probably similar in nature has been described by Dr. Roberts of London, that of a man who died of convulsions in five hours, and presented after death a long rent in the stomach, with escape of its contents into the general cavity of the belly.[1]
Another rare variety of rupture of the stomach must also be particularly noticed, because the course of the symptoms imitates very closely a case of poisoning with the irritants. It is partial rupture,—or laceration of the inner coat only. A very interesting case of that description has been related by Mr. Chevalier. A youth of fourteen, on the evening after a Christmas feast, at which he ate and drank heartily, was attacked with violent and frequent vomiting. Next morning he said he felt as if the blood in his heart was boiling, he was unable to swallow, the pulse became irregular, and pressure on the heart or stomach gave him excruciating agony. These symptoms continued till the following day, when he vomited two pounds of blood at successive intervals, and soon afterwards expired. The inner coat of the stomach was torn in many places, and that of the duodenum was lacerated almost completely round. No other disease existed in the bowels or elsewhere.[2]
Some of the cases now mentioned could hardly be distinguished from the effects of certain irritant poisons by the symptoms only. But the morbid appearances in the stomach will at once determine their real nature.
Rupture of the stomach, it may be observed, does not always occasion the symptoms hitherto related. Sometimes it causes instant death. Thus a healthy coal-heaver in London, while attempting to raise a heavy weight, suddenly cried out, clapped his hand over his stomach, drew two deep sighs, and died on the spot. On dissection a lacerated hole was found in the stomach, big enough to admit the thumb; and the stomach did not contain any food.[3] This case, along with those of Dr. Roberts and Mr. Weekes, will show that rupture may take place without previous distension.
3. Rupture of the Duodenum is a very rare accident from internal causes. The following instance resembles considerably the symptoms of irritant poisoning. A gentleman, 48 years old, quarrelled violently with another while playing billiards immediately after dinner. Soon afterwards he was seized suddenly with violent pain in the stomach, vomiting, cold extremities, and a failing pulse; and he died very soon. The mucous coat of the duodenum was found much inflamed, and four inches and a half from the pylorus there was a lacerated hole involving a third of the circumference of the gut.[4]
4. Under the next head may be classed rupture of the other organs of the belly. Rupture of the Biliary Ducts for example, an extremely rare accident, has been known to imitate the symptoms of irritant poisoning, as the following case will show.—An elderly lady, after a slight attack of jaundice, was seized with violent pain in the stomach,
