REPORT 
OF 
TEN CASES OF GASTRIC ULCER, 
ONE CASE 
MALIGNANT ULCER OF THE STOMACH, 
PERFORATING ULCER OF THE JEJUNUM; 
AND TWO CASES 
With Extracts from a Lecture by Qfr. JLurchison, 
of London, on the Subject. 
I 
A. VAN RRRYREIL. M D 
PROFESSOR OF THE PRINCIPLES AND PRACTICE OP SUEGErWrID CLINICAL SURGERY 
IN THE ALBANY MEDICAL COLLEGE, ATTENDING SURGEON TO THE ALBANY 
AND ST. PETER’S HOSPITALS, MEMBER OF THE BRITISH 
MEDICAL ASSOCIATION, ETC.' - ■—. 
[Reprinted from the .Medical Annals, August, 1880.] 
Burdick & Taijtor, Brinfc-rs. 
ALBANY, N. Y. : 
1880. REPORT 
OF 
TEN CASES OF GASTRIC ULCER, 
ONE CASE 
MALIGNANT ULCER OF THE STOMACH, 
AND TWO CASES 
PERFORATING ULCER OF THE JEJUNUM; 
With Extracts from a Lecture oy (T>r. JLurchison, 
of London, on the Subject. 
BY 
A. VAN DERVEER, M. D., 
PROFESSOR OP THE PRINCIPLES AND PRACTICE OF SORCERY AND CLINICAL SURGERY" 
IN THE ALBANY MEDICAL COLLEGE, ATTENDING SURGEON TO THE ALBANY 
AND ST. PETER’S HOSPITALS, MEMBER OF THE BRITISH 
MEDICAL ASSOCIATION; ETC. 
[Reprinted from the Medical Annals, August, 1880.] 
ALBANY, N.Y.; 
Burdick & lfrmtos. 
1880. REPORT OF TEN CASES GASTRIC ULCER, ONE 
CASE MALIGNANT ULCER OF THE STOM- 
ACH, AND TWO CASES OF PERFORAT- 
ING ULCER OP THE JEJUNUM,* 
WITH EXTRACTS FROM A LECTURE BY DR. MURCHISON, 
OF LONDON, ON THE SUBJECT. 
A. VAN DERYEER, M. D., 
Professor of the Principles and Practice of Surgery and Clinical Surgery in the 
Albany Medical College, Attending Surgeon to the Albany and St. Peter's 
Hospitals, Member of the British Medical Association, etc. 
As having a bearing upon the subject of Gastric Ulcer, I 
wish to present several cases that have come under my own 
observation within the past few years. That perforating ulcer 
of the stomach sometimes causes sudden death is very well 
shown in the following two cases: 
Case I.—Mr. C., aged 26, while delivering ice on the morning 
of October 9, 1870, was suddenly attacked with pain in the epi- 
gastric region, gave several cries of pain, fell to the sidewalk, and 
was soon partially insensible. Dr, P. P. Staats, who lived but 
part of a block away, was called, and immediately responded. 
He found Mr. 0., in a profound collapse, scarcely able to an- 
swer questions, and had him removed to his office, where in a 
short time he expired. The case caused quite an excitement, 
some bystanders believing he had been poisoned, others calling 
it a case of cholera. 
The friends of the deceased were willing to have a post-mor- 
tem. They stated he had complained of dyspepsia for several 
weeks, and had been treated for that disease ; had never vom- 
ited blood to their knowledge. At 4p.m. we held an autopsy, 
and found a perforating ulcer two inches from the pyloric ori- 
fice of the stomach and in front, of an inch in diameter, 
round, and presenting the marked appearance of having been 
done with a good-sized punch. The contents of the stomach 
had escaped into the peritoneal cavity. No evidence of perito- 
nitis. All other organs in a healthy condition. 
* Read at the semi-monthly meeting of the Medical Society of the Connty of Albany, held 
Wednesday evening, March 24, 1880. 2 
GASTRIC ULCER. 
Case ll.—March 20, 1871,1 was requested by Dr. J. M. Bige- 
low to hold a post-mortem in the case of Mr. J., aged 54, car- 
man, of good habits, and usually in excellent health. For some 
time past had complained of distress about the stomach, and at 
times severe pain : had vomited some. On the morning of the 
19th had gone to work at an early hour; at 10 a. m. felt a se- 
vere pain just above the navel, fainted, and was brought home. 
Dr. B. saw him soon after, and found him in a condition of 
collapse, vomiting, and at times having a “cruel pain,” as he 
termed it. From this condition he did not rally, and died at 
4p. m. The post-mortem revealed almost the same location 
of a perforating ulcer of the stomach, of nearly the same size 
as in the previous case. Other organs healthy. Brain not ex- 
amined in either case. 
That perforating ulcer will sometimes result from an old 
injury is shown in a case occurring in the practice of Dr. W. 
H, Bailey. 
Case lII.—J. S., German, carpenter by occupation, aged 57. 
