re and
dyspnea.

Rupture of the esophagus is attributable to many causes. Dryden
mentions vomiting as a cause, and Guersant reports the case of a little
girl of seven, who, during an attack of fever, ruptured her esophagus
by vomiting. In 1837 Heyfelder reported the case of a drunkard, who, in
a convulsion, ruptured his esophagus and died. Williams mentions a case
in which not only the gullet, but also the diaphragm, was ruptured in
vomiting. In this country, Bailey and Fitz have recorded cases of
rupture of the esophagus. Brewer relates a parallel instance of
rupture from vomiting. All the foregoing cases were linear ruptures,
but there is a unique case given by Boerhaave in 1724, in which the
rent was transverse. Ziemssen and Mackenzie have both translated from
the Latin the report of this case which is briefly as follows: The
patient, Baron de Wassenaer, was fifty years of age, and, with the
exception that he had a sense of fulness after taking moderate meals,
he was in perfect health. To relieve this disagreeable feeling he was
in the habit of taking a copious draught of an infusion of "blessed
thistle" and ipecacuanha. One day, about 10.30 in the evening, when he
had taken no supper, but had eaten a rather hearty dinner, he was
bothered by a peculiar sensation in his stomach, and to relieve this he
swallowed about three tumbler-fuls of his usual infusion, but to no
avail. He then tried to excite vomiting by tickling the fauces, when,
in retching, he suddenly felt a violent pain; he diagnosed his own case
by saying that it was "the bursting of something near the pit of the
stomach." He became prostrated and died in eighteen and one-half hours;
at the necropsy it was seen that without any previously existing signs
of disease the esophagus had been completely rent across in a
transverse direction.

Schmidtmuller mentions separation of the esophagus from the stomach;
and Flint reports the history of a boy of seven who died after being
treated for worms and cerebral symptoms. After death the contents of
the stomach were found in the abdominal cavity, and the esophagus was
completely separated from the stomach. Flint believed the separation
was postmortem, and was possibly due to the softening of the stomach by
the action of the gastric acids. In this connection may be mentioned
the case reported by Hanford of a man of twenty-three who had an attack
of hematemesis and melanema two years before death. A postmortem was