J. Redwood
1876 The Lancet  
757 emphysema; there was no appearance of congestion, inflammation, or corrosion. The liquid contents consisted of about eight ounces of thick, gruel-like matter, of a yellowish colour, containing some small solid lumps, and having the odonr of alcoholic fermentation. The oesophagus was normal, and contained some of the same matter as the stomach.-Intestines : Duodenum very soft and easily torn, being ruptured in tying it, but careful examination detected no perforation or ulceration ; mucous
more » ... ceration ; mucous surface pale and yellowish; jejunum had similar appearance.—Ileum: Some of the coils externally very dark, others pale, containing both liquid and gas, which distended the uppercoils. The last portion, about two feet, near the ileo-cæcal valve, was pale, small, and collapsed. Mucous membrane through the whole extent pale and yellowish, with no congestion, except at the lower end, where was a little punotiform redness. Peyer's patches of normal size, and apparently quite natural, as were also the solitary glands. The contents of this portion of intestine consisted of yellow pasty matter, of very offensive odour, without any admixture of blood. IIeo-cseoal valve and vermiform appendix natural.-Large intestine: Caecum immediately below the valve of a deep-red colour, and containing red blood-clots. On examination, the mucous membrane found deeply congested, and exhibiting several small ulcers, or ulcerated pustules, on the surface of most of which was a small quantity of pus, and from several of which small blood-clots were depending. They were mostly the size of shot, the largest the size of half a pea, irregular in shape, and might have originated in the solitary glands. Epithelium in surrounding parts thin, and partly removed, so that the muscular coat was more obvious than natural; but there was no perforation. Remainder of colon very deeply ' , blood-stained, of a dark-red colour, but with no ulceration. The contents were soft, pasty, chocolate-coloured matter, ' ' , very adherent to the walls, composed of fsecal matter ' i mixed with blood-clot and altered blood.-Rectum for about eight inches from anus was empty, the mucous surface slate-coloured and the walls soft, This condition commenced abruptly, and may have been produced by injections. Liver, moderate size; surface smooth; capsule with one linear fibrous cicatrix an inch and a half long; substance firm, of a pale brownish, liver-colour; lobular . structure distinct, and general appearance normal. Bileducts contained bile of natural appearance. Spleen moderate size, of a dark-red colour, and normal in appearance. Pancreas natural. Supra-renal capsules natural. Kidneys moderate size; capsules easily detached, except in one spot; surface smooth, pale. Left kidney contained one solitary cyst, the size of a cherry, containing clear fluid; otherwise quite normal in appearance.; Bladder natural, containing clear urine.-Head (opened after the body): Skull quite natural; dura mater fairly full of blood, not congested; sinuses containing some blood, chiefly fluid; pia mater and arachnoid also normal, with no excess of blood; brain-substance natural, with no.excess of blood or of fluid. Mouth and lips natural, except that papillue at back of tongue were larger than usual, and one contained some puriform matter. Remarks.—The morbid appearances described above do not precisely coincide with those of many published accounts of the appearances after death from antimony; but it must be said that these (as given in Taylor '° On Poisons," &c.) are far from uniform. The most noticeable fact was the limitation of distinct morbid change, as far as I the alimentary tract was concerned, to the large intestine, and here chiefly to the caecum. There were none of the appearances in the stomach, gullet, or small intestine usually looked for as the result of "irritant poison." I desire also to call attention to the extent and conspicuous character of the appearances due to post-mortem transudation of the abnormally fluid or imperfectly coagulated blood. To this was due undoubtedly the presence of blood-stained fluid in the air passages, pleurse, and pericardium, and the pseudo-congestion of the lungs. It is, indeed, not improbable that the settling down of blood in the posterior (i. e., lower, when the body was recumbent) portions may have commenced before death, when the heart's action was failing; but the greater part must have occurred after death. This explanation, so obvious to pathologists, would not be worth dwelling upon, but that I find " congestion of the lungs," and "redness of the posterior portions of the J lungs," set down in some of the accounts of antimony poisoning (especially the older ones) which must clearly have been due to this cause. An analogous explanation applies to the redness of the surface of part of the stomach, caused by the action of the contents of the stomach on blood contained in the vessels, and this may perhaps account for some of the " congestions" often described in the mucous membrane of the stomach. I have found no account of a case in which the lesions of the large intestine were precisely what they were here, or in which the hsemorrhage was so distinctly traceable to ulceration, as, at least in the later stages of the illness, it was here. The contents of the stomach and intestines were at once taken to Professor Redwood for analysis, a portion of the material from the large intestine, which differed in appearance from that in the stomach and small intestine, being kept separate. Portions of the digestive organs and other viscera were also preserved, but the result of the analysis of the contents made it unnecessary to examine them.
doi:10.1016/s0140-6736(02)46101-6 fatcat:yziflvlpgzf4xbtvsyoq3y3hdy