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.