In the fall of 1871, he received an injury over the epigastric 
region, which confined him to his house lor some time, but from 
which he recovered and remained well until November 11,1878, 
when he was taken with symptoms of peritonitis. Having 
suffered somewhat from indigestion, he was not thought to be 
dangerously ill, yet died suddenly on November 24, 1873. 
Post-mortem was held twenty-four hours after death. Body 
well nourished; abdomen tympanitic; greenish discoloration 
of peritoneum over epigastric and right and left hypochondriac 
regions; also in inguinal; in right and left hypochondriac re- 
gions, a large amount of greenish-yellow fluid; the folds of 
intestine adherent to each other; perforation of stomach on 
anterior surface, midway between cardiac and pyloric orifices; 
also a second smaller but imperfect ulceration near the former; 
spleen firm; both kidneys enlarged and pale, capsules partly 
adherent; effusion in right pleural cavity; no adhesions of 
pleura; bladder distended; organs otherwise normal; heart 
healthy; encephalon not examined. 
Case IY.—Mr. W. W., merchant, aged 69, presents what I 
should regard a good clinical history of gastric nicer. He had 
always been a good liver, and accustomed to the use of alcoholic GASTRIC ULCER. 
3 
and malt liquors. During the summer and fall of 1876 he com- 
plained of indigestion, and vomited a few times; but would 
generally get relief from bismuth or pepsine in powder and a 
strict meat and milk diet, the meat being given in liquid form. 
A careful examination could not detect any change about the 
liver, nor tumor in the region of the stomach. Heart and 
lungs normal. The diagnosis of gastric ulcer was made, and 
he was cautioned in every respect regarding his diet. During 
December, ’76, and January, ’77, he was very comfortable, but 
in the first week of February he overexerted himself, and I was 
called hastily to find him suffering from a severe haemorrhage 
from the stomach. He had vomited a large quantity of bloody- 
looking fluid in one bowl and in another about a pint, the latter 
clotting after standing a short time. 
Ice was given him and applied over the stomach, and ano- 
dynes employed. He was also ordered cold milk with lime- 
water. He had no more vomiting, and the next day I gave 
him a pill containing argenti nitras gr. J and quinise sulphatis 
gr. j three times daily. He was restricted regarding his stimu- 
lants to a wineglassful of claret three times a day, and diet of 
liquid animal food, and milk continued. 
The pills were continued, no anodyne required after the sec- 
ond day, and he progressed finely until April 6, when, after 
being engaged for some time in reaching upward, he was sud- 
denly seized with severe pain in the region of the epigastrium, 
followed by vomiting a large quantity of blood. The former 
treatment was repeated. He was strongly urged to be very 
careful in his exercise or work, and all stimulants of any kind 
prohibited ; same diet continued. This line of treatment was 
adhered to, and the pills continued (with the addition 
of ext. rhei gr. and podophyllin gr. g1 to relieve constipa- 
tion) for six months, when he appeared well and medication 
ceased. 
Patient was now allowed more solid food; no potatoes or 
asparagus, but nearly every other form of vegetables: also 
meat in solid form.* 
I believe here was a case of gastric ulcer, due probably to a 
too free use of stimulants and tobacco (the latter he would-not 
* He is now, July 1,1880, in excellent health. 4 
MALIGNANT ULCER OF THE STOMACH, 
leave off), and that nature was making an effort to cure by ad- 
hesions, perhaps, but was interfered with each time by too 
great exertion on the part of the patient, illustrating the im- 
portance of rest in the treatment of these cases. 
Case Y.—May 1, 1877, I wras requested by Dr. Layman, of 
Schoharie Court House, to see Mr. P., aged 62. a very fleshy man, 
who had been suffering for three days from vomiting blood. He 
had for some time given symptoms of dyspepsia. Habits good ; 
no family history of carcinoma. He was now very weak. His 
abdominal walls were so thick that, had any tumor been pres- 
ent, it could not have been detected. The doctor considered 
the case one of gastric ulcer. I, howmver, feared that it might 
be more serious, from his pale, cachectic look, pain, and con- 
stant nausea. It was difficult for him to retain liquid diet. 
He was given nitrate silver, his bowels carefully regulated, and 
he kept perfectly quiet, ultimately making a good recovery. 
I was assured a few days since by the doctor that Mr. P. wms 
in excellent health. 
The case was undoubtedly one of gastric ulcer. 
Case Yl.—The case of Mr. J., farmer, aged 54, which I 
desire to report next, presents many points of interest. The 
notes of the case are dated November 30,1878. Twelve years 
ago he was treated by his physician for what was believed to 
be an abscess in the upper part of the liver. He had coughed 
up for a long time quantities of pus. From this illness he 
made a good recovery, and remained in excellent health until 
taken on or about the Ist of December, 1877, with a dull, heavy, 
continuous pain in the epigastric region. In the following 
March he had another similar and sudden attack, but was able 
to keep up and around until about the 13th of May, when he 
was first confined to his bed. 
