Acute Toxic Gastritis.
Definition:—A violent, acute inflammation of the stomach, induced by powerful irritants and corrosives.
Etiology:—The larger number of suicides are caused by ingestion of irritating and corrosive poisons, which induce this disease, resulting in death. This class of remedies is also taken accidentally. The commonest of these agents are caustic potash in the form of concentrated lye, and ammonia, carbolic and oxalic acids, the mineral acids, phosphorus, arsenic, antimony and mercury. An overdose of elaterium, croton oil, and some other of the irritating vegetable substances, or a large quantity of mustard retained in the stomach, will produce this disease.
Symptomatology:—This is a most violent and serious disorder. The symptoms follow very quickly upon the ingestion of the poison. Extreme pain in the epigastric region, quickly followed by violent vomiting, are the first symptoms. The pain is intense and burning in character, and will usually extend to the throat and mouth. With arsenic the burning sensation is that of a coal of fire in the stomach, the heat and burning radiating from a definite, readily localized, circumscribed spot. The vomiting increases, the vomitus consisting of a large quantity of mucus, blood, and ultimately shreds of membrane. The thirst is intense, and is not quenched with water. The abdomen and stomach soon become distended, and the stomach is exquisitely sensitive upon pressure. Usually the temperature falls from the first, but in an occasional case the temperature will rise rapidly until it reaches from 104° F. to 105° F. The pulse becomes rapid, and soon feeble and compressible. The skin is cold and clammy often, and is covered with a free cold sweat. The expression of the face is drawn and anxious, and prostration develops very rapidly. In those cases in which death is not immediate, a toxic inflammation may develop in the glandular organs. There may be a complete suppression of bile, with marked jaundice, or acute septic nephritis, with perhaps severe hematuria. The patient becomes rapidly dull, taking no interest in the surroundings, stupor and finally coma develop, and occasionally convulsions occur.
It would be interesting at this point to describe the specific action of each of the poisons named, and detail the exact symptoms, but the general influence upon the stomach is so similar that this is not necessary.
Diagnosis:—The diagnosis of a serious stomach lesion is not difficult, but it is occasionally impossible to determine by what agent the condition has been induced. The treatment will prove more satisfactory if this knowledge is obtained. Death often occurs before it is possible to determine the cause. Carbolic acid turns the membranes white, and exhales its characteristic odor. Nitric acid turns the membranes yellow, and has but little odor. With sulphuric acid the parts are turned brown or black. The alkalies produce a brownish discoloration. Arsenic and phosphorus have the characteristic burning, and with phosphorus there is more rapid prostration.
Prognosis:—The prognosis is usually grave. When a chemical antidote can be immediately administered, death may be averted, but serious symptoms may be present to demand careful treatment for a number of weeks. In an occasional case the local inflammation seems to be yielding to the treatment, the outlook appears favorable, when general peritonitis supervenes, resulting in death.
Treatment:—The treatment of these cases resolves itself, first, into neutralizing or antagonizing the effect of the poisoning; second, in relieving the disastrous effects of the agent upon the stomach; and third, in the restoration of the patient. In antidoting the effect of the poison it is important, as has been stated, that the character of the poison should be known. With the immediately corrosive agents it is a waste of time to endeavor to protect the walls of the stomach by the administration of a simple oil. The chemical antidote must be at once administered. With the alkaline poisons, dilute vinegar will be found of immediate service. This agent will also neutralize the effect of carbolic acid, as quickly as other better known antidotes. For the mineral acids a dilute solution of caustic potash, or a solution of common washing soap in cold water, should be drunk freely, in the absence of more scientific antidotes. This should be followed by copious draughts of warm water. Phosphorus is antidoted with an old oil of turpentine, and arsenic with ferric hydrate, and the mercuric bichlorid with raw eggs.
When the irritating agent is neutralized, hot applications should be applied over the stomach and perhaps slight counter irritation or heat to the spinal column. Remedies soothing to the stomach, such as simple oils, mucilaginous drinks, and the subnitrate of bismuth, may be immediately administered. Where severe pain is present, a hypodermic injection of morphin must not be delayed, and often stimulants by this method are demanded to prevent or counteract the shock. No food of any kind must be taken into the stomach, rectal feeding being resorted to. If extreme depression is present, the one-sixtieth or the one-fortieth of a grain of strychnin nitrate may be given every two or three hours hypodermically for the first two days. As the symptoms improve, the treatment must be adjusted to the demands of each day. When it is deemed proper to administer food by the stomach, it must be selected and administered with the utmost care by rules which must be strictly enforced by the nurse.