272 DISEASES OF THE STOMACH. 



inguinal hernia. In doubt, he recommends that manual 

 examination for hernia should take place in the manner 

 prescribed.^ '' It is something/^ adds D^Arboval, " to steer 

 clear of error f' although we still appear to have to regret 

 that we possess no certain diagnostic of a lesion which, 

 being necessarily fatal, would put a stop — the case being 

 once finally decided upon — to all remedial proceedings. 



There exist two cogent reasons for wishing to be able to 

 pronounce at once upon a case of ruptured stomach : the 

 first is, the preservation, if not enhancement, of the medical 

 attendant's reputation ; the second, the saving of solicitude 

 on his part, and annoyance on the part of his patient, of 

 administering anything under such hopeless circumstances. 

 I remember the late Mr. John Field observing to me one 

 day, that he never had witnessed a case of ruptured sto- 

 mach without vomiting occurring prior to death, which he 

 thought very remarkable. The trooper, however, of my 

 regiment, who glutted himself with food over-night and 

 died the following morning, did not exhibit this symp- 

 tom : though very often present, it is not, therefore, one 

 invariably so. The questions naturally arise here — Can 

 vomiting take place after rupture ? Would the ?T??i sto- 

 mach retain any power of ejection ? Could ejection of 

 the contents upward be produced by the abdominal muscles 

 and diaphragm, without the aid of the stomach ? I should 

 very much doubt it. I should rather feel inclined to the 

 opinion, that the act of vomiting should be taken as a proof 

 of the entireness of the stomach. At all events, we may 

 have rupture happen without vomiting; and, consequently, we 

 must cease to regard that symptom as alo7ie pathognomonic, 

 though we may justly consider it, in company with others, 

 as one throwing much light upon the nature of the case. 

 Our guides, in the absence of any one infallible pathogno- 

 monic sign, must be — the history of the case ; the subject 

 of it j the circumstances attending it ; the inflated or tym- 

 panitic condition of the abdomen ; the symptoms of colic or 

 gripes ceasing, and becoming succeeded by cold sweats 



' Under ' Hernia,' which the reader can turn to. 