At this time he vomited more or less frequently for a week. 
On the 19th of May he for the first time vomited fresh blood, 
after which vomiting ceased entirely for a time. The chief 
point of tenderness or soreness seemed to be in the region of 
the pyloric orifice of the stomach. Since May 19 he has been 
unable to attend to any duties, and has gradually grown 
weaker. 
I saw him first August 22, 1878, while in an attack of vom- MALIGNANT ULCER OF THE STOMACH. 
5 
iting blood, this being the third since May. The periods of 
vomiting last from twenty-four to thirty-six hours, during 
which time the patient vomits from seven to nine times, and 
copiously, raising from one to two quarts each entire period. 
These periods of vomiting were separated by intervals averag- 
ing about two weeks. 
The vomiting leaves the patient very much exhausted, and 
there is considerable tenderness in the epigastric region after 
each attack. Solid food was discontinued late in the spring, 
upon the physician’s order, although the patient stated that 
not even solid foods nor warm and sweet foods gave him any 
particular distress or uneasiness. 
On Thursday night, August 28, 1878, he commenced vom- 
iting again, and vomited seven or eight times up to 4 o’clock 
the following Saturday morning. This was the last attack of 
vomiting previous to the time these notes were taken. It is 
worthy of note that he never vomits immediately after taking 
food; can generally retain it for two or three hours. 
On September 28, at 10 p. m., he began to vomit, and at 
10:30 a. m, of the 29th he had vomited, by careful measure- 
ment, nearly five quarts. 
In this time he had taken into his stomach only small por- 
tions of ice and not more than two pints of milk. When I 
saw him August 22 I could not detect any tumor about epi- 
gastrium, and livei’, lungs and heart were healthy. I pre- 
scribed the pill nitrate silver and quinine, with rhubarb and 
grain extract opium, and a careful diet of liquid animal food ; 
milk with one-sixth lime-water; no vegetables of any kind. 
At times he rested well, was comfortable most of the time, and 
did not suffer much acute pain, but did not gain in strength. 
He was troubled much with spitting up a serous fluid, which 
created the suspicion that the case might be one of cancer. 
The latter symptom my attention was first called to in other 
cases by Hr. Curtis several years ago. Bismuth, salicylic acid, 
pepsine, nor ingluvin would give any continuous relief. I 
would state that wTe gave him injections of beef-tea night and 
morning the last two weeks of his life, but without any im- 
provement apparently; also that each time after vomiting, he 
would pass large quantities of bloody looking fluid for several GASTRIC ULCER. 
days afterward from his bowels. Mr. J. became very much 
emaciated, and died October 1, 1878. 
Of the last fluid vomited, no portion coagulated. It had 
more the appearance of true coffee-grounds vomit. 
Post-mortem twenty-four hours after death. Within an inch 
of the pyloric orifice of the stomach, on the posterior wall, was 
found an ulcer the size of a twenty-five cent piece, the edges 
well built up, center deep and adherent to the under surface of 
the liver by old and strong adhesions ; half an inch bach from 
ulcer all the other parts of the stomach appeared healthy. 
Left lung normal; right lung crepitant, but firmly adherent at 
lower portion to outer wall of the chest and upper surface of 
diaphragm, by old and strong adhesions. Beneath the pleura 
pulmonalis and upper surface of diaphragm, in the adhesions, 
was found an old cavity, empty, having thick cyst walls, which 
would hold a teacupful. On careful examination, an old cica- 
tricial sinus was found, communicating with one of the larger 
bronchi. Liver healthy, but firmly adherent to under surface 
of diaphragm hy old adhesions. This condition explains the 
expectoration of pus twelve years ago. Heart, kidneys, and 
other organs healthy. Brain not examined. 
The specimens are here presented. The microscopic exami- 
nation made by Dr. E. Yan Slyke shows the ulcer to be 
cancer of the scirrhus form. 
Case YII.—Mr. C., aged 62, mason, gives an interesting 
history. 
At the age of 86 he suffered from severe cough, night sweats, 
and had two attacks of haemorrhage of the lungs, but within a 
year he made a good recovery, and remained well until June, 
1876, when he suffered from indigestion, and was treated for it 
and torpid liver. These symptoms did not vary much ;he lost in 
flesh, would occasionally vomit, but continued to attend to bis 
business. During the first week in October he vomited more 
constantly, with an increase of pain in the epigastric region. 
On the 10th he vomited blood, when I was called. The quan- 
tity was great, and some of it clotted. I found him quite weak, 
with marked tenderness just below the ensiform cartilage; 
bowels constipated, but other organs apparently healthy. I 
ordered a large injection, which caused a good movement of GASTRIC ULCER. 
7 
the bowels, there being in the passage considerable blood; 
some powders of morphine, and over the tender spot a small 
blister; also to take ice, milk and lime-water. Next day he 
was more comfortable, when I prescribed the pill nitrate silver, 
quinine, ext. rhubarb and podophyllin. This patient had a 
slight return of hsematemesis on the tenth day. The blisters 
were repeated three times, the pills continued for about four 
months, and castor-oil given occasionally to move bowels. At 
the end of that time he seemed well, and has continued in ex- 
cellent health. 
