Treatise on Poisons by Sir Robert Christison
8. _Of Inflammation of the Stomach._—Chronic inflammation of the stomach
837 words | Chapter 55
is a common disease; which, however, on account of the slowness of its
course, is not liable to be confounded with the ordinary effects of
irritant poisons. Acute inflammation, on the contrary, follows precisely
the same course as that of irritant poisoning. But great doubts may be
entertained whether true acute gastritis ever exists in this country as
a natural disease. Several of my acquaintances, long in extensive
practice, have stated to me, that their experience coincides entirely
with that of Dr. Abercrombie, who observes he has “never seen a case
which he could consider as being of that nature.”[167] An important
observation of the same purport has been made by M. Louis, one of the
most experienced and accurate pathologists of the present time. He says,
that during six years’ service at the hospital of La Charité, during
which he noticed the particulars of 3000 cases and 500 dissections, he
did not meet with a single instance of fatal primary gastritis. The
disease only occurred as a secondary affection or complicating some
other disease which was the cause of death.[168] So far as I have
hitherto been able to inquire among systematic authors, the descriptions
of idiopathic acute gastritis appear to have been taken from the
varieties caused by poison.
The following are the only specific accounts I have hitherto met with of
an affection of the nature of idiopathic acute gastritis; and the reader
will be at no loss to perceive that in each of them it admits of being
viewed differently. The first two are the cases of inflammation referred
by Haller and Guérard to drinking cold water incautiously [p. 100]. The
next is a remarkable incident related by Lecat, and occurring in 1763. A
girl, nineteen years old, was attacked while in good health with
shivering, faintness, acute pain in the belly, cold extremities and
imperceptible pulse; and she died in sixteen hours. The stomach was
found red, and checkered with brownish patches and gangrenous pustules
(probably warty black extravasation): yet it was supposed to have been
ascertained that she had not taken any thing deleterious.[169] This
narrative is certainly to appearance pointed. But when it is added, that
the girl’s mother was attacked about the same time with precisely the
same symptoms and died in four hours, I think the reader, when he also
considers the imperfect mode in which chemical inquiries were then
conducted, will by no means rest satisfied with Lecat’s assurance that
nothing deleterious was swallowed. The last is an equally singular case
given by Dr. Hastings, of Worcester, where poisoning with cantharides
was suspected. A young lady, liable to indigestion, but at the moment in
better health than usual, was attacked with sickness before breakfast
and after it with vomiting. Three days elapsed before she was seen by
her medical attendant, who found her sinking under incessant vomiting,
severe pain in the loins, strangury, bloody urine, and swelling of the
clitoris, attended with red extravasation of the eyes, and a red
efflorescence on the skin. Death followed next day amidst convulsions;
and there was found in the dead body extravasation of blood between the
kidneys and their outer membrane, into the pelvis of each kidney, and
into the bladder,—redness of the bronchial membrane, and gorging of the
air-cells with blood,—and general redness of the inside of the stomach,
with numerous extravasated spots in the submucous coat.[170] It seems to
have been clearly proved at the coroner’s inquest that poisoning was
here out of the question. But the case appears rather to have been one
of renal irritation or inflammation than of gastritis, and the affection
of the stomach secondarily merely.
The question as to the possibility of acute gastritis being produced by
natural causes is one of very great interest to the medical jurist. For
its possible occurrence is the only obstacle in the way of a decision in
favour of poisoning, from symptoms and morbid appearances only, in
certain cases by no means uncommon, which are characterised by signs of
violent irritation during life, early death, and unequivocal marks of
great irritation in the dead body, namely, bright redness, ulcers, and
black, granular, warty extravasation. In regard to these effects, it may
with perfect safety be said, that they can very rarely indeed all arise
from natural causes; and for my own part, the more the subject is
investigated, the more am I led to doubt whether they ever arise in this
country from any other cause than poison. The possible occurrence of a
case of the kind from natural causes must be granted. But this
concession ought not to take away from the importance of the contrary
fact as one of the particulars of a chain of circumstantial proof.
In whatever way the fact as to the existence of idiopathic acute
gastritis may eventually be proved to stand, an important criterion of
this disease, as of cholera, will be that the sense of burning in the
throat, if present at all, does not precede the vomiting.
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