Rupture of the stomach is an occurrence which sometimes takes place from the action of vomiting, during the progress of ulceration, when the membranes of this viscus are nearly perforated. It also occasionally happens from external violence. In the _Medical Repository_,[34] a case of ruptured stomach is related by _Mr. Brown_, in which the accident must have been occasioned by the action of the diaphragm and abdominal muscles, at the time of exertion, the stomach of the individual having, from disease, been less capable of sustaining any degree of violence. The following are the particulars of the case; “A coal-heaver, aged 50, whilst stooping in the act of lifting some coals, placed his hand suddenly on the pit of the stomach, and complained of severe pain in that situation; this was immediately succeeded by two deep sighs, when he dropped down and expired. On dissection, the parts immediately round the opening were in a higher state of vascularity than the rest, and put on a decidedly torn appearance, which was also observable in the peritoneal coat.”
In pursuing the track of the alimentary canal we have to observe whether any marks of peritoneal inflammation present themselves; and whether any signs of inflammation in the muscular or mucous coats are visible through the transparent parietes of the intestine; and although no appearance of this kind can be discovered on the external coat of the bowels, we are not, on that account, to conclude that they have been free from inflammation; we must persevere in our dissection, and slit open the intestines in different parts, especially at the entrance of the _ilium_ into the _colon_; the valve of the latter gut should also be inspected; nor should the _rectum_ escape our attention, for its extremity is sometimes inflamed together with the stomach, while the intermediate portions of the canal are not in the least affected; this peculiarity occurs in many cases of poisoning, as those, for instance, in which colocynth or elaterium have been exhibited. An empoisoned clyster may have been administered; or, as in the case of _King Edward_ II, a hot poker, or some other instrument thrust up the rectum. We should also in this part of the dissection, ascertain whether any _intus-susceptio_ has taken place, a derangement not very rare, and frequently fatal; it consists in a portion of gut passing for some length within another portion, and dragging along with it a part of the mesentery; it may take place in any part of the canal, but it more usually occurs in the small intestines, especially where the ilium terminates in the _colon_; in the examination of infants an _intus-susceptio_ is not unfrequently found, which had been unattended with mischief, and in which the natural peristaltic motion of the intestines would have easily disentangled them; but, in other cases, an unrelenting obstruction is established, inflammation follows, and life is soon terminated, as was exemplified in the case of the infant Princess Elizabeth of Clarence.