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al； 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 valve when the stomach was filled。 This valvular protrusion was easily depressed by the finger。 St。 Martin suffered little pain except from the depression of the skin。 He took his food and drink like any healthy person； and for eleven years remained under Dr。 Beaumont's own care in the Doctor's house as a servant。 During this time were performed the experiments on digestion which are so well known。 St。 Martin was at all times willing to lend himself in the interest of physiologic science。 In August； 1879； The Detroit Lancet contains advices that St。 Martin was living at that time at St。 Thomas； Joliette County； Province of Quebec； Canada。 At the age of seventy…nine he was comparatively strong and well； and had always been a hard worker。 At this time the opening in the stomach was nearly an inch in diameter； and in spite of its persistence his digestion had never failed him。
Spizharny relates a remarkable case of gastric fistula in the loin； and collects 61 cases of gastric fistula； none of which opened in the loin。 The patient was a girl of eighteen； who had previously had perityphlitis； followed by abscesses about the navel and lumbar region。 Two fistulae were found in the right loin； and were laid open into one canal； which； after partial resection of the 12th rib； was dilated and traced inward and upward； and found to be in connection with the stomach。 Food was frequently found on the dressings； but with the careful use of tampons a cure was effected。
In the olden times wounds of the stomach were not always fatal。 The celebrated anatomist； Fallopius； successfully treated two cases in which the stomach was penetrated so that food passed through the wound。 Jacobus Orthaeus tells us that in the city of Fuldana there was a soldier who received a wound of the stomach； through which food passed immediately after being swallowed； he adds that two judicious surgeons stitched the edges of the wound to the integuments； thereby effecting a cure。 There is another old record of a gastric fistula through which some ali