'To sum up, before June 29, there were gastric pains caused by ulceration; on the 29th, bursting of the ulcer and acute peritonitis.' Peritonitis is distinctly indicated by the reports. Such are the conclusions of Littré: Dr. Paul Le Gendre, a most competent authority, unhesitatingly confirms them, as also does Professor Brouardel, who writes as follows: 'Admitting ulceration of the stomach, all the phenomena supervene with classic exactitude.' If we refer to the works of the celebrated Cruveilhier, who was the first to describe simple ulcers, we find by an interesting coincidence, in the very case he presents as a type, the closest correspondence with the illness of Madame, and a fresh proof of the soundness of Littré's opinion. 'Now since the complications following perforation of the stomach and rapidly causing death,' writes Cruveilhier, 'supervene suddenly, and sometimes directly after taking food or drink, the question of poison has been raised pretty often. I have never seen a more remarkable case in this respect than that of a coalman, aged twenty-three, and of an athletic vigour, who, carrying a sack of coal, stopped at an inn and drank a glass of wine. He went on his way; but a few minutes afterwards was seized with horrible pains, was attended first at his own house, then carried dying to the hospital of the Faubourg Saint-Denis; his case showed every indication of peritonitis through perforation, and he died three hours after his admission to the hospital, in full consciousness. I was able to get from his own lips the valuable information that he had been suffering from his stomach for several months, and that digesting his food was always painful. The Coal-dealers' Society, convinced that their comrade was the victim of poison, and that the agent of the poisoning was the glass of wine taken immediately before he was attacked by these symptoms, decided to bring an indictment against the wine-merchant, and with this end required the autopsy to be made in presence of a deputation from their body. It was a case of spontaneous perforation through a simple ulcer in the stomach.' The 'estimate' of Littré (to use the phrase he himself uses to describe his work) is thus confirmed in every way. Loiseleur thought fit to object the rarity of the case. That is no argument: the case may be rare and yet have been that of Madame. And besides, Loiseleur makes too much of its rarity. Brinton estimates that perforation of the stomach in cases of simple ulcer occurs in thirteen per cent., and that it is most common in women under thirty. Madame was twenty-six.