ing to his ufual cuftom. At half an hour after nine o'clock, he drank three cups of carduus benedus tea, as he had often done before. He was afked, why he took the infufion that evening: "because," fays he, "I feel flies to his affiftance, and finds him leaning forwards in his bed, and fupported by three of his fervants. In any other pofture his pain became exceffive. He was unable to lie down, either on his back or his fide, or his belly, and much lefs could he fit on a chair. Bo-"fomething difagreeable in the erhaave was the more alarmed at CC upper part of my stomach, and this appearance, because he well knew with how much fortitude the admiral had fupported the most violent attacks of the gout, without once lofing his patience or his courage, amidst the most excruciating pains. The groans of this man, who on other occafions had been fo patient and immoveable, alarmed him still One of the affiftants then gave the following account:- Three days before this diforder, the admiral had been prefent at an entertainment, where he had eat a little too much. The next day he determined to prevent, by abftinence, any ill effects that might refult from this intemperance. The day before the attack, he had dined, with great moderation, and, had got on horfeback in good fpirits, and feemingly in good health, without the leaft fufpicion of any approaching diforder. When returned from his ride, he abitained from fupper, accord "I have a mind to wash it away." This fenfation, he added, he had often felt before, and had always been relieved by vomiting. Soon after this, he puked, but with difficulty, and in fmall quantity; he then took four more cups of the fame infufion, but without feeling any inclination to vomit, although he had drank fo copioufly. He directed more of it to be got ready, thinking to bring on a vomiting by force. While he was feated, and endeavouring to puke. he fuddenly cried in a moft horrible manner; and drew toge ther all his fervants, who were alarmed by his cries. The admiral then told them that he had burst, or torn or difordered fomething at the upper part of his ftomach; and that the anguifh he felt was fo excruciating, he must certainly be near his laft hour. He then recommended himself to his Creator: a cold sweet flowed from all his limbs; his face and his hands became pale, and his pulfe was no longer perceptible. He ordered them to cover his head and breaft with hot cloths, moistened with dome ftrengthening liquors. They did this, but he found no relief: on the contrary, the diforder feemed to become more violent; and they judged that his death could not be far off. The phyficians who were fent for being at fome distance, the admiral, about half an hour after after this, took of his own accord, four ounces of olive-oil, and of this he threw up a fmall quantity, together with fome of the carduus tea. He then called for two ounces more, which he likewife drank, but without vomiting, or having the leaft inclination to vomit; and his diforder all this time went on increafing. Half an hour after this he drank about fix ounces of warm Dantzic beer, which he likewife kept down without naufea, as he did all that he drank afterwards. This is what had paffed, when Bye, a phyfician whom Boerhaave has not left without his fhare of praife, arrived from the Hague. When he faw the ftate of the patient, he determined to give nothing of an active nature till Boerhaave fhould come. These two phyficians began by confidering the causes of so sudden and cruel a pain, before they proceeded to any remedies. Both of them were convinced, that unless these caufes could be afcertained, no dependence could be had on me. dicines administered at random. After the moft careful examination, they could difcover no other guide to direct them than the feat of the pain, together with an uncommon fenfation in the breaft, of which the patient complained, but which, however, was inexplicable. In other refpects the admiral was apparently healthy. He defcribed the pain as being exceffive, continual, and beyond all imagination. It did not relax a moment. He pointed out the feat of it to be at that part where the fophagus terminates in the ftomach; he then cried out that the pain spread with the fame violenc towards his back. Before hi death, he felt this pain through every part of his breaft. It appeared that his tortures were never fo great as when he felt an inclination to belch, and that the air being ftopped in its paffage inftead of rifing, seemed to distract all the neighbouring parts. The disorder likewife increased whenever he endeavoured to bend himfelf backwards, or to fit upright, This was all that his two phyficians could discover, after all the inquiries and care imaginable. At this part of the narrative, Boerhaave requests the experienced reader to paufe with him awhile, and to reflect on the