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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    of many others have shown that the mucous membrane of the stomach plays little part in absorption, either of liquid or of other matters. In consequence, obstruction of the pylorus and vomiting lead to rapid desiccation of the tissues and to decrease in the quantity of the urine. This decrease, however, is largely dependent upon associated conditions, and may fluctuate considerably, so that the exact quantity is of little value in diagnosis or in determining the degree or i:>rogress of the disease. We have thus sketched the principal methods of investigation and points in the symptomatology which are of value in the determination of gastric dilatation. Of necessity allusion has been made to certain methods which we do not ourselves employ, and of whose value and reliability there may be much question. The methods upon which we rely are those of auscultatory percussion and inflation, and upon Dehio's method for determining the lower border of the organ. The mere deter- mination of one or another of the borders of the stomach is of little value ; but taken in connection with the other portions as determined by the same or supplementary methods of investigation, and with the dis- covery of deficient motor activity, the diagnosis can generally be made with ease. Mistaken diagnoses are more often the result of insufficient examination than of unreliability of methods at hand. Differential Diagnosis. The points upon which this will rest have been more or less thoroughly considered ; but it seems advisable to point out certain contrasted conditions with the indications pointing to one or the other, and to consider somewhat the methods by which an opinion may be formed as to the original cause. Megalogastria ami Oastrectasia. Ewald, Riegel, and others have de- scribed cases of enlargement of the stomach without symptoms of func- tional disturbance. Such cases are doubtless instances of physiological or natural largeness of the stomach, and may propeidy be designated as megastria or megalogastria. What we have before said regarding the variation in the size of the stomach in different persons need not be repeated, but it is clear that no definite limits can be assigned to what may be considered a normal stomach. How large a stomach may be without danger of stagnation of food on account of the mere capacious- ness is difficult to say, and cases of enlargement sufficient to be certainly recognized by clinical methods, and in which no symptoms of dilatation are found, are comparatively rare. The diagnosis is simple enough, and depends altogether upon the fact that no sign of stagnation of food or of serious disturbance of digestion can be discovered. The only diffi- culty offered is to distinguish cases of obstructive enlargement with com-