Two strange cases of functional disorder : with remarks on the association of hysteria and malingering / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Two strange cases of functional disorder : with remarks on the association of hysteria and malingering / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the time of her marriage in that year. On the night of her marriage her husband is said to have had haemoptysis and to have died not long afterward. The commencement of her symptoms apparently dated from that time. The chief of these symptoms were the follow- ing: vomiting (sometimes bringing up a little blood), distention of the abdomen, and great constipation. There was no evidence that the idea of possible pregnancy had anything to do with the distention of the abdomen, which was afterward found to disappear at once under chloroform. The vomiting persisted on and off. At one time there was undoubtedly fecal vomiting. Actual scybala or formed faeces from the large intestine were certainly vomited on more than one occasion. At times, when an oil enema was administered, some of the oil reappeared in the vomit. In order to guard against imposture and to obtain an accurate diagnosis, an enema colored with methylene blue was administered at the suggestion of Dr. zum Busch. Some of the methylene blue appeared in the vomited matter within ten minutes after the administration of the enema. Any deception on the patient’s part was altogether impossible. This observation and the history of hsematemesis seemed to fur- nish reasonable grounds for supposing that a fistulous communication between the colon and stomach or duodenum might exist. It may be noted, however, that when the gastric contents were evacuated by the siphon tube immediately after an enema containing methylene blue had been administered, no methylene blue was found to be present in the contents of the stomach. This showed that the methylene blue injected by the rectum took at least some minutes to reach the stomach. Furthermore, there was no extreme emaciation, and Bee,1 * * * * * 7 who collected the records of sixty-two cases of gastrocolic fistula and found that the usual cause was cancer or ulcer of the stomach, men- tions among the chief symptoms abundant diarrhoea, which was cer- tainly not present in this case.8 However, to make a long story 1 Bec: Th6se de Lyon, 1897; quoted by H. D. Rolleston; Practitioner, London, 1899, lxiii, 199. * Sometimes, however, gastrocolic fistula may be accompanied by constipa- tion, as is shown by the experience of Brieoer and Unruii, quoted by F. Perutz: “ Zur Kenntniss der Magenkolonfisteln,” Med. Klinilc, Berlin, 1906, ii, 64. Perutz (loc. cit.) mentions another valuable diagnostic sign of gastre- colic fistula, namely, that fluid specially colored with methylene blue or eosin and poured into the stomach rapidly disappears and then reappears per rectum as a fluid motion of the particular color used.