Case of communication with the stomach, through the abdominal parieties, produced by ulceration from external pressure : with observations on the cases of gasto-cutaneous fistulæ already recorded / by Charles Murchison.

  • Murchison, Charles, 1830-1879
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: Case of communication with the stomach, through the abdominal parieties, produced by ulceration from external pressure : with observations on the cases of gasto-cutaneous fistulæ already recorded / by Charles Murchison. Source: Wellcome Collection.

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    University of Edinburgh, in 1842, proved by experiment that the diaphragm is rigidly contracted during vomiting. This he ascertained by laying open, and introducing his hand into, the abdomen of dogs which were vomiting from the effects of tartar emetic.1 The correctness of this view is also supported by the powerful advocacy of Messrs. Todd and Bowman,3 and is corroborated by what has been observed in the case of Catherine Ross. This case shows that although the coats of the stomach itself do undoubtedly contract, the principal part of the act is played by both the diaphragm and abdominal muscles. The upper wall of the stomach can be distinctly seen to be pressed down by the diaphragm. The contraction of the stomach appears to be confined to the pyloric region, and to have for its object chiefly the closure of the pylorus, so that when the stomach becomes compressed between the diaphragm and abdominal parietes, the only exit for its contents, in the natural condi¬ tion of the parts, must be through the oesophagus. From all the observations which have been made on the matter, the following would appear to be the mechanism of an act of vomiting: 1. A long inspiration followed by partial closure of the glottis. 2. Contraction of the pyloric end of the stomach, with relaxation of the cardia and oesophagus. 3. Persistent contraction of the diaphragm, with rigid contraction of the recti and oblique muscles. In connection with this subject, I may be allowed to correct an erroneous statement of facts, which is to be found in_ several English works on physiology. Dr. Carpenter, in quoting a case, observed by a French surgeon, M. Lepine, to prove that the walls of the stomach contract during the act of vomiting, observes: “ In this case, the abdominal parietes having been accidentally laid open in the human 1 ‘ Lond. and Edin. Monthly Journal of Medical Science/ 1844 p. 1. 2 ‘Physiological Anatomy/vol. ii, p. 213.