Medical jurisprudence / by Alfred S. Taylor ; edited with notes and additions by R. Egglesfield Griffith.

  • Taylor, Alfred Swaine, 1806-1880.
Date:
1845
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Licence: Public Domain Mark

Credit: Medical jurisprudence / by Alfred S. Taylor ; edited with notes and additions by R. Egglesfield Griffith. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    Perforation from disease.—This is by no means an unusual occurrence. Many cases of this description, will be found reported elsewhere. (Guy s Hosp. Rep. No. 8.) It is invariably fatal when it proceeds so far as that the contents of the stomach escape into the abdomen; but sometimes the stomach becomes glued to the pancreas during the ulcerative process, and then the individual may reeover. Several specimens of this kind of adhesion have been met with in post- mortem inspections. The symptoms from perforation commonly attack the indivi- dual suddenly, apparently while enjoying perfect health. Thus then these cases may be easily mistaken for those of irritant poisoning. The principal facts ob- served with regard to this formidable disease, are the following:— 1. It often attacks young females from eighteen to twenty-three years of age. 2. The preceding illness is extremely slight, sometimes there is only loss of appetite with uneasiness after eating. 3. The attack commences with a sudden and most severe pain in the abdo- men, generally soon after a meal. In irritant poisoning, the pain usually comes on gradually, and slowly increases in severity. 4. Vomiting, if it exist at all, is commonly slight, and is chiefly confined to what is swallowed. There is no purging:—the bowels are generally constipated. In irritant poisoning, the vomiting is usually severe, and diarrhoea seldom want- ing. 5. The person dies commonly in from eighteen to thirty-six hours:—this is also the average period of death in the most common form of irritant poisoning, i. e. by arsenic;—but in no case yet recorded, has arsenic produced perforation of the stomach, within twenty-four hours; and it appears probable that a considerable time must elapse before such an effect would be produced by this or any irritant. 6. In perforation from disease, the symptoms and death are clearly referable to peritonitis. 7. In the perforation from disease, the aperture is commonly of an oval or rounded form, about half an inch in diameter, situated in or near the lesser curva- ture of the stomach, and the edges are smooth. The margin of the aperture is often blackened, and the aperture itself is funnel-shaped from within outwards, i. e. the mucous coat is the most removed, and the outer or peritoneal coat the least. The coats of the stomach, round the edge of the aperture, are usually thickened for some distance; and when cut, they have almost a cartilaginous hard- ness. These characters of the aperture, will not indicate, whether it. be the result of poisoning or disease; although the absence of poison from the stomach, with the want of other characteristic marks of irritant poisoning, would enable us to say, that disease was the cause. Besides, the history of the case during life, would materially assist us in our diagnosis. The great risk in all these cases, is that the effects of disease may be mistaken for those of poisoning; for we are not likely to mistake a perforation caused by irritant poison for the result of disease. Among numerous cases, tending to show the medico-legal importance of this subject, I shall select one, which lately came before Mr. Hilton and myself for examination. A female in a noble family, aged twenty-three, died somewhat suddenly under suspi- cious circumstances. She had beep unwell for about three weeks, and was subject to occasional vomiting and disturbance of the stomach. Still, her illness was so slight that it did not in the least interfere with the performance of her usual duties. One afternoon, about four o'clock, and about three hours after her last meal, she was suddenly seized with the most excruciating pain in the abdomen, and violent vomiting. Her skin was cold and clammy, and the abdomen tender and painful. It was suspected that she had taken poison; and magnesia and sulphate of magnesia were given to her. No poison was found in the room, and she strongly denied the imputation. The symptoms became worse, the vomiting more violent, and she died the following morning about fifteen hours after her first seizure. On inspection, all the organs were found healthy, except those