Case YIII.—The case of Mrs. S., widow, aged 61, would seem 
to show an hereditary tendency to gastric ulcer. Mrs. S, was 
married at the age of 18, and has had ten children. One, a mar- 
ried daughter, died at the age of 24, of acute phthisis; a son, 
aged 6, died of convulsions after measles; other children all 
living. Her mother vomited blood when about fifty years old, 
her next oldest sister vomited blood when 21 years old, and 
she herself vomited blood forty-two years ago, all making good 
recoveries, but sick for some time with what was believed to be 
dyspepsia. Her father died aged 64 years, of acute pneumonia; 
her mother died at the age of 81. Mrs. S. remained in fair health 
up to the night of January 6, 1879, when, without any previous 
warning, she felt sick at her stomach, and began to vomit 
blood. The quantity was quite large, and for some two or 
three days she remained in an insensible state. Gradually she 
improved, being under the care part of the time of Hr. Snow. 
I first saw her in this sickness May 14, 1879, when she was 
suffering from a third attack of hsematemesis. She was then 
quite weak, and looking very pale; some tenderness in the 
epigastric region, no desire for food, and bowels constipated; 
no tumor about stomach, nor any appearance of organic dis- 
ease present in the system. She was given anodynes as re- 
quired ; belladonna plaster over stomach; nitrate silver, liq. 
pernitrate iron, and quinine alternately, as medicine, and her 
bowels moved by the aid of injections and calcined magnesia 
The latter, she said, was cooling to her stomach. A strict 
milk and lime-water diet was maintained at first; later, animal 
broths were given, and all starchy food abstained from. At 
the present time Mrs. S. is again in very good health. Lately 8 
GASTRIC ULCER. 
she has taken with good effect maltine with pepsine and pan- 
creatine. As diet a baked potato is aliowed, with other well- 
cooked vegetables. She is gaining her color, and looks very 
much better. Mrs. S., previous to her sickness in January, 
was induced to take a few doses of Vinegar Bitters, and to this 
she attributes her sickness. 
Case IX.—The next case, that of Mrs. Y., aged 87, married 
when 18, though not so clear as to final result, is worthy I think of 
recording as one of gastric ulcer. There is no history of cancer in 
the family. Her father died aged 62, from injury to the kid- 
ney ; mother still living, aged 64 ; four brothers and one sister 
living, one sister died at the age of 11 of convulsions. She has 
had five children, four dying in infancy ; one daughter living, 
aged 18. States she has always had pain in her back, and 
more severe about opposite the seventh dorsal vertebra; first 
vomited blood about ten years ago, during confinement. The 
vomiting continued one day and night and was a good deal in 
quantity; child born two days after. She made a fair recov- 
ery. Two years later she suffered for three months from 
chronic dysentery and diarrhoea, and every summer since has 
had a return of it; finds it best controlled by repeated small 
doses of castor oil. Six years ago she had, during her men- 
strual period, her second attack of vomiting blood. Since then 
she has had one or two attacks every year until the past six 
months, when it has been every month. Six weeks ago it 
ceased during that menstrual period, the latter being more 
natural. I saw her soon after this. There is great tenderness 
over the stomach, but no lump can be felt; food rests like a 
heavy load, but is not vomited ; pain and throbbing pretty 
constant, the former not always relieved when vomiting blood. 
She has generally been pretty careful in her diet, but thinks it 
does little good ; can at times eat anything. She always felt 
very weak after vomiting blood. Has been treated during the 
past year for ulceration of os uteri. I ordered small blisters over 
the epigastrium, and gave her \ grain nitrate silver three times 
daily ; also to take from three to five ounces beef tea night and 
morning as an injection. Under this treatment she has steadily 
improved up to the present time, though to-day she states that 
from her fullness, and the other old symptoms about her GASTRIC ULCER. 
9 
stomach, she feared another attack. Four blisters were used, 
2x2 indies, applied every fourth day, and each time sprinkled 
with grain sulphate morphine. 
