Medical and surgical monographs / by Ashwell [and others].

Date:
1840
Catalogue details

Licence: Public Domain Mark

Credit: Medical and surgical monographs / by Ashwell [and others]. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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    they be effused or not, the lesion is unattended with symptoms in- dicative of so great an injury to an imjDortant organ; and thus we may regard it as improbable that it should have taken place during life. 2. Substances effused into the peritoneum during life are well known to excite peritonitis; but here liquids of the most irritating character have become effused, and no appear- ances of inflammation have been found in that cavity. This is not, perhaps, positive evidence of a post-mortem change, because the perforation and extravasation might be said to have occurred recently before death ; and it does not seem to have been yet settled, how long a time is required for effused matters to remain in contact with the peritoneum, in order that they should leave the undisputed morbid changes of peritonitis. Again, no marks of inflammation have been found in the stomach ; this point, perhaps is not yet established in the affirmative : but it is clear, if the edges of an aperture pre- sent any traces of inflammation or adhesion to the surrounding vis- cera, it could not have a post-mortem origin assigned to it. 3. The perforation generally occurs at the cardiac extremity; the most depending part of the stomach, where digestion is chiefly carried on. The viscera at or near the aperture are discoloured and softened ; just as if some corroding liquid had escaped through the opening, and had accidentally come in contact with them. It is thus we have seen, in two cases, the diaphragm has been found perforated. 4. Experiments made on animals, and on animal matter, in relation to the gastric secretion, show that a liquid is poured out capable of thus acting on the coats of the organ after death. John Hunter first called the attention of the profession to this subject; behaving found the stomach thus acted on in the case of three persons who had died a violent death, as well as in some animals killed for the sake of experiment. It was then considered that a healthy state of the body was necessary for this change to be observed ; and thus the rarity of its occurrence was attempted to be accounted for. It was also believed, that, in a state of abstinence, the gastric juice con- tinued to be secreted, accumulating more especially at the greater end of the stomach ; and that, so soon as the vital properties of the organ were lost in death, its coats underwent digestion, just as its contents might do during life. Experience has, however, shown that both of these positions require to be modified. The stomach has been found equally destroyed in diseased subjects :—it has not been found destroyed in all cases of violent death, from a state of health; nor in those instances where men or animals have perished from starvation. Besides, the liquid poured out by the stomach in a state of abstinence is found to be entirely different, in its nature and properties, from the secretion which really acts upon the food introduced. After long fasting, the liquid contained in the stomach is viscid, neutral, and destitute of albumen : it yields not more than 1.64 per cent, of solid residue, which consists of the salts of ammo- nia, potash and lime, chiefly muriates and sulphates. Such a liquid cannot, of course, act chemically on animal matter; and thus it is