origin, the progrefs, the fymptoms, and figns of this difeafe. He requires of him the first cause of these extraordinary effects. He had himfelf confidered every thing with the greatest care, and had exerted all the powers of his understanding to find out fome fixed principle, by means of which he might unravel this obfcure caufe, and thus afford fome relief to a disease which hitherto feemed to be every moment increafing. All his fpeculations, however, were useless, and Boerhaave candidly confeiles, that he found himself altogether unable to imagine what could be the fpecies to which this difeafe could be referred. It afforded no fign of inflammation. There could be no fwelling fufpected capable of producing thefe cruel fymptoms, and fo fuddenly. The preceding circumftances afforded no grounds for fuch a fufpicion, and all the vertebrae were in their proper fituation; nor could a difplacement F 4 placement of the foft parts within the thorax, be fuppofed capable of causing these torments. There remained only fome cauftic and mortal poifon to be fuf pected as the cause of thefe horrid fymptoms; but no poifon could be thought of, the effects of which agreed with the circumftances of the admiral's cafe. So that, of all the known caufes of pain, not one could be fixed on as applicable to what he felt. It is well known that the gout, to which he was fubject, might by changing its feat, occafion pain, anxiety, and vomiting; but it never produces pains fo excruciating as thote the admiral complained of in patients who are in other refpects healthy. Befides, the gout exerts its effects flowly, and comes on and goes off by degrees. Of all known difeafes, therefore, there was not found one which could by any affinity throw any light on the admiral's complaint, a violent pain that had come on fuddenly. This was all that could be faid with certainty. Boerhaave knew, from the experience of all ages, that the most acute pain, when not attended with inflammation, may long be fupported. He was, therefore, led to conclude, that the admiral's death would not be immediate; and this was all his prognoftic. Uncertain as was the cause of this disease, it was neceffary to think of fomething which might calm the pain. All the remedies, however, that were given, though of a very mild nature, ferved only to add to the torments of the pa tient. Such was the melancholy fituation of the admiral, and of the two able phyficians, who continued with him till five o'clock in the morning; when Boerhaave's affairs required him to be abfent. At going away, he very prudently advifed Bye to leave Nature a little while to herself, by not attempting to give even the mildest and most innocent medicines; fince the best chofen ones feem. ed hitherto only to have increafed the complaints. His advice was followed, but without fuc. cefs. The admiral remained without any relief till eight o'clock in the morning; and then Dr. Bye faw that the vital functions began to weaken, borne down as it were by the pain; but ftill there was no new symptom that could throw any light on the disease. He then wrote to Boerhaave, and in his letter proposed fome new remedies: Boerhaave agreed to their being tried; but their effects were equally fruitless with the former ones. In thefe circumstances the admiral fettled his affairs. Boerhaave returned to him about three o'clock in the afternoon. The admiral received him with the greatest friendship, and at the fame time told him how ineffi. cacious all the remedies had been, and how certain he was of the ap proaches of death, which he ar dently wifhed for, as a relief from his mifery. Boerhaave perceived, indeed, that this period was at hand and about five o'clock the admiral expired, with the utmost compofure." : The two phyficians converfed together in private, and confeffed to to each other, that it was impoffible for them to conceive the cause of this disease, much lefs of fo fudden a death. They requefted leave to open the body; and this was granted. This diffection proved what no man would even have fufpected. Notwithstanding the great quantity of drink the patient had taken previous to and during the attack, and of which he had voided no part, the inteftines, the abdomen, and bladder, were empty. Nothing but air made its efcape when thefe parts were opened. There was no appearance in either of thefe which could throw light on the nature of the difeafe, The ftomach was almoft empty, it contained no blood or bile, and but very little remains of aliment. At this appearance Boerhaave was fo aftonished, that he hardly knew whether he was dreaming or awake. Thefe are his own expreflions. He then proceeded to open the thorax with the greatest attention. The moment he had penetrated through the diaphragm, though he had taken care not to injure the lungs, a great quantity of air rushed out, and with no