From the statements which I have given, it may, I think, be fairly inferred, that, in the villous coat of the stomach, appearances of vascular fulness, whether florid or dark-coloured, in distinct vessels, or in extravasations of various sizes, are not to be regarded as unequivocal marks of disease. They occur in every variety of degree and character, under every circumstance of previous indisposition, and in situations where the most healthy aspect of an organ might be fairly expected. They are found in every part of the stomach, but principally in the posterior part of the great end, and in the lesser curvature; and they cover spaces of various extent, but are generally well defined, and terminate abruptly. These circumstances have been confirmed by a great number of other examinations, which I have, at various times, had occasion to make; and I am inclined to think, that the first series of cases, may therefore be regarded as a fair average of the appearances seen in the adult human stomach. In young subjects, I should imagine, there is in general little vascularity seen after death; for in the 16th case*, (that of a young man of 22,) there was none apparent; and of the bodies of two boys, which I have since examined, one, where death was produced by an abscess, exhibited a very obscure portion; and the other, where the cause of death was a fracture of the occipital bone, showed none.t The appearances which I have described, preserve their distinctness for a short time only, being best marked on the first day, and soon after, but at irregular periods, becoming more obscure; the parts which were vascular acquiring a dark red, or purple tinge, which loses itself gradually. This effect more readily takes place when the villous coat is in contact with a fluid, particularly water. They exist in the body of the * In the last case, the whole surface of the small intestines was covered with small florid vessels, generally giving the appearance of small transverse parallel streaks. † Vide Table, p. 7. villous coat, and in general appear to be greatest, where that membrane is the least firm and resisting. Careful dissection discovers a fine net-work of veins between the villous and the muscular coat, from which the minute vascularity of the former evidently proceeds. This is very often capable of being traced, through the semi-transparent mucous coat, into larger veins beneath, by gently stretching the mucous coat, so as to render it thinner. The arteries are always empty, or very nearly so. The vascularity now mentioned, often possesses a starred appearance, from the circumstance of its spreading in minute vessels, continually ramifying into smaller ones, to very near the extremity of the villous surface. A slight degree of friction, with the point of a scalpel, will open the minute extremities of the vessels; but I have never observed, that even by squeezing the larger branches, in a retrograde way, effusion into the cavity of the stomach could be produced, so as to stain a white substance which might be applied to the villous surface. An appearance, very similar to the vascularity now described, is easily produced by injecting the veins (when there happens to be but little blood in them) with red-coloured injection; in which case, the villous coat, to the naked eye, but still more when a magnifying glass of moderate power is employed, exhibits a branched, or slightly stellated form of vessels, so descriptive of those which are seen in the human stomach.* If the veins, when injected, contain blood, the blood is forced, by the injection, into more remote branches, and at last escapes by rupture.-An appearance, a good deal like this, also takes place by injecting the arteries; but the vascularity * Isinglass, or calves foot jelly, rubbed up with a proper quantity of colouring material, was the injection employed. It was thrown in through a pipe fixed on the coronary artery or vein, by a syringe, which contained about an ounce. The stomach was inverted, the pyloric extremity tied, and the pipe brought out at the cardia, which was slightly enlarged, if necessary, and a ligature (as far as the pipes would admit,) placed on it. By this means, the flowing of the injection through the villous coat was kept under view. now mentioned can be completely imitated, by forcing back with the finger, or the back of a scalpel, the blood from the larger branches of veins into the smaller ones, by which means a species of minute injection into the very extremity of the villous coat, most readily takes place. Where a few larger veins have been apparent, this effect can be produced without the least extravasation, to a considerable extent; more particularly when the coats are thin. I have never been able to produce, satisfactorily, a passage of injection from the artery to the vein; either in the stomach or intestines. The termination of the artery in the vein, must be very remote in the villous covering; for when these vessels are filled by injections of different colours, they are found to run, side by side, as far as they are capable of being traced. There is a very remarkable similarity in the appearances exhibited in the stomachs of each of the malefactors, whose cases are mentioned above; and a general resemblance apparent between