Case X.—The next case is quite a remarkable one. Miss D., 
aged 29, in easy circumstances; mother died at the age of 81 of 
what was supposed to be cancer of the stomach ; had had con- 
sumption for three years; no post-mortem; patient’s mother’s 
parents both died of consumption, as did also four sisters and 
three brothers ; father was killed, his people all living to be 
old; no malignant disease ever known on either side aside 
from mother’s case. Miss D. has lost two brothers of consump- 
tion, aged 17 and 19, and two sisters, aged 16 and 18. She 
began to menstruate in her twelfth year, and has always been 
regular since. She visited Europ'e in the fall of 1875, travel- 
ing and studying. She remained in good health until the lat- 
ter part of May, 1878, when she first observed ti’ouble about 
her stomach in regard to symptoms of indigestion and, as she 
thought, approaching dyspepsia. . She thought, also, she could 
discover some “lumps” in abdominal cavity, over the surface 
of the bowels ; great loss of appetite, she lived on fluids mostly 
for weeks, and now had her first attack of vomiting blood. At 
Hanover, in the early part of August, she consulted Dr. Baer, 
who told her she had a rupture of some blood-vessel about the 
stomach, and prescribed for her, after which she improved 
some. She had her second attack of vomiting blood, a very 
large quantity, at Goettingen in the early part of October, and 
then consulted Dr. Blake, who told her she had cancer of the 
stomach, and that she would probably not live to exceed two 
years. In this attack she had but little sickness at her stom- 
ach. She continued her travels from Florence through Ger- 
many and Switzerland, and enjoyed very good health, improv- 
ing somewhat in flesh, although very despondent. Dr. Hall 
saw her at Florence, and gave an unfavorable prognosis. She 
had her third attack of vomiting blood in Paris, the middle of 
February, 1879, when she consulted M. Pseon, who examined 
her case very carefully, and told her she had scirrhus cancer of 
the stomach. At this time she vomited over a quart, much of 
it clotting on standing. She recovered her strength quite rap- 
idly from this attack, and continued her journey through 10 
GASTRIC ULCER. 
Great Britain, being exceedingly well most of the time. In 
London she saw Dr. Radcliffe, who also told her she had can- 
cer of the stomach, and Dr. Hall, who told her she had not. 
She sailed from Liverpool May 3, and on the 10th she had her 
fourth attack of vomiting blood, over two pints, and was much 
prostrated. She was now positive she could feel “ lumps,” 
more distinct about her bowels and stomach. On her arrival 
in New York she consulted Dr. Thomas, who expressed a 
doubt as to her having cancer, and Dr. Sayre was called in 
consultation, who told her she undoubtedly had cancer of the 
stomach. She was now very much depressed in spirits, and 
after remaining for a time in New York, she returned to 
Albany, and was under the care of Dr. J. W. Cox during the 
summer. I was first called to see her November 8, 1879, when 
in her fifth attack of vomiting blood, it having lasted for a 
week. 
I made a careful examination of her case at this time, but 
could not detect any tumor anywhere about the abdomen. I 
considered the case one of gastric ulcer. She had not lost 
much in flesh, and did not present the cachexia of malignant 
disease. Her bowels being constipated, I ordered an injection 
to cause motion; menstruation normal. At this time I pre- 
scribed ingluvin, in 8 grain doses; but she could not retain it, 
nor, in fact, any other medicine. Nourishment was given in 
the form of rectal injections, of which she would not retain one 
of more than two ounces, given night and morning. She 
stated at times in vomiting she thought she could taste the 
beef-tea, a point brought out so clearly by Professor Campbell, 
of Georgia, in his excellent pamphlet on rectal alimentation. 
On December 1, 1879, Dr. S. 0. Yander Poel saw Miss D. 
with me, and after a very thorough examination of her case, 
considered it one of gastric ulcer; advised a continuance of the 
rectal feeding, and to give hypodermic injections of morphine 
to grant rest, and to stop all fluids entering the stomach by the 
mouth. After a few trials, she thought the hypodermic injec- 
tions gave her distress in bringing on the vomiting, and she 
preferred the use of the morphine applied over the epigastrium 
by aid of blisters. Under this treatment she improved, and at 
the end of two weeks fluids were allowed per orem. During the GASTRIC ULCER. 
11 
middle of February she was able to get out some, but about 
March 1 she had another attack of haematernesis. 
Up to July 2, 1880, she has been able to retain food about 
half the time. At this date she is suffering from another 
attack of vomiting blood; has not menstruated sirice last week 
in March. She is now looking very well in flesh. Medication, 
though persevered in, has not been very satisfactory, as she 
really has not been able to retain medicine of any sort formany 
days in succession. No tumor can be felt through abdominal 
walls. She has been able to walk out a great deal, but cannot 
bear carriage riding. 
Case Xl.—October 14, 1879, I was kindly requested by Dr. 
W. H. Bailey to see Mr. L., aged 58, who gave the following 
history : 
Printer by occupation. His habit for years had been to take 
about two glasses of ale daily; otherwise temperate. Uses 
tobacco. Aside from suffering from what he believed to be 
dyspepsia, he has been in good health. Nearly three years 
ago, quite suddenly he vomited a large quantity of fluid con- 
taining blood. Was told by Drs. Bailey and Curtis he had an 
ulcer of the stomach. He soon recovered under their treat- 
ment, but the dyspeptic symptoms continued. Kemained at 
his work. Had his second attack of vomiting blood four days 
since, and quite a large quantity. Now looks very pale and 
feels exhausted, but was able to walk some distance to the 
doctor’s office. Has for some time had a cough in the early 
morning, and as it continues he will spit up quite an amount 
of serum. No actual vomiting. There is well marked ten- 
derness on pressure over the epigastric region, but no tumor 
can be detected. He has had for a long time pain in his back 
and soreness in the region of the seventh dorsal vertebra. 
