Lesions In The Gastric Mucosa

In these instances the defect did not heal and a condition similar to a real ulcer was established. In some of the animals even perforation of the ulcer took place. Koch and Ewald1 produced gastric hemorrhages in animals by section of the spinal cord. By introducing one-half-per-cent solution of hydrochloric acid into their stomachs deep ulcers arose. Silbermann 2 introduced substances into the circulation which disintegrated the blood corpuscles and produced haemoglobinsemia. Here also the artificial defect of the gastric mucosa healed very tardily, and presented a similar aspect to a real ulcer. There is no doubt that the above experiences gained by experiments on animals apply also to the human being. Acute lesions of the gastric mucosa in man very frequently occur and heal very rapidly without any ill effects. Clinically we know of cases in which a trauma in the gastric region produced hemorrhage by causing a tear in the gastric mucosa. In a few days, however, the patients recovered without presenting any gastric symptoms whatever at a subsequent period. Old English literature contains several reports of cases in which persons had swallowed knives which had passed the whole digestive tract without presenting any palpable symptoms.

One of the most striking instances is that reported by Dr. Marcet 2 and mentioned by Ewald. "In the year 1790 an American sailor saw a juggler in Havre perform the trick of knife swallowing. Returning to his vessel somewhat intoxicated he was foolhardy enough to try to swallow his open pocket knife, and succeeding in this, he ate three more. Three passed off in the stool during the next few days, but one disappeared forever. One evening, six years later, he again swallowed portions of six knives, but this time not without unpleasant though very transient results, on account of which he was admitted to a hospital. He did this frequently till he had swallowed about thirty-five knives. Finally he was taken seriously ill and he died in Guy's Hospital in London in 1809. In the stomach some thirty pieces of blades, in parts markedly corroded, together with handles, were found; two blades in the colon and rectum which were placed transversely and had perforated the intestinal wall (and that without causing peritonitis!), but no recent or old ulcers of the stomach or any remains of them." In this as in other instances undoubtedly the gastric wall had suffered considerable injury but quickly regained its normal state.

1 C. A. Ewald: "Klinik der Verdauungskrankheiten," 1. Theil, 8. Aufl., p. 122.

2 Silbermann: Deutsche med. Wochenschr., 1886, No. 29. 3 Marcet: Medico-Chirurgical Transactions, vol. xii., p. 72.

A similar instance of a grave lesion of the gastric mucosa without any ill effects I had the opportunity to witness myself, and it might be worth while briefly to describe it.

A boy of eleven years, suffering from epilepsy, during one of his attacks fell from a window on the first floor of the house into the yard, striking the stone pavement with his abdomen. He was found unconscious and brought up into his room, where he remained in this condition for about an hour. Upon thorough examination no traumatic lesions of the skull could be discovered; his nose did not bleed, nor was any blood found in his mouth. About two hours after his fall he suddenly vomited over a pint of fresh blood partly mixed with food. Six hours afterward about the same quantity of blood was again brought up. On palpation there was no pain in the gastric region. The boy was kept quiet for a few days and quickly recovered. Even during his stay in bed he never complained of pain. Afterward he could eat everything and remained entirely free from any gastric symptoms.

Analogous to the above experiments on animals which had been rendered anaemic, we also find gastric ulcer quite frequently in chlorotic individuals, and it may be readily imagined that many lesions of the gastric mucosa which would otherwise remain without ill effects are prevented from healing by the depreciated condition of the blood and become converted into ulcers. It is, however, impossible to say that this theory would apply to all cases of ulcer of the stomach, for very often we find this affection in people who are a picture of health, and whose blood condition is apparently without any anomalies.