after; and on dissection two holes were found in the back part of the stomach, surrounded with much softening of the villous coat.[1] Another case will be mentioned in page 118.—The appearances produced by this disease have been mistaken for the effects of corrosive poisons.
12. The gullet may be perforated in a similar manner either with or without symptoms. Under the head of the morbid appearances [119] two instances will be mentioned in which there were no corresponding symptoms. In the following case symptoms did pre-exist. A man, six weeks after being bit by a dog, which was killed without its state of health having been ascertained, was attacked with a sense of strangling, impossibility of swallowing, delirium, excessive irritability, glairy vomiting; and he died within twenty-four hours. The gullet, a little above the diaphragm, was perforated by a hole two-thirds of an inch in diameter, with thin edges; and effusion had taken place into the posterior mediastinum.[2]
13. Perforation of the alimentary canal by worms may here also be noticed shortly as a disease liable in careless hands to be confounded with irritant poisoning. This is far from being a common accident, and very rarely takes place during life. In most of the cases in which it has been witnessed the symptoms antecedent to death were those not of irritant, but of narcotic poisoning, and were then owing simply to the great accumulation of worms in the alimentary canal. On this subject the reader is referred to the article Epilepsy in the introductory remarks on the effects of the narcotic class of poisons. But at times the symptoms have been like those of irritant poisoning. Thus the following is a case of perforation by worms during life giving rise to all the phenomena and symptoms of peritonæal inflammation. A soldier at Mauritius was seized with slight general fever and severe pain, at first in the pit of the stomach, and afterwards over the whole belly, which on the third day began to enlarge. A tendency to suppression of urine and costiveness ensued, then bilious vomiting; and he died on the fourth day, the belly having continued to increase to the end. On dissection, several quarts of muddy fluid were found in the sac of the peritonæum, the viscera were agglutinated by lymph, a round worm was discovered among the intestines between the navel and pubes, and the ileum was perforated six inches from the colon by a hole corresponding in size with the worm.[3]—A singular case, not however fatal, but which confirms the fact, that worms may make their way through the intestines and other textures during life, is mentioned in Rust's journal. A woman after a tedious illness first vomited several lumbrici, and was then seized with a painful swelling in the left side, which in the process of time suppurated, and discharged along with the purulent matter three other worms of the same species.[4] Another
