33 SURGICAL APPLIED ANATOMY. [Ch ap .xvn. 



being deeply placed and lying against the posterior 

 abdominal wall in a collapsed state, is but little ex- 

 posed to injury. A small punctured wound of the 

 stomach need not be followed by escape of contents, 

 since the loosely attached mucous membrane may 

 escape from the wound and effectually plug it. The 

 stomach has protruded through wounds in the ab- 

 dominal walls, and has been returned, with no evil 

 results following. In a few cases the belly wall in 

 front of the stomach has been wounded, the viscus has 

 protruded, its anterior wall has been wounded by the 

 same injury that penetrated the parietee, and a fistu- 

 lous opening leading into the stomach cavity has 

 resulted. The best example of such cases is afforded 

 by the well-known instance of Alexis St. Martin, the 

 subject of so many physiological experiments. In this 

 man the abdominal parietes in front of the stomach 

 were torn away by a gunshot wound, a part of the 

 anterior wall of the stomach sloughed, and a perma- 

 nent fistula resulted. Dr. Murchison. reports the case 

 of a woman in whom a gastric fistula was produced by 

 the continued pressure of a copper coin worn over the 

 epigastric region. This coin was deliberately worn by 

 the patient in order to excite a lesion that would 

 arouse the sympathy of her friends. The pressure led 

 to an ulceration that finally opened up the stomach. 

 In many cases the fistula has been due to ulcerative 

 diseases commencing in the stomach itself and spread- 

 ing outwards. 



Some remarkable cases have been recorded where 

 foreign substances have been swallowed and have 

 lodged in the stomach. Certain of these cases serve 

 to illustrate the capacity of the stomach, and among 

 the most striking is an instance where the viscus at 

 death was found to contain thirty-one entire spoon- 

 handles, each about five inches long, four half-handles, 

 nine nails, half an iron shoe-heel, a screw, a button, 



