An Account of an Extraordinary Effect of the Cholick: Communicated to the Royal Society, by That Curious Anatomist Mr. St. Andre, and Read March 21. 1717

V. An Account of an extraordinary Effect of the Cholick: communicated to the Royal Society, by that curious Anatomist Mr. St. Andre, and read March 21. 1717. The Peristaltick Motion of the Intestins is by all Anatomists suppos'd the proper Motion of those Cylindrical Tubes. The use of this Motion is to propel the Chyle into the vasa lactea, and to accelerate the grosser Parts of the Aliment downwards, in order to expel them, when all their nutritive Contents are extracted. This Motion thus establish'd, it naturally seems to follow that an inversion of it (call'd for that Reason an Antiperistaltick Motion) shou'd force the Aliments, Bile, pancreatick Juice, and lastly the Faeces to ascend towards the Mouth. The Cause of this imaginary Antivermicular Motion, is assign'd to a Stoppage of the Intestin, or to a great length of it being ingaged in the same manner as the Fingers of a Glove are choak'd by inverting the Glove in drawing it off: Or like as a Silk-Stocking, which when 'tis not gartered, falls upon the Foot, and is in a manner strangled, so that some Force is required to bring it up again. This suppos'd, the Antiperistaltick Hypothesis seems at first Sight very natural, and answers most Difficulties. For if the Vermicular Motion accelerates the Contents of the Intestins downwards; the Antivermicular, by the Law of Contraries, should force them upwards towards the Mouth. Was this Supposition as certain as 'tis generally receiv'd, I shou'd not presume to advance that there is no such thing as an Antiperistaltick Motion of the Intestins; nor that the Miserere mei is oftner a violent Contraction of the Abdominal Muscles, than a Stoppage or Inversion of the Intestins, as 'tis suppos'd. So laying aside all Prevention, let it be granted that this Disease is a violent Contraction of the Abdominal Muscles, as I have already suppos'd it, caus'd by the Redundancy of the Intestins or their Contents. Then comparing the Symptoms of this Disease, with those of the different Kinds of Hernias, we shall find by the Analogy of the Parts, Reason and repeated Experience, that the Chordapsus, so call'd by Celsus, is a Disease in which the Intestins and Omentum; at other Times the Pancreas or Spleen; nay, even the Mesentery it self are forc'd through the Diaphragma into the Thorax. All these tender Parts being strongly compress'd, by the continual Motion of this Muscle, must by consequence cause the same Accidents as in the Bubonocele or compleat Hernia, there being no difference in these two Cases; but that the first is a strangling of the Intestin by the Diaphragm, and the latter a choaking of the Intestins by the Abdominal Muscles. One Example of the many of the like Nature, that I can produce, will much confirm this Assertion, and may serve to convince any Person that is impartial. The Case is this: A Gentleman that came to Town yesterday was Sevennight in good Health, meeting with some Friends, drank a great deal of new bottled Oat-Ale, after some Pints of Wine. These Liquors fermented so violently in his Stomach and Intestins; that he was taken with a violent Cholick the same Night. In the morning an Apothecary was sent for, who administered a Clyster, and took some Ounces of Blood to relieve the Patient, who complain'd of a great Pain in his left Side. The Clysters being repeated the Night following, as also the next Morning, and the Patient growing worse; the Apothecary, without Order of any Physician, gave him a violent Vomit; which operated Eight or Nine Times: This added Fewel to the Fire; and the Patient having from that Time been in a desperate Condition, two eminent Physicians were call'd, who order'd that the Clysters shou'd be repeated: But they not prevailing, I was sent for about six Hours before the Patient died: I found him complaining of a violent Pain in all the Region of the Abdomen; a frequent Inclination to vomit; having a great Difficulty of breathing, together with a very flow Pulse; his Belly being as hard as a Stone, tho' not swell'd. This last Indication made me conclude, that the Disease was a violent Contraction of the Abdominal Muscles, which had overcome the Diaphragm, and that probably the Intestins might be forc'd into the Thorax. I was the more confirm'd in this Opinion from the Examples of the like Case, which I shall shortly lay before the Society; upon which I order'd a Fomentation of hot Milk, adding to every Quart a Drachm of Liquid Laudanum, which in these Maladies gives great Relief: But before it cou'd be got ready, the Patient expir'd in a violent Convulsion. My Opinion having been highly censur'd by the two Physicians; I open'd this Gentleman, to justify my self, or to own my Fault openly, if I had been mistaken: But as the thing happen'd as I conjectured, those Gentlemen will forgive me for taking the Liberty of justifying my self. In opening this Body, I found the Abdominal Muscles so much contracted, that it was almost impossible to penetrate them with a very sharp Scalpel. Upon Upon Examination, I found the Stomach empty, and some Parts of the Duodenum, but the Jejunum and Ilium so much distended with the fermented Oat-Ale, that the Ilium had four Inches of Diameter, and the Colon above eight. The Ilium was also pretty much inflam'd in its inferior Part; and all the Valves of the Colon were obliterated, by the great Distention of that Intestin. But the greatest Disaster was, the Dilatation made in the Diaphragm, as I suppos'd; made just upon the Chink which remits the intercostal Nerve to the Viscera of the Abdomen, through which a Portion of the Colon was forc'd, and the greatest Part of the Omentum and Pancreas. These tender Parts being choak'd, soon inflamed, a Mortification of them following; and a Rupture of the Pancreatick Vein caus'd an internal Hemorrhage, which fill'd all the left Cavity of the Thorax, insomuch that the whole left lobe of the Lungs was compris'd almost under the Musculus Scalenus. The Quantity of extravas'd Blood was very great, and it was not in the least coagulated. I have brought the diseas'd Parts with me, to shew the Society the Certainty of this Account, and I shou'd have been more particular in proving the Impossibility of the Antiperistaltick Motion; if Doctor Hagumot had not prevented me by his Memoir. This Gentleman is not far from Truth, and what he says is certain: but I am surpriz'd that the like Case has not occurr'd in his Practice.