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.