anomalies and curiosities of medicine-第158部分

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


ostal　space；　the　broadened　end　of　it　remaining　outside　of　the　wound。　The　mother　seized　the　needle　between　her　teeth　and　withdrew　it；　but　the　child　died；　before　medical　aid　could　be　summoned；　from　internal　hemorrhage；　causing　pulmonary　pressure　and　dyspnea。

Rupture　of　the　esophagus　is　attributable　to　many　causes。　Dryden　mentions　vomiting　as　a　cause；　and　Guersant　reports　the　case　of　a　little　girl　of　seven；　who；　during　an　attack　of　fever；　ruptured　her　esophagus　by　vomiting。　In　1837　Heyfelder　reported　the　case　of　a　drunkard；　who；　in　a　convulsion；　ruptured　his　esophagus　and　died。　Williams　mentions　a　case　in　which　not　only　the　gullet；　but　also　the　diaphragm；　was　ruptured　in　vomiting。　In　this　country；　Bailey　and　Fitz　have　recorded　cases　of　rupture　of　the　esophagus。　Brewer　relates　a　parallel　instance　of　rupture　from　vomiting。　All　the　foregoing　cases　were　linear　ruptures；　but　there　is　a　unique　case　given　by　Boerhaave　in　1724；　in　which　the　rent　was　transverse。　Ziemssen　and　Mackenzie　have　both　translated　from　the　Latin　the　report　of　this　case　which　is　briefly　as　follows：　The　patient；　Baron　de　Wassenaer；　was　fifty　years　of　age；　and；　with　the　exception　that　he　had　a　sense　of　fulness　after　taking　moderate　meals；　he　was　in　perfect　health。　To　relieve　this　disagreeable　feeling　he　was　in　the　habit　of　taking　a　copious　draught　of　an　infusion　of　〃blessed　thistle〃　and　ipecacuanha。　One　day；　about　10。30　in　the　evening；　when　he　had　taken　no　supper；　but　had　eaten　a　rather　hearty　dinner；　he　was　bothered　by　a　peculiar　sensation　in　his　stomach；　and　to　relieve　this　he　swallowed　about　three　tumbler…fuls　of　his　usual　infusion；　but　to　no　avail。　He　then　tried　to　excite　vomiting　by　tickling　the　fauces；　when；　in　retching；　he　suddenly　felt　a　violent　pain；　he　diagnosed　his　own　case　by　saying　that　it　was　〃the　bursting　of　something　near　the　pit　of　the　stomach。〃　He　became　prostrated　and　died　in　eighteen　and　one…half　hours；　at　the　necropsy　it　was　seen　that　without　any　previously　existing　signs　of　disease　the　esophagus　had　been　completely　rent　across　in　a　transverse　direction。

Schmidtmuller　mentions　separation　of　the　esophagus　from　the　stomach；　and　Flint　reports　the　history　of　a　boy　of　seven　who　died　after　being　treated　for　worms　and　cerebral　symptoms。　After　death　the　contents　of　the　stomach　were　found　in　the　abdominal　cavity；　and　the　esophagus　was　completely　separated　from　the　stomach。　Flint　believed　the　separation　was　postmortem；　and　was　possibly　due　to　the　softening　of　the　stomach　by　the　action　of　the　gastric　acids。　In　this　connection　may　be　mentioned　the　case　reported　by　Hanford　of　a　man　of　twenty…three　who　had　an　attack　of　hematemesis　and　melanema　two　years　before　death。　A　postmortem　was　made　five　hours　after　death；　and　there　was　so　much　destruction　of　the　stomach　by　a　process　resembling　digestion　that　only　the　pyloric　and　cardiac　orifices　were　visible。　Hanford　suggests　that　this　was　an　instance　of　antemortem　digestion　of　the　stomach　which　physiologists　claim　is　impossible。

