Among the poisonous substances which directly • affect the gastric mucous membrane, the following deserve special notice: Alcohol, phosphorus, arsenic, potassium cyanide, corrosive sublimate, nitrobenzol, potassium chlorate, concentrated mineral acids (sulphuric acid, nitric acid), and the caustic alkalies. The first-named substances cause an intense acute gastritis. The mucous membrane becomes swollen and superficially necrotic, leaving behind small hemorrhagic spots. Microscopically the glandular tubuli are found to have undergone fatty degeneration. The latter group of poisons (acids and alkalies) act quite differently. They directly destroy the parts they come in contact with and in this way the whole mucous layer may become destroyed; sometimes, should the poison penetrate still farther, the submucosa may also be destroyed, and rupture of the stomach takes place.

Symptomatology

The symptoms will be more or less marked according to the quantity of poison taken. There is always pain in the gastric region, which is increased on pressure. Vomiting is of very frequent occurrence. The vomited matter may contain an admixture of blood. Thirst is always present. In cases of a severe nature there is always found a small pulse, cyanosis, cold perspiration, slight coma, and death may occur in collapse.

In other cases the course may be somewhat more protracted and either peritonitis or icterus, hematuria caused by the poison circulating in the blood, may develop. In those instances in which death does not occur there may arise - after the acute symptoms of poison have been subdued - a condition which is similar to that of a subacute gastritis.

It sometimes, though seldom, happens that the mucous membrane of the stomach is affected to such a high degree that it may entirely atrophy and then a condition of achylia gastrica will result. In cases of poisoning by mineral acids or caustic alkalies, it may occur that in consequence of the sloughing of an area situated either near the cardia or near the pylorus a stricture develops, thus causing serious complications. These strictures frequently develop later on, at a time when the patient perhaps imagines that he is entirely rid of his trouble. The stricture of the cardia causes dysphagia, and the stricture of the pylorus ischochymia.

Diagnosis

The diagnosis is frequently made by the cross-examination of the patient, provided he is able to state what kind of poison he took. The inspection of the mouth, tongue, and pharynx may lead us to suspect poisoning by mineral acids or caustic alkalies, as both cause manifest lesions (sloughing) at these places when taken. The examination of the vomited matter will also frequently lead us to discover the nature of the poison.

Prognosis

The prognosis will greatly depend upon the quantity of poison taken, and upon the condition in which we find the patient. On the whole, every case of poisoning must be considered as quite serious, recovery being doubtful.

Treatment

In all cases of poisoning by concentrated mineral acids and caustic alkalies, the best mode of treatment is to effect dilution of the poison, and if possible its neutralization. Thus we give calcined magnesia (100 gm. dissolved in a pint of milk) to the patient as a drink in case the poison consisted of a mineral acid; the magnesia will then neutralize the acid. On the other hand, we administer a drink consisting of lemonade or a weak solution of acetic acid (one to two per cent) in case the poisonous substance had been a caustic alkali, for the reason that the acid introduced forms a harmless combination with the poison. In the instances just mentioned, lavage cannot be used for fear of a perforation of the stomach; nor is it permitted to bring on vomiting, as the poisonous matters lodged within the stomach would cause a great deal of harm by their coming in contact with the oesophagus and mouth when ejected.

In all other kinds of poisoning (alkaloids and metals) it is always best to use lavage as early as possible, in order to free the stomach and the organism of that portion of the poison that has not yet entered the small intestine. Although an emetic (like apomorphine) can be used for this purpose, siphonage of the stomach is, however, by all means preferable, for only the latter permits a thorough emptying and cleaning of the organ. It is not the place here to speak of all the antidotes that have to be employed in these cases. The subsequent treatment will always depend upon the symptoms in each given case. In peritonitis ice will have to be applied on the abdomen, and opiates freely given. The treatment of a resulting stricture of the cardia or of the pylorus must, in most instances, be a surgical one. In the former cases, dilating of the cardia by means of bougies will first be tried.