cold water; bilious vomiting and common cholera; malignant cholera; inflammation of the stomach; inflammation and perforation of the intestines; inflammation of the peritonæum; spontaneous perforation of the stomach; melæna and hæmatemesis: colic, iliac passion and obstructed intestine.
1. Distension of the Stomach.—Mere distension of the stomach from excessive gluttony may cause sudden death. Generally indeed the symptoms and appearances in the dead body show that death is the consequence of apoplexy; but sometimes not. In order to preserve the continuity of the succeeding remarks on the diseases of the stomach which imitate poisoning, it may be useful to consider in the present place all the varieties of the effects of distension.
Excessive distension of the stomach, then, sometimes causes sudden death by inducing apoplexy, which is commonly of the congestive kind,—that is, without rupture of vessels. Mérat has related an instructive case of this kind. A man in good health, while greedily devouring an excellent dinner, became suddenly blue and bloated in the face; a clammy sweat broke out over his body; and he died almost immediately. On dissection the stomach was found enormously distended with food, and the vessels of the brain were so gorged, that the brain appeared too large to be contained within the skull.[1]
There is reason, however, to suppose that death from distension is the consequence not always of apoplexy,—but sometimes of an impression on the stomach itself. Sir Everard Home relates the case of a child, who, being left by its nurse beside an apple-pie, was found dead a few minutes afterwards, and in whose body no appearance of note could be discovered, except enormous distension of the stomach with the pie.—A still more distinct case in point forms the subject of a medico-legal report by Wildberg. A corpulent gentleman died suddenly fifteen minutes after dinner; and as he lived on bad terms with his wife, a suspicion arose that he had been poisoned. His wife said that he fell asleep immediately after dinner; but had not slept many seconds, when he suddenly awoke in great anguish, called out for fresh air, exclaimed he was dying, and actually expired before his physician, who was instantly sent for, could arrive. Wildberg found the stomach so enormously distended with ham, pickles, and cabbage-soup, that, when the belly was laid open, nothing could be seen at first but the stomach and colon. Some white powder, found on the villous coat of the stomach, was at first suspected to be arsenic; but it proved on analysis to be merely magnesia, which the gentleman had been in the habit of taking frequently. The diaphragm was pushed high into the chest by the distended stomach. There was not any particular congestion in the brain. Wildberg very properly ascribed death to simple over-distension of the stomach.[2]—In all such cases the symptoms may be suspicious; but when carefully considered they can scarce be said to re-*