them, and the stomachs of persons who have died of natural death. In the former, however, the vascular character is more universal, and more vivid; and there is, besides, a disposition to effusion of blood into the cavity of the stomach, which does not occur in the latter. These differences may readily be accounted for, by the circumstances in which the vascular system is placed, before the total cessation of life, in persons who die by hanging; for in them, the usual disposition to vascular fulness in the stomach, is increased by the loading of the venous system, which occurs in consequence of the difficult transmission of blood, from the right side of the heart, during suspension. In considering the state of an organ after death, with reference to the circumstances under which it may have appeared during life, it is necessary to consider, that in the latter case, both systems of vessels are filled with blood; while, in the former, blood is found in the veins only, the arteries being nearly, if not entirely empty.* It is likewise important to remark, that it is not from injections, that we can form any opinion as to the colour of parts, or the state of their circulation during life. Coarse injections will fill only large vessels; while fine injections will exhibit those which, like the vessels of the eye, are incapable, from their minuteness, of conveying red blood in the healthy subject. There is, besides, a considerable difference between the uniform colour of a living part, where the finest glass can discover no separation of vessels, and the vascular distinctness produced by injection. These circumstances apply strongly to any deductions which we may endeavour to make, as to the usual state of the mueous coat of the stomach during life, from its appearance after death. It is, indeed, extremely difficult to form an adequate conclusion as to this point, and authors have given various opinions relative to it. By some it has been stated to be white;f by others to be reddish;‡ by others to be greyish, bordering upon yellow and red;§ clay-coloured or reddish;|| or strongly marked red.¶ I have frequently seen the human stomach soon after death, and in such parts of it as were free from vascularity, it had usually a light straw-coloured tinge:** but, from the analogy -"et a morte semper, arteriæ magis et magis inaniuntur, furtim et sensim, donec penitus albæ, et absque vestigio sanguinis sint, unaque cum membranis mesenterii pelluceant, a quibus non facillime distinguuntur." HALLER'S Opera Minora, tom. I. p. 200. If any blood were contained in the minute arteries, it would be extrava sated in injecting them, which I have never seen to occur with the arteries of the stomach, though it sometimes happens, as I have already stated, with the veins. † DUMAS, Principes de Physiologie, tom. iv. P. 241. + CUVIER'S Leçons d'Anatomie comparée, tom. iii. p. 353. S BOYER'S Traité complet d'Anatomie, tom. iv. p. 337. ** In dogs which have been hung, I have seen it with a slight crimson blush nearly over its whole surface, which is most apparent at the plicæ, anti of the mucous covering of the mouth and fauces, and of the urethra, it is probable, that when circulation is going on in the stomach, its inner surface is of a pale red hue, arising from vessels so minute as to give an uniform colour, without any appearance of distinct vascularity. After death, the arteries and minuter veins are almost wholly emptied of their contents, and thus the colour of the villous coat is removed; but by dissection it will generally be found, that fine vessels are discoverable in the cellular membrane, which is interposed between the villous coat and the muscular. The removal of the colour, if we may judge from the analogy of the mucous membrane of the mouth, takes place very speedily. It is difficult to ascertain in what way vascular appearances, such as those described by me, originate. That they take place about the close of life, is highly probable; but I feel myself unable satisfactorily to account for the mode in which they are produced. They are wholly venous, as is also the vascularity seen in many other parts of the body after death; the ar teries, to which the veins which are so distended, correspond, being generally empty. It would therefore appear, that there is a power capable of being exercised in the artery itself, which carries on the blood to the capillaries, or to the veins, after the further supply of fresh blood from the heart is stopped; and that there is thus a species of accumulation pro seems to consist of minute crimson points formed as if by the projection of minute straw-coloured villi on a red surface This appearance, I apprehend, is in some degree dependent on the mode of death. In pigs, I have always seen it of a light straw colour, with a slight crimson blush over a part of its surface. The colour of the villous coat of the stomach and intestines is much alike in the dead body; being in both a light straw colour. Bichat states generally, that the natural appearance of the former, (meaning of course in the living body,) is a strongly marked red; and he gives an instance of a wounded and inverted portion of intestine, in which there was the redness, 'qui caracterise cette surface dans l'etat naturel.' VOL. V. C No. 17. |