302 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



a part of the anterior wall of the stomach sloughed, 

 and a permanent fistula resulted. Dr. Murchison 

 reports the case of a woman in whom a gastric fistula 

 was produced by the continued pressure of a copper 

 coin worn over the epigastric region. This coin was 

 deliberately worn by the patient in order to excite 

 a lesion that would arouse the sympathy of her 

 friends. The pressure led to an ulceration that 

 finally opened up the stomach. In many cases the 

 fistula has been due to ulcerative diseases commencing 

 in the stomach itself and spreading outwards. 



Some remarkable cases have been recorded 

 where foreign substances have been swallowed and 

 have lodged in the stomach. Certain of these 

 cases serve to illustrate the capacity of the stomach, 

 and among the most striking is an instance where 

 the viscus at death was found to contain thirty-one 

 entire spoon handles, each about five inches long, four 

 half -handles, nine nails, half an iron shoe-heel, a screw, 

 a button,* and four pebbles. The whole mass weighed 

 2 Ibs. 8 ozs. The patient was a lunatic. In spite of 

 the narrowness of the pylorus, large substances that 

 have been swallowed have been passed by the anus 

 without trouble. Among these may be noted a metal 

 pencil-case 4^ inches long, ten ounces of garden nails 

 and fragments of crockery- ware swallowed by a lunatic ; 

 a fork, a door-key, and other strange bodies. Needles 

 and similar sharp substances that have been swallowed 

 have travelled out of the stomach or bowels and have 

 found their way to the surface at various points in the 

 body. In a. patient under my care at the London 

 Hospital, I extracted from beneath the skin, near the 

 groin, a needle swallowed some months previously. 

 In a case reported in the Lancet, a needle was ex- 

 tracted from the middle of the thigh six months after 

 it had been swallowed, and like instances are recorded 

 elsewhere. 



