Treatise on Poisons by Sir Robert Christison

imitates in its symptoms the effects of the irritant poisons. It is generally the consequence of over-distension, combined with efforts to vomit. The cause of it seems to be, that the abrupt turn which the gullet makes in entering an excessively distended stomach acts as a valve, so that the contents cannot be discharged by vomiting. A case of this kind is related by M. Lallemand in his Inaugural Dissertation at Paris in 1818.[143] A woman convalescent from a tedious attack of dyspepsia, being desirous to make amends for her long privations as to diet, ate one day to satiety. Ere long she was seized with a sense of weight in the stomach, nausea, and fruitless efforts to vomit. Then she all at once uttered a piercing shriek, and exclaimed that she felt her stomach tearing open; afterwards she ceased to make efforts to vomit, soon became insensible, and in the course of the night she expired. In the fore part of the stomach there was a laceration five inches long; and a great deal of half-digested food had escaped into the cavity of the abdomen. The coats of the body of the stomach were healthy; but the pylorus or opening into the intestines was indurated; which had been the cause of her dyspepsia. In other cases of death from rupture the laceration is caused not by the accumulation of food, but by the accumulation of gases arising from depraved digestion, constituting a disease almost the same as that which attacks cattle that have fed on wet clover. A singular example of this rare affection, in which death was preceded by the symptoms of irritant poisoning, has been noticed by Professor Barzelotii.[144]—Another case, which appears to have been of the same kind, is mentioned in a late French journal. A child, a twelvemonth old, after eating cabbage-soup, died during the night unperceived by its mother. On the body being examined, a great quantity of fetid gas escaped from the abdomen, and a smooth laceration like an incised wound, three inches in length, was found in the lesser arch of the stomach.[145] In other cases, however, it is not easy to say what occasions the injury. An instance, for example, has been related, where the accident followed the drinking of a little shrub and water. The individual, a man of middle age, who had been long liable to fits of severe pain in the stomach, going off with vomiting, was suddenly seized the day after one of his fits with violent pain in the epigastrium, extreme tenderness and tension of the muscles, and for a short time with violent vomiting. In seventeen hours he expired. On dissection a dark-brown fluid was found in the cavity of the belly, and the fore part of the stomach presented a laceration four inches long. There were likewise several lacerations, one of them three inches long, which intersected the peritonæal coat alone.[146] A case 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.[147] 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. Chevallier. 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.[148] 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.[149] This case, along with those of Dr. Roberts and Mr. Weekes, will show that rupture may take place without previous distension.