Not that a rupture has not been found where the texture of the parts has seemed to offer no natural facilities to its occurrence—as in the case related by Harvey himself, who found a lacerated aperture in the left ventricle, capable of admitting his finger, through which blood had escaped into the pericardium, the walls of the ventricle being increased in thickness and strength, while an obstacle existed at the entrance of the aorta[18]. Here the heart must have torn itself asunder by the simple violence of its contraction, in contending against the impediment to the egress of blood from its cavity. This is an effect which would hardly be thought capable of being thus produced; but I can well believe it possible after having seen one of the recti muscles of the abdomen literally torn in twain, in a man who died of tetanus[19].
[To be continued.]
DILATED ŒSOPHAGUS.
To the Editor of the London Medical Gazette.
Sir,
Permit me to send the following case to you for insertion in the Gazette.
Mary Blores, æt. 33, was admitted into the Middlesex Hospital on the 16th of November. She was in a state of extreme feebleness and emaciation. Those who brought her said that during the preceding month she had appeared to swallow nothing: what she took as food seemed to her to stop in the gullet, and after a few minutes returned. I found, however, that a large œsophagus-bougie passed readily into the stomach, meeting with no obstruction beyond a spasmodic resistance in the pharynx. A draught of milk and water was given her—she swallowed it without much effort, but it quickly returned. In the course of the afternoon a pint of beef tea was injected through an elastic tube into the stomach—it was thrown up directly.
I now learnt from her that she could swallow liquids much more readily than solid food; that when she took a small quantity, it seemed to her not to reach the stomach, and in three or four minutes was invariably thrown up; that on taking a large draught she had an impression that it reached the stomach—in this case vomiting did not follow so soon, and some part of the draught was permanently retained; that she craved food and drink, and was literally dying of hunger and thirst; that the vomiting which took place was not preceded by nausea, although in its progress it had all the appearance of ordinary retching; that the matter vomited was not thrown up at once, but by successive efforts; it consisted of the food she had last taken, mixed with colourless mucus. The belly was so shrunk that the umbilicus was not more than an inch distant from the spine, upon which the pulsations of the aorta were readily felt: there was no enlargement or hardness about the stomach, no particular tenderness on pressing the epigastrium, no sensation of pain or heat now or formerly.
The complaint had began ten years ago, during pregnancy, since when she had never been free from it, although at times her sufferings had been less, and she had been able to retain some portion of her meals. She had borne in this period three children; the vomiting had lasted during the whole period of her pregnancies, and during her confinement. The principal remedies which had been used for her relief were a succession of blisters on the pit of the stomach—but they had produced no benefit. Latterly her symptoms had been greatly aggravated.