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

  • Edwards Crisp
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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    MORBID APPEARANCES. UTERINE DERANGEMENT. circumstance which I alluded to iu my former Essay is curious, viz., that in eighteen examples two ulcers were present on opposite sides of the stomach. I find by measurement the distance between the two orifices of the stomach in the adult is about six or seven inches; in the child at birth, from an inch to an inch and half. I mention this because some of the accounts of the distance of the ulcer from the orifices are vague and unsatisfactory, and it will be well for future observers to speak from accurate measurement. The greater vascularity, the more abundant supply of nerves and absorbents to the smaller curvature of the stomach, will probably account for the more frequent occurrence of ulceration in this part; and the situation of the pancreas, offers a ready explanation of the more frequent adhesion of this organ to the aperture in the stomach. I have not in this enquiry contented myself with a mere examination of recorded cases, but I have visited most of the museums of London, Dublin, and Edinburgh, for the purpose of examining specimens, and the result fully agrees with the conclusions I had formerly arrived at. Ulcerations of the pyloric end of the stomach, especially from malignant disease, are comparatively more numerous in the museums ; but it must be borne in mind, that a young girl affected with perforation would seldom be taken to an hospital; a fact that some enquirers have entirely lost sight of, and hence their statistical errors. The distinction between ulcerative perforation and that from the gastric juice, (after death,) is so well marked that it is scarcely neces- sary again to allude to it. The aperture in the former being generally circular and smooth; in the latter, irregular, ragged, and flocculent. I have two preparations in my museum from perforation by the gastric juice, which illustrate this. The rounded form in simple ulceration is easily accounted for by the elasticity of the peritoneum. If the mucous membrane is scraped off a healthy stomach, and the peritoneal coat ruptured, the aperture will assume a round or oval form. And in many of these perforations, I believe that the serous membrane for a long time is the only boundary wall between the stomach and the cavity of the peritoneum ; the rupture being often occasioned by distension of the digestive organ by food or gas. Perforation from poison, as before remarked, is of rare occurrence and would readily be detected; the mineral acids, especially the sul- phuric, being the most likely agents to lead to this result. The black- ening by the sulphuric, the yellow tinge of the nitric, and the state of the oesophagus would generally lead to a correct opinion. In the Dublin College of Surgeons’ Museum, and in the Guy's Hospital Museum, there are some interesting specimens of stomachs acted upon by the mineral acids. Let us ask what proof is there that these ulcers in the female generally depend upon uterine derangement? I think the table is the best answer to this question, although, I am far from admitting that a positive conclusion can be drawn from it; but when the ages of the patients, the sex, and the situation of the perforations and their- comparative unfrequency in married women, are taken into account, the probability is much strengthened. I know of no case on record of ulcerative perforation of the stomach, before the age of puberty; although, I i«tve not examined all the foreign journals. If anemia, and the impov ens e
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