This condition is much less frequent as the result of cancer than of simple ulcer of the stomach, and occurs in only 026 per cent, of the cases of the former disease (vide p. 51). It is interesting to observe that out of the nineteen cases which have been recorded, fourteen occurred in women and only five in men, the average age in the former sex being forty-two and in the latter fifty-six years. In every instance the formation of the fistula was preceded for some time by a palpable tumour, which usually occupied the umbilical region, but occasionally presented itself in the left or even in the right hypochondrium. Pain was invariably present, and. the temperature of the body was often elevated. In those cases which were not subjected to surgical treatment adhesion of the growth to the abdominal wall was followed by redness and oedema of the skin, subcutaneous emphysema, and finally by the discharge of a small quantity of turbid fluid through one or more openings at the summit of the tumour. The discharge consisted of pus, serum, or of a greyish fetid material, which, after an interval that varied from eleven days (Petit) to a month (Auger), became mixed with particles of food. The introduction of a probe revealed a cavity of some size behind the abdominal wall, but no direct communication with the stomach could be discovered. Death ensued from debility, aggravated by the discharge, and occurred at varying intervals after the formation of the fistula, viz. three days (Fereol), twentyone days (Wencker, Stokes), twenty-three days (Leflaive), one month (Cameron, Balluff, Murchison, Monod), six weeks (Coote), seven weeks (Feulard), and three months (Petit, Auger.)
As a rule the intra-peritoneal abscess which preceded the formation of the fistula was easily recognised, but in four instances where the patient was less than thirty-five years of age it was mistaken for tubercular peritonitis. In several cases also the connection of the abscess with the stomach was not surmised until after the discovery of particles of food in the discharge.