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 witho