Nearly　all　cases　of　rupture　of　the　stomach　are　due　to　carcinoma；　ulcer；　or　some　similar　condition；　although　there　have　been　instances　of　rupture　from　pressure　and　distention。　Wunschheim　reports　the　case　of　a　man　of　fifty…two　who　for　six　months　presented　symptoms　of　gastric　derangement；　and　who　finally　sustained　spontaneous　rupture　of　the　posterior　border　of　the　stomach　due　to　overdistention。　There　was　a　tear　two　inches　long；　beginning　near　the　cardiac　end　and　running　parallel　to　the　lesser　curvature。　The　margin　of　the　tear　showed　no　evidence　of　digestion。　There　were　obstructing　esophageal　neoplasms　about　10　1/3　inches　from　the　teeth；　which　prevented　vomiting。　In　reviewing　the　literature　Wunschheim　found　only　six　cases　of　spontaneous　rupture　of　the　stomach。　Arton　reports　the　case　of　a　negro　of　fifty　who　suffered　from　tympanites。　He　was　a　hard　drinker　and　had　been　aspirated　several　times；　gas　heavily　laden　with　odors　of　the　milk　of　asafetida　being　discharged　with　a　violent　rush。　The　man　finally　died　of　his　malady；　and　at　postmortem　it　was　found　that　his　stomach　had　burst；　showing　a　slit　four　inches　long。　The　gall　bladder　contained　two　quarts　of　inspissated　bile。　Fulton　mentions　a　case　of　rupture　of　the　esophageal　end　of　a　stomach　in　a　child。　The　colon　was　enormously　distended　and　the　walls　thickened。　When　three　months　old　it　was　necessary　to　puncture　the　bowel　for　distention。　Collins　describes　spontaneous　rupture　of　the　stomach　in　a　woman　of　seventy…four；　the　subject　of　lateral　curvature　of　the　spine；　who　had　frequent　attacks　of　indigestion　and　tympanites。　On　the　day　of　death　there　was　considerable　distention；　and　a　gentle　purgative　and　antispasmodic　were　given。　Just　before　death　a　sudden　explosive　sound　was　heard；　followed　by　collapse。　A　necropsy　showed　a　rupture　two　inches　long　and　two　inches　from　the　pyloric　end。　Lallemand　mentions　an　instance　of　the　rupture　of　the　coats　of　the　stomach　by　the　act　of　vomiting。　The　patient　was　a　woman　who　had　suffered　with　indigestion　five　or　six　months；　but　had　been　relieved　by　strict　regimen。　After　indulging　her　appetite　to　a　greater　extent　than　usual；　she　experienced　nausea；　and　made　violent　and　ineffectual　efforts　to　discharge　the　contents　of　the　stomach。　While　suffering　great　agony　she　experienced　a　sensation　as　if　something　was　tearing　in　the　lower　part　of　her　belly。　The　woman　uttered　several　screams；　fell　unconscious；　and　died　that　night。　Postmortem　examination　showed　that　the　anterior　and　middle　part　of　the　stomach　were　torn　obliquely　to　the　extent　of　five　inches。　The　tear　extended　from　the　smaller　toward　the　greater　curvature。　The　edges　were　thin　and　irregular　and　presented　no　marks　of　disease。　The　cavity　of　the　peritoneum　was　full　of　half…digested　food。　The　records　of　St。　Bartholomew's　Hospital；　London；　contain　the　account　of　a　man　of　thirty…four　who　for　two　years　had　been　the　subject　of　paroxysmal　pain　in　the　stomach。　The　pains　usually　continued　for　several　hours　and　subsided　with　vomiting。　At　St。　Bartholomew's　he　had　an　attack　of　vomiting　after　a　debauch。　On　the　following　day　he　was　seized　with　vomiting　accompanied　by　nausea　and　flatus；　and　after　a　sudden　attack　of　pain　at　the　pit　of　the　stomach　which　continued　for　two　hours；　he　died。　A　ragged　opening　at　the　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　v