Diagnosis of dilatation of the stomach / by William Pepper and Alfred Stengel.

  • William Pepper
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Diagnosis of dilatation of the stomach / by William Pepper and Alfred Stengel. 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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    on the one hand, and on account of the very wide variation in the size of the stomach in presumably healthy individuals, on the other hand. In so far as the value of percussion itself is concerned, it must be recog- nized that the amount of distention, the quantity of material contained within the stomach, and the condition and position of adjacent viscera must largely influence the results. In particular, the position of the lower border is difficult to determine from the fact that the tympany obtained over the transverse colon may so closely resemble that obtained over the stomach that an accurate separation of the two is impossible. In the second place, not rarely the colon overrides the stomach and thus makes the determination of the lower border of gastric tympany im- practicable. When the left lobe of the liver is enlarged or unnaturally prominent in the epigastrium it is difficult or impossible to determine the exact outlines of the stomach even though it be quite well distended. To a certain extent percussion may be rendered more precise and valu- able by cleansing the colon carefully, and by repeating the percussion in different positions ; but despite these precautions no reliable deductions can be drawn. Other Methods of Determining the Size a>id Capacity of the Stomach. Perhaps the oldest method devised for this purpose is that of Leube, of introducing a stiff sound and palpating the end through the abdominal walls. The dangers and unreliability of this method have, however, led its originator himself to abandon it, and the method is no longer prac- tised anywhere. A variety of methods have been introduced which, for the most part, depend upon the amount of liquid that may be introduced into the organ. These, however, are all subject to objections of a serious character. The tolerance of the patient varies so greatly that one will complain of pain when the slomach is scarcely at all distended, while another will bear the greatest possible amount to be introduced. This objection alone would suffice to make these methods unreliable were there not the greater difficulty—that stomachs vary widely in their capacity in different indi- viduals of the same age, size, etc. We therefore place no reliance at all on these methods excepting so far as it may be assumed with tolerable certainty that a stomach which will accommodate 2.5 or 3 litres is prob- ably larger than normal. The usual standard that has been adopted is 1700 c.cm. ; but this is certainly too small to warrant positive deductions. In another group of methods the attempt is made to localize the lower border of the organ, and of these that wdiich has attracted most atten- tion is the method of Dehio. This observer, it will be recalled, deter-
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