.
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