SYMPTOMS. 629 



rupture of the stomach ; now, although I would not for a 

 moment desire to cast doubt on the value of what I justly 

 appreciate, and which is probably one of the few symptoms 

 sufficiently well marked in the majority of cases of this lesion 

 to cause us to regard it as a valuable diagnostic symptom, still 

 we must not forget that other lesions of a similar character in 

 connection with other viscera — as in the condition of rupture 

 of the colon and diaphragm — have attached to them as symp- 

 toms, attempts at vomition, as also that rupture of the walls of 

 the stomach may take place, and this attractive symptom not 

 be developed. 



With regard to the relation of the sjnnptom of vomition, or 

 attempts at vomition, to the actual occurrence of the rupture, 

 there has been some considerable speculation and little cer- 

 tainty. Many have regarded the existence of the lesion as 

 incompatible with any action of the organ approaching to 

 what may be looked upon as vomition; that with the walls of the 

 stomach torn there could be no effort made for the ejectment 

 of what material was contained in it, and that consequently 

 the symptom of vomition, where existing, was always a symp- 

 tom antecedent to the occurrence of the lesion. Of the cor- 

 rectness of this conclusion we are far from being satisfied ; it 

 proceeds upon assumptions which we can scarcely admit, such 

 as the necessity of a stomach ere vomition can be accomplished, 

 the impossibility with a rent in its walls of pressure being 

 exercised upon its contained materials, or of relaxation of its 

 cardiac opening. To our mind, these latter conditions will 

 altogether depend upon the nature and extent of the rupture, 

 and the relations of the viscus to other influences, nervous and 

 muscular. The lesion can certainly be conceived of as being 

 of such a character that its interference with forcible contrac- 

 tion of the muscular tissue and lessening of the capacity would 

 not be absolute and complete. While from observations made 

 on many cases shortly previous to death, and immediately after- 

 wards, there appears satisfactory evidence that rupture and 

 escape of ingesta into the peritoneal cavity may exist some 

 time antecedent to the exhibition of attempts at vomition. In 

 some of these there were adhesions, the result of inflammatory 

 action consequent on the escape of contained material into the 

 abdominal cavity, which adhesions could not possibly have 