Has by advice of his physicians, been careful regarding his 
diet. His mother died of cancer of the uterus. No other case 
of malignant disease known among his relatives. No con- 
sumption. 
August 28, 1880, I saw Mr. L., by consent of Dr. Bailey, 
who told me he made a rapid recovery from his last attack of 
vomiting blood, and had been at his work ever since. He 12 
PERFORATING- ULCER OF THE JEJUNUM. 
now looks in excellent health. Still has the morning cough 
and, as he says, the dyspeptic symptoms. 
In the following case, occurring in the practice of the late 
Dr. Moore, we have an illustration of perforating ulcer of the 
jejunum being the immediate cause of death. 
Case Xll.—Miss 8., aged 14, had been suffering for six months 
from chronic peritonitis; died quite suddenly and unexpectedly 
June 80, 1876. Permission was granted to hold a post-mortem 
at 4 p. m. July 1, the accompanying notes being kindly taken 
at the time by Dr. J. M. Bigelow: 
Body well nourished ; no rigor mortis : ecchymotic spots on 
side of chest. On opening the abdominal cavity about a pint 
of fluid was discovered, consisting of serum, pus, and feculent 
matter. The peritoneum exhibited signs of acute general peri- 
toneal difficulty. The abdominal peritoneum was studded 
with little black ecchymotic spots, the size of a split pea, filled 
with dark, grumous blood. There were also millet-seed de- 
posits, hard and white, about the size of a pin’s head. The 
omentum on the left side was wholly adherent to the perito- 
neum and intestines. The folds of intestines were glued 
together by adhesions, and when torn apart revealed a number 
of small abscesses filled with pus. A perforation, round as if 
drilled with a punch, was discovered in the lower end of the 
jejunum. Peyer’s patches in the vicinity were enlarged, and 
had taken on ulcerative action. The coats of the intestines 
were studded with small ecchymotic spots, filled apparently 
with blood, dark and grumous, extending through the coats 
of the intestinal wall. The perforation was discovered on the 
free border of the gut. The mesenteric glands were enlarged 
and indurated. The liver was firmly attached to the abdominal 
walls by adhesions ; also to the adjacent organs. The liver 
was fatty and very friable; spleen very soft; kidneys normal. 
The uterus was covered with millet-seed deposits; otherwise 
normal. There were discovered in each broad ligament, in the 
fallopian tube, the remains of old abscesses. Each presented 
the appearance of a small tumor, the size of a butternut, en- 
cysted, filled with a cheesy, purulent deposit, probably remains 
of previous salpingitis. The transverse colon was firmly adhe- EXTRACTS FROM MURCHISON. 
13 
rent to the stomach and abdominal walls. Right lung firmly 
adherent throughout, otherwise normal; left lung slightly ad- 
herent posteriorly. Heart and brain not examined. 
Case XIII.—The case of 8., tramp, who was brought to the 
Almshouse Hospital June 4, 1878, suffering from railroad acci- 
dent received a few hours previous, is quite interesting. He died 
about seven hours after the accident occurred, and the next day I 
was requested to hold the post-mortem. We found a fracture 
of the sixth, seventh and eighth ribs on the left side, but no 
other marks of injury. On opening the abdomen, the fluid 
contents of the bowels, quite an amount, were found free in the 
abdominal cavity. A careful examination discovered a perfo- 
rating ulcer in the lower portion of the jejunum. It was typi- 
cal in character, conical, and as if a portion of the gut had been 
punched out. There was no evidence of peritoneal inflamma- 
tion present. His previous history was unknown. Beyer’s 
patches did not show any evidence of disease, nor did the soli- 
tary glands. 
When we consider these cases carefully, especially that of 
Miss D, perforating ulcer is seen to be not so easy of diagnosis 
as many of the books would have us believe. In her case, it 
is evident, the “ Doctors have disagreed very decidedly.” 
In connection with this subject, I wish to present a few notes 
taken while listening to Dr. Murchison, in London, November, 
1874, when he was lecturing on cancer of stomach and gastric 
ulcer. They seem to have a direct relation to some of the 
cases I have reported. 
“ Simple ulcer may last for years, and not cause death ; may 
not have haemorrhage or perforation for a long time. One form 
of death is from sudden perforation causing peritonitis, and 
yet not always fatal. Person may die suddenly after a hearty 
meal, and so arouse suspicions of poisoning. Simple ulcer may 
be a long time latent. Diagnosis—Sudden haemorrhage; a 
fixed pain in certain part of the back ; more common in women 14 
EXTRACTS FROM MURCHISON. 
between twenty-eight and thirty-five years of age; cancer rare 
under thirty-five. The symptoms in each case may be much 
the same. 
