instance of the same kind, where the perforation of the gut succeeded strangulated hernia, and was followed by the discharge of two lumbrici and ultimate recovery, is detailed in the Revue Médicale.[1]
Symptoms like those of narcotico-acrid poisoning may be caused by worms without perforation. A girl, eight years old and in excellent health, was suddenly seized with violent colic pains, vomiting, bloody stools, tenderness and swelling of the belly, followed by convulsions and coma, and proving fatal in seven hours. No other explanation of the case could be discovered on dissection except the presence of several hundred ascarides in the intestines and thirteen in the stomach.[2]
14. The next diseases to be mentioned are melæna and hæmatemesis, or purging and vomiting of pure or of altered blood.
It is hardly possible to mistake them for poisoning, as the pain which accompanies them is seldom acute, and the discharge of blood generally profuse.
15. The last are colic, iliac passion, and obstructed intestine. As the symptoms of some poisons are the same with those of colic, it is of course sometimes impossible to distinguish the natural disease from the effects of poison by attending to the abdominal symptoms only. But the distinction in severe cases of poisoning may almost always be drawn from collateral symptoms and extraneous circumstances.—The iliac passion is distinguished by a complete reversion of the vermicular motion of the intestines in consequence of which the fæces are often discharged by vomiting. I am not aware that stercoraceous vomiting is ever caused by poisoning.—A case has been recorded in Corvisart's journal, in which iliac passion, originating in obstruction of the ileum by hardened fæces, and proving fatal in twenty-six hours, gave rise to a judicial inquiry into the possibility of poisoning.[3] Another instance, that led to a strong suspicion of poisoning, has been lately published by M. Rostan, in which there was continued vomiting and pain of abdomen, proving fatal in two days, and arising from the small intestines being obstructed by an adventitious band.[4] In this case the first inspectors failed to observe the true cause of the symptoms; but Rostan and Orfila, who were appointed to examine the body a second time, discovered the constriction, and were unable to find any poison in the stomach by analysis. Stercoraceous vomiting occurred during life; which might have been held sufficient to settle the real nature of the case.—Obstruction of the intestines arising from twisting of the gut, intussusception, foreign bodies, or strangulated hernia, is easily known by the seat where the pain begins, by the obstinate constipation, and also by the excessive enlargement of the belly,—which last, however, is rather an equivocal symptom.
The preceding observations will enable the medical jurist to de-*
