RUPTURE OF THE STOMACH. 171 



not be accepted as a positively reliable symptcm, as vomiting 

 has been known to take place when the diaphragm or intestines 

 have post mortem exhibited a rupture, while the stomach was in- 

 tact; moreover the stomach has been found ruptured after death 

 while during life no symptoms of vomiting were presented. 



The late Professor Robertson, whose experience was very con- 

 siderable, states in his '''' Equine Medicine'' that "with regard to 

 the relation of the symptoms of vomition or attempt at vomition, 

 to the actual occurrence of the ruptures there has been considerable 

 speculation and little certainty. Many have regarded the existence 

 of the lesion as incompatible with any action of the organ approach- 

 ing to what may be looked upon as vomitiou; that with the walls 

 of the stomach torn, there could be no effort made for the eject- 

 ment of what material was contained in it, and that consequently 

 the symptom of vomition, where existing, was alwa^'s a symptom 

 antecedent to the occurrence of the lesion. Of the correctness of this 

 we are far from being satisfied; it proceeds upon assumptions we 

 can scarceh' 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 relaxa- 

 tion of its cardiac opening. To our mind these latter conditions 

 will altogether depend upon the nature and extent of the rupture, 

 and the relation 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 contraction of 

 the muscular tissue and lessening of the capacity would not be 

 obsolute and complete. While from observ'atiou made on many 

 cases shortly previous to death, and immediately afterwards, there 

 appears satisfactory evidence that rupture and escape of ingesta 

 into the peritoneal cavity may exist sometimes antecedent to the 

 exhibition of attempts at vomition. In some of these there has 

 been ample evidence of inflammatory action consequent on the 

 escape of contained material into the abdominal cavity, and 

 changes which could not possibly have occurred under a period of 

 several hours, while not long prior to death we had attempts at 

 vomition with ejection of material from the nose. Again it is 

 equally certain that actual vomition has occurred during the simple 

 repletion and distension of the stomach without any rupture of 

 its walls, seeing that following the vomition and discharge of 



