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on suddenly, is intensely severe, and may be felt in any part of the abdomen; while that from arsenic is one of a burning character, comes on gradually, increases slowly, and is confined to the region of the stomach.
4. "In perforation, vomiting, if it exists, is commonly slight; and it is chiefly confined to what is swallowed. There is no purging; the bowels are generally constipated. In arsenical poisoning, the vomiting is usually severe, and diarrhea is seldom wanting."
5. In the former death takes place in from eighteen to thirtysix hours, and very often within twenty-four; whereas in the only case given by the author in which perforation was produced by arsenic, the individual lived four days; and of the great number of reported cases in which death resulted from arsenic in twenty-four hours, perforation was not found in
Indeed it can hardly be supposed that arsenic could effect perforation in so short a space, as it has to accomplish it through the medium of inflammation and ulceration.
6. “In perforation, peritonitis is the sole cause of death. In arsenical poisoning, the fatal result takes place under the peculiar symptoms produced by the poison.”
7. In the former, the marks of severe peritoneal inflammation will be found; while in perforation from arsenic, these may also exist, but not necessarily, for the individual may die so soon after perforation has taken place, (from the other effects of the poison) that there has not been sufficient time for the peritoneal inflammation to set up. Even though this should be found, there will also be the effects of the poison upon the mucous coat.
8. In perforation from disease, there is not necessarily any inflammation of the mucous membrane of the stomach and small bowels, although it may sometimes be present; while in that from arsenic, the inflammation of the stomach and duo. denum, is, generally, considerable, and not unfrequently is also found in the fauces, oesophagus, and rectum.
9. In perforation from disease, no poison will be found, while in that from arsenic, we may expect to find it, either in the matters vomited, in the contents of the stomach, or in the substance of the viscera.
And lastly, if several persons have partaken of the same food, and but one of them is taken ill shortly after, it is strong presumptive evidence against the supposition of poisoning; while, if they are all taken suddenly ill, the reverse obtains.
In regard to perforation by solution; if any thing be known of the symptoms under which the patient labored, there will be but little difficulty in making out the diagnosis, for if the perforation be cadaveric, the disease by which death has been produced will have been characterized by its symptoms, whereas if it have been produced by poisoning, its very evident symptoms will have been present. In case however that none of these facts be attainable, there will be some danger of confounding it with perforation by the “corrosive poisons." The aperture itself simulates, in no inconsiderable degree, that produced by sulphuric acid, for instance; while the contiguous viscera have the appearance of having been acted on by some corrosive substance. But still a diagnosis may be made out with some certainty; by inspecting the condition of the fauces, esophagus—and by applying chemical tests to the contents of the stomach, and cavity of the peritoneum, together with the coats of the stomach. And if the mucous membrane of the stomach and bowels, together with the peritoneum, evince marks of inflammation, it will greatly heighten the probability of poisoning, provided other circumstances concur to the same point.
The last ten pages of his paper Mr. Taylor devotes to the consideration of the following medico-legal propositions:
“1.-A person may have died from perforation of the stomach through disease and not from poison.
“2. A person laboring under the disease, may be the subject of poison.
“3.-A person laboring under the disease, may have received blows or injuries on the abdomen, in which case it may be necessary to state, whether the perforation did or did not result from the violence used.
“4.-A perforation of the stomach from post-mortem changes may be mistaken for perforation from poison."
In connection with the first, he gives a very interesting case, in which the circumstances of a moral nature—the symptoms under which the patient labored-and some of the post-mortem appearances, were very strongly in favor of the supposition of poisoning, but upon applying the diagnostic tests, already detailed, for perforation by ulceration, the case was made out so clearly that it was not even deemed necessary to have a coroner's inquest over the body.
Two questions very naturally grow out of the second proposition.—“1. Whether the perforation, or the diseased state of the stomach leading to it, was due to poison. 2. Whether the disease or poison was the cause of death.”—“The first question will be answered by considering the nature of the substance. Thus, knowing that the corrosives and irritants alone are liable to cause perforation of the stomach, the discovery of a narcotic poison will shew that the disease and the substance taken, could not have had any connection with each other. So again among the irritants, there are some, perhaps the greater number, not likely to be followed by perforation of the stomach.”—The second may be determined, by ascertaining the symptoms under which the patient labored; whether those of ulceration, or of poisoning and by the appearances found upon dissection. See the characteristics of perforation by ulceration, and those by poisoning, already detailed.
With respect to the third proposition, any case of the kind may be determined, with some degree of certainty, by considering the nature of the violence inflicted, and the character of the perforation. Thus, if it proceed from the disease alone, a perforation peculiar to ulceration will be found; whereas, if from the violence, some laceration might be expected.
The fourth proposition presents a case which may possibly happen by the concurrence of extraordinary circumstances; but must necessarily be very rare. A case however may occur, in which the person may labor under the symptoms of irritant poisoning, and perforation be caused after death by the gastric secretion. In such a case, it will be necessary to take into consideration the general circumstances—to ascertain minutely the character of the symptoms—and attend to the post-mortem appearances, as already directed in such
We have thus given an abstract of this paper of Mr. Taylor's, and trust that we will not be considered to have devoted more space to it, than was due to its merits.
3. On the diurnal variations of the Pulse. By William Au
gustus Guy, M. B. foc. In former numbers of these reports, Dr. Guy gave the results of his experiments on the effect produced by change of posture on the pulse of healthy males—and on the effect produced by the same cause, as modified by age and sex. The object of his paper now before us, besides that set forth by its title is to show the susceptibility of the pulse to effects by different agents, at different periods of the day.
The experiments are reported fully, and with minuteness; but as it is only desirable to show the general effects, it will suffice to notice the mean results.
Twenty observations made on himself, upon rising in the morning, and the same number, upon going to bed, gave as an average, sixty-four beats in the morning, and fifty-four at night. There was however between the highest number in the morning and the lowest at night, a difference of eighteen beats. “This remarkable diminution towards night” he observes, “ took place in spite of the various excitements produced by food, study, or exercise, during a space of fifteen or sixteen hours.!!
His next series of observations was designed to show the state of the pulse throughout the entire day, in which it was counted every quarter of an hour, from nine and a half in the morning to twelve and a quarter at night: during which time he was engaged in a study, which produced no excitement of mind and required no change of position. From the results, it appears that there was a sudden increase in the number of beats, at a quarter to ten, from sixty to seventy-nine, produced by breakfast. That from this time there was a gradual diminution, until it got as low as fifty-two at quarter past four—that it remained at this, one hour and a quarter, when it suddenly increased again to seventy; which increase was produced by dinner. From this time there was an irregular diminution, falling and then rising again two or three beats, when, at a quarter to twelve, it was again at fifty-two. At twelve, and a quarter past twelve, it was at fifty-six and fiftyfive.
Another single series of observations, from nine A. M., until two P. M., showed that the diminution towards evening