Toxic Gastritis.
Symptoms.—The symptoms succeeding the ingestion of a corrosive poison vary, of course, with the amount and variety of the poison taken. These, however, usually are: intense pain in the mouth, throat, msophagus, and the stomach. There is profuse salivation, and urgent and uncontrollable vomiting. The vom ited matter is usually blood-stained, and may contain bits of the destroyed mu cous membrane. There is great thirst, and prostration and collapse may early occur.
Albumin and blood appear in the urine, and, microscopically, blood-cells, renal epithelium, and epithelial and blood- casts are apt to abound.
If the patient survives, the sloughs that have formed in the stomach are suc ceeded, after separation, by ulcers, which. in process of cicatrization, may lead to stricture of the oesophagus, cardia, pylo rug, or to hour-glass contraction of the stomach. A generalized atrophy of the mucous membrane may result in cases in which the poison taken in a more dilute form exerts a necrotic effect upon the glandular epithelium.
Diagnosis.—The diagnosis is commonly readily made. The corrosive effect of the poison evident in the mouth and throat, the character of the vomit (and later its chemical examination), the characteris tic symptoms evident, and perhaps the history of the ingestion of a toxic sub stance, all tend to render the diagnosis easy.
Etiology.—This disease is originated by the ingestion of substances which act by local destruction of tissue,—poisons, —such as oxalic acid, the mineral acids, caustic alkalies, arsenous acid, antimony, phosphorus, carbolic acid, ammonia, and the like.
The mucous membrane and the sub mucous tissue of the stomach is usually extensively destroyed by the corrosive poison; or, with such non-corroding poi sons such as phosphorus and arsenic, its glandular structure is the seat of an acute degeneration.
Treatment. — The treatment consists in the neutralization of the irritant poi son; for instance, for acids, the adminis tration of a mixture of magnesia, lime, and water may be used; this forms with all the acids, except oxalic, soluble, harm less salts. If magnesia is not at hand a
solution of sodium carbonate or bicar bonate, chalk, or soap should be admin istered. For neutralization of the caus tic alkalies there should be employed dilute vinegar, lemon-juice, diluted acetic acid, or tartaric acid. Carbolic acid calls for soluble sulphates or calcium hydrate or the saccharate. Poisoning by phos phorus demands the use of copper sul phate or of the old, unrectified oil of turpentine. The ingestion of arsenic calls for the hydrated iron sesquioxide or magnesium sulphate.
Mucilaginous substances and oils are administered as demulcents after neu tralization and evacuation of the alkalies and mineral acids. In all cases of poison ing not due to corrosives or to the min eral acids the stomach should be emptied and thoroughly washed out by means of the soft stomach-tube.
Chronic Gastritis.
Synonym.—Chronic gastric catarrh.
Definition.—A condition characterized by chronic disturbance of digestion orig inated and maintained by definite ana tomical alterations in the stomach-wall.
Varieties.—Clinically it seems proper to distinguish four forms of chronic gas tritis, all of which, finally, if unchecked, tend to terminate in hypertrophic or atro phic gastritis.
(a) Acid gastritis; (b) subacid gastri tis; (c) mucous gastritis; (d) atrophic The occurrence of acid gastritis, as first described by Boas, is, curiously, still disputed; but, of its existence and fre quency apart from the neurosis hyper chlorhydria, the writer sees almost daily examples. In this there occurs either a normal or frequently a marked heighten ing in the secretion of HC1, but, in the writer's experience, associated also with the presence of organic acids of fermenta tion out of proportion to that encoun tered in simple hyperchlorhydria. Here, as in many cases of hyperchlorhydria, there exists as a result of an hypertro phy and proliferation of the gland se creting elements, an actual increase of the oxyntic, or IIC1-secreting, cells.