Treatise on Poisons: In relation to medical jurisprudence, physiology, and the practice of physicChristison, Robert, Sir
Science
Treatise on Poisons: In relation to medical jurisprudence, physiology, and the practice of physic
Christison, Robert, Sir
Medical jurisprudence; Toxicology
The second variety of perforation takes place by simple ulceration
without previous scirrhus. In one of Dr. Crampton’s papers will be found
some remarks by Mr. Travers, along with a case of this kind. The subject
of it was a man of a strumous habit, who enjoyed good health, till one
day at dinner he was suddenly attacked with acute pain in the pit of the
stomach, and died in thirteen hours. The stomach was found perforated in
the centre of a superficial ulcer of the mucous coat, occupying
two-thirds of the ring of the pylorus.[179] This case shows that the
present variety of perforation may take place without the preliminary
organic disease being indicated by any symptom. The circumstances under
which it commenced are peculiarly important in relation to the medical
jurisprudence of poisoning. Another case which has been lately described
with great exactness by M. Duparcque, was preceded only by very trivial
dyspeptic symptoms. Here the whole mischief arose from a small ulcer
eight lines long and five in breadth on the inside of the stomach, and
not more than a line and a half in diameter at the perforation through
the peritonæum.[180] Several excellent examples of the same disease have
been related by Dr. Abercrombie.[181] In one of these the ulcer in the
centre of which the perforation had been formed, was not bigger than a
shilling, and the rest of the stomach quite healthy. A very instructive
case of a similar nature, but of unusual duration, has been related by
Mr. Alfred Taylor. A young woman, after suffering for some time from
nausea and constant craving for food, but inability to indulge it, and
occasionally from pain in the stomach, was attacked suddenly with the
usual symptoms of perforation, and died forty-two hours afterwards. The
villous coat of the stomach, though generally healthy, presented at the
lesser curvature several small elevated points, and in the middle of two
of these a sharply-defined ulcer, one affecting the mucous coat only,
while the other, which was half an inch in diameter where it affected
the mucous coat, perforated the muscular and peritonæal coats by a hole
no bigger than a crow-quill.[182] A case still more remarkable has been
also related by the same author, where the circumstances naturally gave
rise to a strong suspicion of poisoning. A young female in a noble
family, subject to slight dyspepsia, was suddenly attacked, three hours
after a meal, with violent vomiting and pain in the belly. Collapse soon
ensued, and in fifteen hours she died, under so strong suspicions of
poisoning that various antidotes were administered. This suspicion was
in some measure borne out by proofs of an intrigue having been carried
on between her and a male person in the house, and by the discovery
after death of the signs of recent sexual intercourse. On examining the
cavity of the abdomen, however, there was found, at the upper and back
part of the stomach near the pylorus, an oval perforation, half an inch
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