On gastro-colic fistula : a collection of cases and observations on its pathology, diagnosis, etc. / by Charles Murchison, M.D.
- Charles Murchison
- Date:
- [1857]
Licence: Public Domain Mark
Credit: On gastro-colic fistula : a collection of cases and observations on its pathology, diagnosis, etc. / by Charles Murchison, M.D. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![32), the stomach is noted as small and contracted; and in two (2, 26), the smalt intestines, as contracted or empty, as also the ascending colon in 26 ; while, at the same time, in four of these cases (2, 21, 26, 32) the descending colon is described as dilated, or containing feces. In case 11, the csscum and ascending colon were much distended, but here there was a stricture in the arch, immediately to the left of the fistula. 7. Contents of Stomach and Intestines.—In two cases (9 and 29), fecal matter is noted as having been found in the stomacli after death ; and in two others (21 and 25), undigested food was found in the colon. D.—SYMPTOMS AND DIAGNOSIS OF GASTRO-COLIC FISTULA. Some of the symptoms about to be detailed have only been ob- served in a few, or in individual cases. It is to be recollected, how- ever, that the observers of these cases have had no previous experi- ence of the affection they were treating, nor any knowledge of the symptoms they might expect. In all probability, several of these symptoms will yet be found to be of more general occurrence. Some of them are so marked, that, even with the hitherto obscure knowledge of the subject, in two cases, at least, the existence of the lesion has been determined during life (18 and 29). In reference to the diagnosis of gastro-colic fistula, it will be convenient to consider the symptoms according to three different stages of the affection, viz., the previous disease, the period of formation of the fistula, and the fistula fully established. I. Tlie Symptoms of the Disease which gives rise to the Fistula.— The great majority of cases (28 at least out of 33) have been found to result from either cancer or simple ulceration of the stomach. The symptoms of these affections (epigastric pain, vomiting, ca- chexia, etc.) are sufficiently characteristic, and so well known, that it would be superfluous here to consider them. I would merely desire to impress the importance, of ascertaining the previous exist- ence of either of these complaints, in cases of suspected gastro-colic fistula. Moreover, as the fistula is more than twice as frequently a sequela of cancer as of simple ulcer, the existence of an epigastric tumour would, cwteris parihus, be favourable to the supposition of its existence. Out of the twenty-one cases depending on cancer, In 10, the history is either absent or imperfect (1, 6, 12, 13, 14, 16, 16, 17, 22, 23). In 3, a tumour was absent or not mentioned (9, 10, 32). In 8, a distinct tumour could be felt (7, 11, 18, 20, 26, 28, 31, 33). Thus, out of eleven cases of cancerous fistula, a tmnour \yas detected during life at least in eight. In case 29, also, in which there was no cancer, a firmness was felt on pressure over the e])igapti-ium.](https://iiif.wellcomecollection.org/image/b21477966_0028.jp2/full/800%2C/0/default.jpg)
