The Case of Mr. Smith, Surgeon, at Sudbury in Suffolk; The Coats of Whose Stomach Were Changed into an Almost Cartilaginous Substance; Communicated by the Rev. Mr. Murdock to Cromwell Mortimer M. D. Secret. R. S.

P. S. Dr. Miles says they belong to Dr. Clark of St. Alban's; that they were found in Oxfordshire, and were formerly in the Possession of the late Mr. William Becket Surgeon, F. R. S. XI. The Case of Mr. Smith, Surgeon, at Sudbury in Suffolk; the Coats of whose Stomach were changed into an almost cartilaginous Substance; communicated by the Rev. Mr. Murdock to Cromwell Mortimer M. D. Secret. R. S. Rev. Sir, Clare, Oct. 11, 1747. Read Feb. 9. 1748-9. According to your Desire I send you the material Particulars of Mr. Smith's Case. As there was something uncommon in it, and as it may be for the Benefit of Mankind, which was the Design, and a generous one it was, of my deceased Friend, in resolving a good while before his Death to be opened, I shall take it as a Favour that you will communicate it to Dr. Mortimer. I could not, for the Thing struck me very strongly, forbear making a few Remarks: But I leave it entirely to your Discretion to suppress or send them with the Case. I am, Dear Sir, Yours most sincerely, J. Sayer. HE was in the vigorous Time of Life, being no more than thirty-six Years of Age; and, to all Appearance, of a strong well-set Habit. His Way of living was quite regular; but his Practice of Midwifry, which was pretty large, often forced him in severe Weather from a warm Bed into bad Roads, and sometimes into raw uncomfortable Houses. He had for several Years complained of Uneasiness at his Stomach; but it was not considerable, till about January 1746-7. From that time, he almost constantly threw up his Food within an Hour or two after taking it, and he felt violent Pain about the Scrobiculus Cordis. Divers Physicians were advised with, but Medicines availed him nothing; nor had he any Ease, except from Opiates, or spirituous Liquors; and this was of short Continuance. It being, in the September following, recommended to him to go to Bath, he for some Weeks drank the Waters, and afterwards bathed. The first had no remarkable Effect; but he found himself worse after bathing. Upon his Return home, new Physicians were consulted, and new Methods were tried, but to no purpose; and, to make Life tolerable, he was forced to be very free in the Use of spirituous Liquors and Opiates. In February 1747-8. he voided, by two or three Stools, about a Couple of Ounces of Matter. Some Weeks before his Death the Pains went off, and his Vomiting was at times stay'd; but whenever that happen'd, whatever he took ran directly through but And indeed he was now-and then, during the whole Illness, subject to bilious Dejections. On this Remission of the Symptoms, his Friends flatter'd themselves yet that all might do well; but his Wasting, which had long began, continued, and his Legs, especially one of them, became oedematous. After growing gradually weaker, till Nature was quite spent, he expired, with the utmost Serenity of Mind, in the Evening of August the seventh. His Body being, pursuant to his Request, opened in the Presence of Dr. Scarling, and three or four Surgeons, the Coats of the Stomach were found chang'd into an uniform, white, inelastic, almost cartilaginous Substance, which was four Tenths of an Inch in Thickness. Besides this strange Alteration in its Coats, the Stomach was so contracted, as to be incapable of holding more than five or six Ounces; and its inner Surface was besmeared with a various colour'd Matter. The rest of the Viscera seemed to be quite unaffected, and every thing was in its natural Situation, except the Omentum, which, besides being, as it is in all tabid Bodies, vastly wasted, was necessarily drawn upwards by the Contraction of the Stomach. Remarks. It is highly probable, that this Gentleman's Disorder, whether constitutional or acquired, was at first an Obstruction in those Glands, which separate the Humour that serves to defend the villous Coat from the Acrimony of what is taken into the Stomach, and to prevent its being stimulated by the Aliment in Digestion; for want of which it was so subject to Irritation, that scarce any thing would stay upon it. The Matter voided by Stool was undoubtedly formed in the Stomach, because he never complained of considerable Pain in any other Part; besides, had it been from an Abscess in the Intestines, or any other of the Viscera, the Seat of it would in all Likelihood have been apparent. The Looseness, which in the latter Part of his Illness, always attended him when the Vomiting ceased, plainly shews, that the Stomach had at that time acquired a great if not its greatest Degree of Contraction; for which Reason, as it could contain but little, any Quantity of Food must, if not thrown up, go immediately downwards. The going off of the Pain some Weeks before his Death, was owing to the Sensibility of the Coats of the Stomach being in a great measure, or quite destroyed. The bilious Dejections, that frequently attended him, may be ascribed to Want of Digestion; which, as little or no Chyle was sent into the Duodenum, rendered the Bile useless. The Consequence of this was a Non-secretion of that Humour, an Accumulation of it in the Liver, or Gall-bladder; its being reconveyed into the Blood; or its going off by Stool. If the first or third had been the Case, it would have shown itself in a Jaundice; if the second, there would have been an Abscess in the Liver or Gall-bladder; so that of course it must run off by Stool. Spirituous Liquors might help to bring on this Contraction, Inelasticity, and Insensibility of the Stomach: But it seems pretty clear that they were not the sole Cause; else immoderate Drinkers of them would generally be affected in the same Manner.