On perforating ulcer of the stomach, from non-malignant disease. Pt. I / by Edwards Crisp.

  • Crisp, Edwards, 1806-1882.
Date:
1852
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Licence: Public Domain Mark

Credit: On perforating ulcer of the stomach, from non-malignant disease. Pt. I / by Edwards Crisp. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    On Perforations of the Stomach, from Malignant and Non- Malignant Ulceration, with their Causes, Pathology, and Treatment: By Edwards Crisp, M.D., Physician to the Metropolitan Dispensary. In December, 1837, I exhibited a perforated stomach at the Medical Society of London, and after relating the case, I made the following remarks, which I extract from the report in the Lancet (1837, p. 423). “ This case Mr. Crisp considered of importance in a medico-legal point of view. Four cases of a similar kind had happened in his neighbourhood within a few years. All these cases occurred in young girls, in whom there was a disordered state of the uterine function. The ages of two of chese patients were fifteen, one was sixteen, and another twenty years of age; in all of them the stomach was perforated near the cardiac orifice. Death took place, in sixteen, seventeen, twenty-seven, and thirty-six hours. Sixteen other cases of this kind he had found on record, fourteen of them occurring in females, one only of whom was married ; and in most of them irregu- larity of the uterine function existed. He (Mr. Crisp) was inclined to the opinion that in these cases there was much connection between the disease and the uterus. In chlorosis a peculiar state of the gastric juice existed, which gave rise to the ap- petite for strange and unnatural kinds of food. Might not this kind of ulceration be the result of this acrid state of the gastric juice 1 In two of the cases which had occurred in his neighbourhood, it was supposed Dy some that oxalic acid had been swallowed, as a small quantity of this poison was detected in the stomach, by analysis after death. The jury, nevertheless, returned a verdict of“ Died by the visitation of God.” He (Mr. C.) was not surprised that oxalic acid was often found in the stomach, when its contents were analysed, considering the quantity of oxalate of lime which some vegetables contained.” In August, 1843, after more extensive investigation of this subject, the following paper appeared in the Lancet (also in the form of a pamphlet). I now republish this communication ; and then, as in my Essays on Intestinal Obstructions, and on the Morbid Conditions of the Bile, I will give the result of my subsequent experience and statistical inference. ON PERFORATION OF THE STOMACH. (1843). Several treatises upon this disease have been written by conti- nental physicians during the last fifteen years. The subject, however, has been but little attended to in this country ; for, although a large amount of information exists in the medical journals in the form of cases and short essays, but few communications of a comprehensive character are to be met with. Among the few, I may mention particularly, the papers of Messrs. Taylor and Williamson, the former in the “Guy’s Hospital Reports” (18&9), and the latter in the “ Dublin Journal ” (1841.) The various authors that I have consulted differ much respecting the nature, cause, kc., of these lesions, and the discrepancies appear to me to arise from the very common error, amongst medical writers, of drawing conclusions from a few facts. I shall endeavor to avoid this by selecting a large number of cases from which I can deduce my inferences. Perforations of the stomach arise from three causes, viz., external violence, poison, and from simple or malignant ulceration. The perforation from the action of the gastric juice I believe is invariably fi post-mortem occurrence, and therefore is not included. Spontaneous