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.
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.
In Britain the most common form of death from this cause appears to have been instant death, arising from the impression on the stomach. It is not an uncommon thing for people to drop down instantaneously and die on the spot, in consequence of drinking freely of cold water or other fluids while over-heated.[[152]] There is an interesting report on a case of this kind by Pyl in his Memoirs and Observations. The individual had been quarrelling with a companion, and in the height of a fit of violent passion swallowed a glass of beer; when he dropped down senseless and motionless, and died immediately. His wife suspecting the administration of poison, demanded a judicial inquiry; but nothing was found in the body to account for death. Pyl therefore came to the conclusion that the man died from the sudden impression caused by the cold beer.[[153]] Dr. Currie, after quoting several instances of the like kind, relates the following remarkable case which occurred to himself. A young man, having just sat down, panting and bathed in sweat, after a severe match at tennis, drank greedily from a pitcher of water fresh drawn from a neighbouring pump. Suddenly he laid his hand on his stomach, bent forward, became pale, breathed laboriously, and in a few minutes expired.[[154]]
But when combined with exposure to a burning sun, as in hot climates, drinking cold water when the body is over-heated seems often to excite along with irritation in the stomach congestive apoplexy. Dr. Watts has given a good account of these effects as they occurred in the neighbourhood of New York during the hot season of 1818. During the summer of that year the thermometer often stood in the shade so high as 92°; and the labourers in consequence could not be restrained from drinking frequently and excessively of cold water. Many were attacked with pain in the stomach, sickness, giddiness, and fainting; next with difficult breathing, and rattling in the throat; then with apoplexy; and not a few perished.[[155]] These symptoms are very like the effects of some narcotico-acrid poisons.
Lastly, drinking cold water sometimes causes symptoms more nearly allied to those of the pure irritants. Thus some persons, on eating ices, or drinking iced-water, or cold ginger-beer in the hot days of summer, are attacked with violent colic. Others in the like circumstances are attacked with violent fits of vomiting.[[156]] Haller has even mentioned an instance of a man, who after swallowing a large draught of cold water while over-heated, was seized with symptoms of acute gastritis, and died in fifteen days: and in the dead body the stomach was found gangrenous and ulcerated at its fundus.[[157]] M. Guérard relates a similar case, that of a quarter-master who, swallowing iced-beer after a hurried journey in a hot day, was attacked in six hours with shivering, then with heat and tightness in the pit of the stomach, vomiting of every thing he took, anxiety, thirst and frequency of the pulse; next with extreme prostration, cessation of pain, hiccup, and lividity of the face; and he expired in five days. Signs of inflammation were found in the stomach, such as great redness internally, with spots of extravasation, and a blackish matter like what he vomited.[[158]] Cholera has also been sometimes referred to the same cause. In the hot summer of 1825 it was remarked that a great number of persons who used to frequent a particular coffee-house in the Palais-Royal at Paris, and the owner among the rest, were severely affected with cholera. Poison being suspected to be the cause, a judicial inquiry was instituted. It was proved, however, that similar accidents had been observed at other coffee-houses, in other cities, and likewise in former hot seasons; and when the whole medical evidence was referred to a commission of physicians and chemists, they gave their opinion, that the disease was owing to the incautious use of ices and iced-water in an unusually hot summer.[[159]] Perhaps cholera arising thus may prove fatal. The following extraordinary case, which appears to have been of this nature, was communicated to me by the late Dr. Duncan, junior. A bookbinder in this city, previously in excellent health, rose one morning at six to kindle his fire, and took a large draught of cold water from a pitcher used in common by the whole family. He went immediately to bed again, complaining of pain in the pit of the stomach, and extreme anxiety, and affected with incessant vomiting. In twelve hours he died without any material change in the symptoms, and no disease whatever could be detected in the dead body. Dr. Duncan satisfied himself from general circumstances, that poisoning was quite out of the question; so that, however extraordinary it may appear, his death could be accounted for in no other way than by ascribing it to the cold water.—Hoffmann says he was acquainted with instances where fatal inflammatory fever was induced by drinking too freely of cold water, and a suspicion of poisoning in consequence excited.[[160]]
6. Of Bilious Vomiting and Simple Cholera.—Of all the diseases which are apt to be confounded with the effects of the irritant poisons, there is none which it is of so much importance that the medical jurist should be able to distinguish as cholera. A trial for poisoning with the common poisons hardly ever occurs, but an attempt is made to ascribe death to that disease; for it is very frequent, and its symptoms bear a close resemblance to those of the principal poisons of the class we are now considering.
It is unnecessary to give here a detailed account of the symptoms of simple cholera. There is the same burning pain in the stomach and bowels as in irritant poisoning, the same incessant vomiting and frequent purging, the same tension and tenderness of the belly, the same sense of acridity in the throat, and irritation in the anus, the same depression and anxiety, the same state of the pulse.