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

  • Pepper, William, 1843-1898.
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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    the pylorus, have generally corresponded with the outlines given by Luschka; while in cases of dilatation and in cases of gastroptosis wide variations from the normal position or size have been readily demon- strated. Inflation. Far more useful, however, than any of the methods thus far described is that of inflation. A number of methods have been pro- posed, the best known of which is that performed by administering sodium bicarbonate followed by tartaric acid. Our experience with this method is comparatively limited, as the objections which have been urged against it, and which have occurred to us, have made us hesitate to employ it, except in occasional instances; and, further, because we have found the method of inflation with atmospheric air entirely satis- factory. The administration of effervescing mixtures seems to us objec- tionable from the facts that the distention is entirely uncontrollable, and that in cases of ulceration or other disease of the stomach dangerous results might follow. Thus we have known of cases in which consider- able irritation was produced, and others have been reported in which actual hemorrhage was caused. The method is unreliable also in that at times the amount of gas generated falls short of that necessary for distention of the stomach. Still further, it may be objected that sudden and intense distention may give rise to serious pressure or reflex disturb- ances, though no actual cases proving this suspicion are known to us. On the other hand, the method of inflation with atmospheric air has the one objection, that it necessitates the passage of a stomach-tube ; but this is certainly an objection of little importance. There are, of course, certain cases in neurotic or oversensitive individuals in which the passage of a tube may be objectionable ; but where the necessity of making an accurate diagnosis of a possibly serious gastric disease arises, objection to the passage of a stomach-tube is certainly scarcely worth considera- tion, and, as accurate diagnosis will require the passage of the tube for other purposes, it is not likely that this objection will interfere with the application of the method. For the purpose of inflation we employ a simple bulb, such as that used in the ordinary Davidson syringe, and begin the inflation by vigorous and rapid compressions, so that the amount of air projected into the stomach at the beginning may be as considerable as possible. In this way it has seemed to us that the pylorus is at once placed in a condition of spasm or contraction, and that thus the escape of the air into the intestine is prevented. The latter accident, however, does sometimes occur in cases of relaxation of the pylorus; but more frequently some of the air tends to escape along the