3. _Rupture of the Duodenum_ is a very rare accident from internal causes. The following instance resembles considerably the symptoms of irritant poisoning. A gentleman, 48 years old, quarrelled violently with another while playing billiards immediately after dinner. Soon afterwards he was seized suddenly with violent pain in the stomach, vomiting, cold extremities, and a failing pulse; and he died very soon. The mucous coat of the duodenum was found much inflamed, and four inches and a half from the pylorus there was a lacerated hole involving a third of the circumference of the gut.[150] 4. Under the next head may be classed rupture of the other organs of the belly. _Rupture of the Biliary Ducts_ for example, an extremely rare accident, has been known to imitate the symptoms of irritant poisoning, as the following case will show.—An elderly lady, after a slight attack of jaundice, was seized with violent pain in the stomach, and vomiting recurring in frequent fits, and in seventeen hours with extreme tenderness, tension of the muscles, coldness of the skin, and failure of the pulse. She expired in twenty-four hours; and after death the hepatic duct was found torn across, a gall-stone lay at the opening of the cystic duct, the peritonæum was here and there inflamed, and three pounds of blood and bile were effused into the cavity of the abdomen.[151]—The nature of such cases will be always apparent on dissection, but by no means always from the symptoms. In like manner _rupture of the uterus or its appendages_ may in certain circumstances occasion similar symptoms, and so be mistaken for the operation of poison. A striking example of the kind once came under my notice. A middle-aged woman much addicted to drinking, and on that account living on indifferent terms with her husband, was suddenly seized at two in the afternoon with pain in the belly, afterwards with vomiting and purging, then with extreme exhaustion and coldness of the extremities; and at ten in the evening she expired. A suspicion of poisoning having arisen in the neighbourhood, a judicial inspection was ordered by the sheriff of Linlithgowshire, where the case happened; and the examination was entrusted to her medical attendant, Mr. Robertson, and myself. On inquiry, it was found that she had taken nothing whatever after breakfasting at eight in the morning, six hours before; and farther, that the pain had begun violently in the lower part of the belly. These two circumstances alone were almost, if not altogether, incompatible with the idea of irritant poisoning having been the occasion of death. But all doubt was completely removed by the inspection of the body; for the lower part of the belly was filled with a great quantity of clotted blood, which had proceeded from the rupture of a Fallopian conception. 5. The next accident which may be noticed on account of its being liable to be mistaken for the effects of poison is _sudden death from drinking cold water_.