“In cancer you have a marked cachexia; loss of flesh rapid ; 
copious haemorrhage very rare. There is more of a constant 
oozing, and the well marked coffee-grounds vomit. Cancer 
you can often detect, tumor not always. Microscopic exami- 
nation of vomit of little true value. May have an inflamed 
mass in true simple ulcer. Examine with care umbilicus as to 
cancerous deposits there ; a frequent secondary deposit when 
stomach is diseased. Length of time and treatment aid in dis- 
tinguishing between cancer and simple ulcer. The latter gener- 
ally yields to proper treatment. Cancer does not. In simple 
ulcer you see improvement at once, when rest and diet are 
looked after. 
“ Treatment of Simple Ulcer.—No solid or animal food ; beef- 
tea and broths ought to be excluded, as they contain onty cer- 
tain albuminous food. Milk best; teacupful every two or 
three hours, or less and oftener, being very punctual as to time. 
We have reason to believe that ulcer actually heals, leaving a 
sort of puckered surface on coats of stomach. If case is very 
severe, no food administered per mouth for four, six or ten 
days. Must be very strict. Give enemata of beef-tea, to which 
you may add five or ten or more drops tincture opium if neces- 
sary ; also arrowroot in this manner. May make beef-tea—one 
pound beef and half pound pancreas of ox, made into fine pulp, 
and simmer in pint or quart of water. Is very nutritious. 
Small enemas must be given; four to five ounces, and not as 
large even. May give with each enema, every four or six 
hours, a dessertspoonful of brandy. If in this way the stomach 
becomes quiet, you may then begin with small quantities of 
milk, farinaceous food, fish, etc., creeping up gradually; to 
return to enemata, if stomach refuses to do its work. Food to 
be given cold at first, and by all means keep patient in bed. 
“As medicine, give opium and its compounds, bismuth, 
hydrocyanic acid; magnesia, if bowels must be moved, but 
don’t hurry in this. Aquae calcis with milk, one-fourth to one- 
fifth lime-water. Use blisters. Before you begin treatment in 
a case of this kind, it is sometimes well to clear the bowels by EXTRACTS FROM MURCHISON. 
15 
an injection containing castor-oil; or you may give a mild dose 
of oil, but never any other cathartic. Don’t irritate ulcer by 
giving too much medicine. Remember this. 
“After the above treatment, and the stomach begins to tole- 
rate food, you may give some mild form of iron, without any 
acid in it. If you are treating the bleeding, apply ice and give 
tannin, turpentine, and fluid extract ergot; latter, 3j doses, or 
you may inject under skin five minim doses ergotine. If peri- 
tonitis is present or threatens, then under no circumstances let 
patient out of bed ; use bed pan, urinal, etc. Allow no move- 
ment; enjoin absolute rest, and apply over abdomen ice freely. 
Now give opium freely; no food. Patient may sip of ice water 
or take small pieces of ice occasionally. Enemas now given 
only once or twice in twenty-four hours. 
“To differentiate between cancer of the stomach and gastric 
ulcer a little further: 
“ Cancer of stomach is less rare than simple ulcer. It may 
be an hereditary tendency. It is more common in men, though 
cancer is generally more apt to occur in women. May be pri- 
mary or secondary; rarely the latter, unless it spreads from 
pancreas or organ near. Common form, that ol scirrhus; rar- 
est, colloid and villous. More common near pylorous and in 
submucous tissues; will extend from pylorous upward. As 
disease advances you have ulceration of the mucous membrane, 
and then the formation of ulcers and breaking down of the 
hardened mass. Next, cancer is seen in the cardiac opening of 
stomach, but usually of the soft form and grows more rapidly; 
more of the colloid kind. Villokis cancer is found growing 
from all parts of the stomach. These deposits produce changeB 
in the size and passages of the stomach. It may so enlarge in 
disease of the pylorous as to be seen through the walls of the 
abdomen. Cancer will produce a condition of catarrh of the 
stomach. Haemorrhage may result; is constant but not free, 
unless sloughing takes place, when it is very great. In cancer 
you may get perforation, but adhesions are more apt to form 
in this disease than in simple ulcer. In cases of sloughing 
there may be absorption of pus, and then we get a condition of 
septicemia. Sometimes we have pleurisy or pneumonia as a 
result. 16 
EXTRACTS FROM MURCHISON. 
“As to the pathology of gastric ulcer, I am rather in favor 
of the following : The gastric tubules secrete acid. The blood 
in the blood-vessels of the stomach is supposed to be more 
alkaline than elsewhere, but when thrombus occurs then the 
gastric juice rapidly digests the coats of the stomach. There 
is no alkaline blood to resist it, and thereby occurs the perfo- 
rating ulcer, conical in appearance, wider in mucous coat, less 
in muscular, and still less in serous.” THE MEDICAL ANNALS: 
A Journal of the J/Ledical Society of the County of Albany. 
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The last half of each number is a serial part of Volume 111 of Transactions of the Medical Society of 
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Notes of the Albany Medical College, prepared by an officer of the Alumni organization; occasional re- 
ports from the Hospitals of Albany, Troy, and vicinity; original articles; and items of local and general 
Interest to the Profession that may arise in this center. 
