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 101/3 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.