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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![II. Si/mptoms at the penod of formation of the Fistula.—It is probable that sometimes the fistula may form, without any charac- teristic addition to the previously existing symptoms marking its advent. Thus, in case 2, the first symptom of the fistula (fecal vomiting) came on suddenly, after some weeks of dyspepsia, when the patient was walking in the street, and was attended by no other unpleasant feeling. In many of the cases, however, the formation of the fistula appears to have been accompanied by some local symptoms, or by disturbance of the general system ; and, perhaps this has more frequently been the case, than has been observed. Thus, in case 11, the symptoms indicating the existence of fistula were preceded by pain in the abdomen, and the passage of shreds of disorganized mucous membrane per anum; in 18, by diarrhoea; in 20, by general pain over the abdomen, urgent vomiting, and quick pulse; in 21, by violent pain in the belly; in 26, by the symptoms of peritonitis, sudden violent pain in the abdomen, vomit- ing, collapse, etc., while, at the same time, the patient himself felt as if something had burst in his belly. In case 29, there was pain and sickness for several days; and in 33, rigors, great prostra- tion, vomiting, brown tongue, and irregular, intermitting pulse. Cases 11 and 26 particularly deserve attention in future observations. III. The Symptoms and Physical Signs after the formation of the Fistula.—When a communicating aperture has been formed be- tween the stomach and colon, there is no bariier to prevent the contents of the one viscus passing into the other—fecal matter from entering the stomach—crude and undigested food from passing into the colon, and so being voided per anum. These results are what might have been naturally expected from the new condition of the parts ; and they are what we actually find. Fecal vomiting, and the presence of undigested food in the stools, are the most frequent and characteristic symptoms of gastro-colic fistula. I shall now consider each of these symptoms, as well as some others, a little in detail. 1. Vomiting.—This has been an almost invariable symptom in all the cases observed during life, in which there has been a free com- munication between the stomach and colon; and in the majority of cases, the vomited matters have contained feces. The following analy- sis shows the frequency of the symptom in the thirty-three cases:— Tn 11 cases, fecal vomiting (2, 7, 8, 11, 18,19, 21, 27, 29, 31, 32). In 3 „ vomiting very fetid (9, 20, 33).^ In 3 „ vomiting not fecal (10, 26, 26). In 2 „ no vomiting (4, 28). In 2 „ history imperfect (1, 30). In 12 „ no history (3, 6, G, 12 to 17, 22, 23, 24). ] In these cases, the fetov may have been due to the presence of feces, but this is not stated; and it is to be borne in mind, that the matters vomited from a cancerous stomach are sometimes very fetid, when there is no fi^luhi.](https://iiif.wellcomecollection.org/image/b21477966_0029.jp2/full/800%2C/0/default.jpg)
