A Preternatural Perforation Found in the Upper Part of the Stomach, with the Symptoms it Produc'd, by Mr. Christopher Rawlinson, Surgeon

VIII. A preternatural Perforation found in the upper Part of the Stomach, with the Symptoms it produc'd, by Mr. Christopher Rawlinson, Surgeon. James Skidmore had complain'd for Three or Four Years last past, of a violent Pain in his Stomach and Bowels, never being able to rest in his Bed at Night, 'till he had vomited up the greatest Part of what he had eat or drank the Day before. He would often compare his Pain to some great Weight laying upon the Region of the Stomach, which he in some Measure alleviated, by pressing hard with his Hand upon that Part. When he turn'd himself in Bed from one Side to the other, he told me, he could plainly perceive that some Fluid or other fell down with Noise to the depending Side; which Fluid he believ'd to be the Occasion of all his Misery: For which Reason he often said, he would willingly consent, nay, often earnestly press'd that the Surgeons would cut him open (as he expressed it) and let it out. He had no apparent Tumour upon the Part, nor was his Belly more extended than usual. He had had the Advice of several able Physicians before he came into the Hospital, but all without the least Amendment to his Disease. When he died we were desired to open him, and try if we could find out the Cause of his Complaints. As soon as we had penetrated the Peritoneum, there flow'd out a whitish Liquor, not much unlike to Whey, only a little more thick and faeculent; nor did it emit so noisom a Smell as might be expected from its long Residence in that Place. We computed there were above Four Quarts of this Liquor contain'd in the Cavity of the Abdomen. When we came at the Stomach we found it perforated in its upper Part, about the middle Space betwixt the Two Orifices, wide enough to contain the End of one's Finger. We cut it open Length-ways, and found it pretty full of a thick glutinous Matter, inclining to be yellow; and to its inner Coat, on the lower Side, there firmly adher'd the Stone of a Prune, or some other Fruit resembling it. On its Inside, near the preternatural Perforation, 'twas gangreen'd for two or three Inches; and on the other Side of the Perforation there was an Ulcer near the same Bigness. The whole Stomach was a great deal thicker than usual; but that Part next the Pylorus was above Four Times thicker than in a natural State. It adher'd closely to all the Parts about it; and to the Pancreas 'twas so firmly ty'd down, that it could not be separated without tearing. The Spleen did not exceed a Quarter of an Ounce in Weight. The Pancreas was schirrous, tho' pretty near its natural Size. In the Liver and Kidneys there was no apparent Defect; nor had the Parts in the Thorax receiv'd any visible Alteration, except that the Lungs adher'd more firmly to the Pleura than usual. The Intestines and all the Viscera contain'd in the Abdomen were of a whiter Colour than usual, by being so long sodden in the Liquor they floated in.