little noife. Boerhaave's wonder was increased by this, because this phenomenon never happens but when the lungs have been wounded. The lungs in this fubject appeared fo mall and contracted, that they feemed to have been compreffed by fone very great external force. The heart was perfectly healthy. Boerhaave, on opening the breaft, perceived a difagreeable fmell. He faid at the time, that he fhould have compared it to duck, if it had proceeded from the ftomach. Somebody who ftood by and heard this, immediately obferved, that the admiral had indeed eaten part of a duck at his last meal. It was then that Boerhaave began to conclude that he was going to difcover a very different caufe from any which might till then have been prefumed. He no fooner raised the right lobe of the lungs than he found it fwimming in a watery fluid, which filled the whole of the right cavity of the thorax. To his great furprife he found this fame water, and in the fame quantity, in the left cavity. He found this liquor to be fimilar to the little that remained in the stomach. On drawing it off, it appeared of the colour of Dantzic beer when mixed with an infufion of carduus. The fmell of it, was exactly like that of duck's flesh. Upon the furface of this water was fwimming all the oil the admiral bad fwallowed. There was neither extravafated blood, nor pus, nor any corrupted matter to be feen anywhere. The quantity of fluid found in the thorax, amounted to an hundred and four ounces. The nature of the disease now became more and more manifeft. But it ftill remained to be difco❤ vered, how all that the admiral had fwallowed had made its way into the breast. The left lobe of the lungs was, therefore, carefuly elevated, that Boerhaave might have a complete view of the parts. Every thing appeared to him to be in a healthy itate, until he came within about two inches of the diaphragm, to that part part of the pleura which lies on the left fide of the cefophagus. He there faw diftinctly, a part which was very different from the reft by its mobility, and by its being fwelled; and at the fame time of a blackish colour. This part was round, and about three inches in diameter. In the middle of it was an opening, of about an inch and a half long, and three-tenths of an inch wide. Boerhaave preffed this part flightly with his finger, and there im mediately flowed out, into the cavity of the thorax, a fluid, which refembled that which was before there. His aftonishment was extreme. He next attempted (taking care at the fame time not to confufe the parts) to introduce his fore finger through this opening of the pleura. He found it foft, tumid, and open. Here his at tention, if poffible, redoubled, because he was unable to difcover in this wound any traces of the cefophagus. After having with drawn his finger a little, he pushed it upwards, and came at length to that part of the oefophagus which was broken off. 1 Boerhaave could hardly believe what he faw. He called all the afliftants to him, and fhewed them with the greatest aftonishment, a thing that was fo unexpected. He then, with the fame precaution, directed his finger downwards, and it paffed eafily into the fomach; and then, with a view of giving them a clear idea of the difeafe, he made an opening into the fophagus, about three inches above the wound, and then introducing his finger through it, it paffed out at the opening which had occafioned the difeafe. The caufe of the admiral's death was, therefore, very clearly afcertad to be a laceration of the iophagus; by means of which every thing he drank paffed into the cavity of the breaft, through the opening in the pleura, which took place at the fame time. Boerhaave has proved, that the cardia, or upper orifice of the ftomach, muft have been clofed, after the admiral had taken feven cups of the infufion of carduus benedi&us, and of which he voided but little; because the more the ftomach is filled, the more difficult it is to empty it. We know, that when the ftomach is full, the bottom of it comes forwards, while its upper part forms an angle, more or le acute, with the cefophagus. All the admiral's efforts to vomit were, therefore, chiefly exerted on the diaphragm and cefophagus. It was in the midft of these efforts that the cefophagus burst, being unable any longer to refift the motions of the ftomach and diaphragm; and being the more readily difpofed to rupture by the irritation occafioned by the admiral's finger, which he paffed down his throat in order to force a vomiting. It was at that inftant that the admiral cried out, and drew to him all his fervants, telling them, with fo much pain, that he had torn fomething within him. But it does not appear that the fophagus was lacerated to, this degree at once. The wound was probably gradually increased till the feparation was complete. The ftomach when loaded with fresh |