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44 Medical Annals,” No. 5 High Street, Albany, N. V. 
CONTENTS OF \O. 3.-JUNE, 1880. 
Primary Deposit in the Liver of a Carci- 
nomatous Nature.—N. L. Snow, M. D 41 
Cardiac Syncope.—P. b. Collier, M. D 42 
A Case of Cardiac Syncope.—S. B. Ward, 
M. D 45 
The Turkish Bath; its Place as a Thera- 
peutic Agent.—E. A. Bartlett, M. D 49 
lodine in Intermittent Fever.—Wm. Geog- 
han, M. D 53 
Naso - Laryngeal Syphilis.— J. W. Moore, 
M. D., of Cohoes 54 
Calcareous Degeneration and Osseous 
Metamorphosis in the Eye.—Thos. Feath- 
erstonhaugh, M. D 56 
Editorial : The Metric System 58 
Necrology, 59; Removals, 60; Notes 61 
Hospital Notes.—Reported by Sheldon Voor- 
hees, M. D 61 
Iridectomy for Artificial Pupil, 61; Opera- 
tion for Senile Cataract, 62; Eczema Ru- 
bru.n, following Venous Thrombosis, 62; 
Acute Alcoholism 63 
Book Notices 63 
College and Alumni Notes 64 
Legislative Items i (Advertising page) iv 
National Guard Appointments do. v 
Transactions op the Society, 1870-’79: 
Meetings held from March 30, 1872, to 
March 12, 1873. 24 pages. 
Epidemic Cerebro-Spinal Meningitis 42 
Idiopathic Peritonitis; President’s An- 
nual Address.—Joseph Lewi, M. D. ...... 45 
Hydrorrikea.—J. V. P. Quackenbush, M. D. 48 
Intoxicants in Practice.—o. Devol, M. D.. 51 
Syphilitic Paraplegia. Lorenzo Hale, 
M. D 53 
Cancer of the Uterus.—Wm. Morgan, M. D. 53 
Adherent Pericardium. —J. V. Lansing, 
M. D : 54 
The Anatomy of Necrosis, etc. Wm. 
Hailes, Jr., M. D 55 
Pleuritic Effusions Treated by Para- 
centesis.—E. H. Davis, M. D 55 
Lipomata of the Abdomen.—Jas. S. Bailey, 60 
M. D 61 
Cerebral Apoplexy.—A. Van Derveer, M. D. 
Laryngitis.—S. H. Freeman, M. D 61 
Gangrene during Paralysis.—A. Fowler, 
M. D., and James McNaughton, M. D 63 
Autopsy of the late U. g. Bigelow, m. D.— 
J. P. Boyd, Jr., M. D 63 
Five Cases in which the h.emastatic 
Properties of Ergotine were Tested.— 
Jno. Ben. Stonehouse, M. D 64 
CONTENTS OF NO. 4.-AUGUST, 1880. 
Office-Hour Lists of Societies 
Twelve pages. 
Transactions of the Society, 1873-79: 
Meetings held from March 26 to May 28. 
1873. 21 pages. 
The Care of the Insane.—C. S. Hoyt, M. D. 66 
Aniline Poisoning.—J. s. Bailey, M. D 67 
Rupture of Oesophagus —J. S. Bailey, M. D. 67 
A Case of Pyelitis.—A. Van Derveer, M. D. 67 
Ligature of the Subclavian artery.— 
James H. Armsby, M. D 68 
Longitudinal Hypertrophy of the Cer- 
vix Uteri: Amputation. —A. Van Der- 
veer, M. D 72 
Phlegmasia Dolens.—Anthony P. Ten Eyck, 
M. D 72 
The Cervix Uteri in Conception.—J. h. 
Blatner, M. I) - 67 
Rheumatic Peritonitis.—John M. Bigelow, 
M. D 77 
Hospital Hygiene.—lsaac De Zouche, M. D. 80 
Etiology of Bright’s Disease.—e. 0. Cur- 
tis, M. D eg 
City Water-Supply from Hudson River.— 
Discussion 84 
Treatment of Fracture of the Inferior 
Maxilla, with Cases.—S. 0. VanderPoel, 
Jr., M. D 65 
Perforating Gastric Ulcer.—e. B. Tefft, 
M. D 70 
Hematemesis Due to Rupture of a Small 
Sacculated Aneurism of the Gastro-Epi- 
ploica Artery.—F. C. Curtis, M. D 72 
Gastric Ulcer, with Two Oases of Perfo- 
rating Ulcer of the Small Intestine.— 
A. Van Derveer, M. D 74 
Current Proceedings of the Medical Soci- 
ety of the County of Albany.—January 28, 
February 25, March 10 and March 24 82 
Editorial : 
Necrology 85 
Notes 87 
College and Alumni Notes. 88 
W, J3.—lt is intended another year to publish the Journal MONTHLY.