Anomalies and Curiosities of Medicine [394]
esophageal orifice, on the anterior surface of the stomach was found. This tear extended from below the lesser curvature to its extremity, and was four inches long. There were no signs of gastric carcinoma or ulcer.
Clarke reports the case of a Hindoo of twenty-two, under treatment for ague, who, without pain or vomiting, suddenly fell into collapse and died twenty-three hours later. He also mentions a case of rupture of the stomach of a woman of uncertain history, who was supposed to have died of cholera. The examination of the bodies of both cases showed true rupture of the stomach and not mere perforation. In both cases, at the time of rupture, the stomach was empty, and the gastric juice had digested off the capsules of the spleens, thus allowing the escape of blood into the abdominal cavities. The seats of rupture were on the anterior walls. In the first case the coats of the stomach were atrophied and thin. In the second the coats were healthy and not even softened. There was absence of softening, erosion, or rupture on the posterior walls.
As illustrative of the amount of paralytic distention that is possible, Bamberger mentions a case in which 70 pounds of fluid filled the stomach.
Voluntary Vomiting.--It is an interesting fact that some persons exhibit the power of contracting the stomach at will and expelling its contents without nausea. Montegre mentions a distinguished member of the Faculty of Paris, who, by his own volition and without nausea or any violent efforts, could vomit the contents of his stomach. In his translation of "Spallanzani's Experiments on Digestion" Sennebier reports a similar instance in Geneva, in which the vomiting was brought about by swallowing air.
In discussing wounds and other injuries of the stomach no chapter would be complete without a description of the celebrated case of Alexis St. Martin, whose accident has been the means of contributing so much to the knowledge of the physiology of digestion. This man was a French Canadian of good constitution, robust and healthy, and was employed as a voyageur by the American Fur Company. On June 16, 1822, when about eighteen years of age, he was accidentally wounded by a discharge from a musket. The contents of the weapon, consisting of powder and duck-shot, entered his left side from a distance of not more than a yard off. The charge was directed obliquely forward and inward, literally blowing off the integument and muscles for a space about the size of a man's hand, carrying away the anterior half of the 6th rib, fracturing the 5th rib, lacerating the lower portion of the lowest lobe of the left lung, and perforating the diaphragm and the stomach. The whole mass of the discharge together with fragments of clothing were driven into the muscles and cavity of the chest. When first seen by Dr. Beaumont about a half hour after the accident, a portion of the lung, as large as a turkey's egg was found protruding through the external wound. The protruding lung was lacerated and burnt. Immediately below this was another protrusion, which proved to be a portion of the stomach, lacerated through all its coats. Through an orifice, large enough to admit a fore-finger, oozed the remnants of the food he had taken for breakfast. His injuries were dressed; extensive sloughing commenced, and the wound became considerably enlarged. Portions of the lung, cartilages, ribs, and of the ensiform process of the sternum came away. In a year from the time of the accident, the wound, with the exception of a fistulous aperture of the stomach and side, had completely cicatrized. This aperture was about 2 1/2 inches in circumference, and through it food and drink constantly extruded unless prevented by a tent-compress and bandage. The man had so far recovered as to be able to walk and do light work, his digestion and appetite being normal. Some months later a small fold or doubling of the stomachal coats slightly protruded until the whole aperture was filled, so as to supersede the necessity of a compress, the protruding coats acting as a valve when the stomach
Clarke reports the case of a Hindoo of twenty-two, under treatment for ague, who, without pain or vomiting, suddenly fell into collapse and died twenty-three hours later. He also mentions a case of rupture of the stomach of a woman of uncertain history, who was supposed to have died of cholera. The examination of the bodies of both cases showed true rupture of the stomach and not mere perforation. In both cases, at the time of rupture, the stomach was empty, and the gastric juice had digested off the capsules of the spleens, thus allowing the escape of blood into the abdominal cavities. The seats of rupture were on the anterior walls. In the first case the coats of the stomach were atrophied and thin. In the second the coats were healthy and not even softened. There was absence of softening, erosion, or rupture on the posterior walls.
As illustrative of the amount of paralytic distention that is possible, Bamberger mentions a case in which 70 pounds of fluid filled the stomach.
Voluntary Vomiting.--It is an interesting fact that some persons exhibit the power of contracting the stomach at will and expelling its contents without nausea. Montegre mentions a distinguished member of the Faculty of Paris, who, by his own volition and without nausea or any violent efforts, could vomit the contents of his stomach. In his translation of "Spallanzani's Experiments on Digestion" Sennebier reports a similar instance in Geneva, in which the vomiting was brought about by swallowing air.
In discussing wounds and other injuries of the stomach no chapter would be complete without a description of the celebrated case of Alexis St. Martin, whose accident has been the means of contributing so much to the knowledge of the physiology of digestion. This man was a French Canadian of good constitution, robust and healthy, and was employed as a voyageur by the American Fur Company. On June 16, 1822, when about eighteen years of age, he was accidentally wounded by a discharge from a musket. The contents of the weapon, consisting of powder and duck-shot, entered his left side from a distance of not more than a yard off. The charge was directed obliquely forward and inward, literally blowing off the integument and muscles for a space about the size of a man's hand, carrying away the anterior half of the 6th rib, fracturing the 5th rib, lacerating the lower portion of the lowest lobe of the left lung, and perforating the diaphragm and the stomach. The whole mass of the discharge together with fragments of clothing were driven into the muscles and cavity of the chest. When first seen by Dr. Beaumont about a half hour after the accident, a portion of the lung, as large as a turkey's egg was found protruding through the external wound. The protruding lung was lacerated and burnt. Immediately below this was another protrusion, which proved to be a portion of the stomach, lacerated through all its coats. Through an orifice, large enough to admit a fore-finger, oozed the remnants of the food he had taken for breakfast. His injuries were dressed; extensive sloughing commenced, and the wound became considerably enlarged. Portions of the lung, cartilages, ribs, and of the ensiform process of the sternum came away. In a year from the time of the accident, the wound, with the exception of a fistulous aperture of the stomach and side, had completely cicatrized. This aperture was about 2 1/2 inches in circumference, and through it food and drink constantly extruded unless prevented by a tent-compress and bandage. The man had so far recovered as to be able to walk and do light work, his digestion and appetite being normal. Some months later a small fold or doubling of the stomachal coats slightly protruded until the whole aperture was filled, so as to supersede the necessity of a compress, the protruding coats acting as a valve when the stomach