of the mucous membrane of the alimentary canal, which appears to affect almost every part of it from the throat downwards, and begins commonly in the throat. I once met with a remarkable case in which it appeared in the form of little white ulcers in the back of the throat, and gradually travelled downwards to the stomach and from that to the intestines,—being characterized by burning pain in every one of its seats, and successively by difficulty of swallowing, by sickness, vomiting, and tenderness of the stomach, and finally by purging. Such cases resemble the slow forms of poisoning with arsenic. But they differ in attacking the several divisions of the alimentary canal in turn, while in the examples of poisoning with arsenic now alluded to, the whole canal from the mouth to the anus is affected simultaneously. Dr. Abercrombie has described a similar disorder, which he appears to have occasionally seen affecting both the stomach and intestines at the same time; but he seems to doubt whether it ever occurs as an idiopathic disease, or independently of some co-existing or preceding fever or local inflammation.[1]
10. Inflammation of the Peritonæum, or lining membrane of the belly, will not require many remarks. When acute, it is rarely attended in its early stage by vomiting; rarely also by irregular action of the intestines, and never by diarrhœa; and it is at once distinguished in the dead body by unequivocal marks of peritonæal inflammation, which are very seldom caused by irritant poisons.[2]
11. The subject of Spontaneous Perforation of the Stomach is an important topic for the medical jurist, because both the symptoms before death and the appearances in the dead body are occasionally very like the effects of some of the most active irritant poisons. The following is a statement of the most material facts hitherto ascertained on this subject; but it must be premised that a good deal of obscurity still hangs over some parts of it.
Spontaneous perforation of the stomach is of three kinds. One is the last stage of some varieties of scirrhus. The indurated membrane ulcerates, the ulcer penetrates first the villous, then the muscular, and at last the outer or peritoneal coat, so that the contents of the stomach escape into the belly. The symptoms of the perforation are a sense of something giving way in the pit of the stomach, acute pain gradually extending over the whole abdomen, great tenderness and tension, excessive prostration, and death commonly within twenty-four hours. The symptoms which precede the perforation in general clearly indicate organic derangement of the stomach, namely, aggravated dyspepsia of long standing. Several cases of this description may be seen in a thesis by M. Laisné,[3] a pupil of Professor Chaussier. Two characteristic cases have been published by Dr.
- ↑ Abercrombie on Diseases of the Stomach, &c., p. 52.
- ↑ For cases of this disease, see Abercrombie on Diseases of the Stomach, &c. p. 156 and 181.
- ↑ Considérations Medico-légales sur les perforations spontanées de l'estomac, 1819. This thesis, published with three others on medico-legal subjects, is understood to have been in a great measure the work of the late Professor Chaussier.
