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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    mines the lower border by introducing measured quantities of water into the stomach and determining the lower border by percussion, the patient standing erect. He has determined that the lower border will be found 11.5 cm. below the end of the sternum after the introduction of one-quarter litre of water, and that the border descends between 2 and 3 cm. with each additional quarter litre introduced ; but that in the normal individual the lower border never descends below the umbili- cus. With this last conclusion we are quite ready to agree, though we cannot regard the method free from objections or its results valuable in the diagnosis of dilatation. Our own studies with other methods lead us to entirely the same conclusions regarding the lower border, viz., that it always lies above the umbilicus. When, however, it is found below the umbilicus the conclusion is by no means warranted that the stomach is .dilated. The same thing will be found in dislocated stomachs, and this condition, we are convinced, is one of great frequency. The method itself is open to some objections which impair its reliability; but, on the whole, it is useful for the determination of the lower border of the organ. The great weakness of Dehio's plan, or rather the great error of many of those who have used it, is the interpretation that has been placed upon the results. We still employ the method and find it satisfactory ; but in all cases we seek to control the result by auscultatory percussion and by inflation, and in particular to determine the position of the lesser curvature and of the pylorus. If, then, by Dehio's method we find the lower border of the organ below the umbilicus and the pylorus and lesser curvature similarly depressed, we conclude that dislocation or vertical position is the cause of the depression of the lower border rather than dilatation. Finally, we would add a few words regarding the method of illumi- nation. This, we must confess, has not from the first appealed to us as a practical method, though in hospital practice it seemed to offer the hope of accurate and useful results. Our own experience is very lim- ited and not very encouraging ; and if the results of Martius and Meltz- ing indicate the conclusions as to the normal situation of the stomach, and are to be attributed to the method, and not to their having investi- gated cases of gastroptosis, we are disposed to believe that gastro- diaphanoscopy will not prove a reliable guide. Certainly the method of inflation, which can scarcely give erroneous results when it is at all suc- cessfully practised, and the experience of post-mortem examination do not warrant the belief that the stomach normally occupies a position so far down in the abdomen as Martius and Meltzing have found. It seems