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.

    17/36 (page 15)
    Dehio has claimed that his method of determining the lower border of the stomach by introducing measured quantities of water is useful also for the estimation of motor activity. He has found that in cases of atony the lower border of the stomach descends to the umbilicus with the addi- tion of only moderate quantities of liquid, while the border in dilatation is found below the umbilicus eveu after the introduction of the first quan- tity. From such differences in different cases he would determine the less or greater motor power. This assumption, however, seems to us an unwarranted one, and we agree with Riegel in his assertion that greater elasticity does not of necessity imply less motor power ; but entirely aside from this point, the method of Dehio is fallacious, in that it does not take into consideration movability of the stomach apart from dilatability. In addition to these methods of determining the motor power directly, there are certain examinations, particularly the chemical investigation of the gastric contents, which furnish evidence of the decay of food in the stomach. The most striking and obvious feature is the decomposition which leads to sour and ill-smelling vomita. To a certain extent this is a measure of the motor insufficiency, as is also the presence or absence of sarcinae, yeast-fungi, and other organisms of fermentation and putre- faction. In cases of extreme delay of the contents of the stomach decomposition of the starchy and saccharine foods may lead to the fer- mentation of lactic, acetic, butyric, or other fatty acids, while putrefac- tive changes of proteids lead to ill-smelling gases containing sulphuretted hydrogen in particular. The existence of these substances in vomited matters, or in the stomach-contents removed with the tube, is always indicative of undue retention of the food. The amount and kind of decomposition that prevails depend to a large extent upon the kind of food taken and the character of the gastric secretion, especially upon the presence or absence of free hydrochloric acid. Boas has recently maintained that the presence of lactic acid in the stomach-contents after a test-meal containing no lactic acid is specially significant of carcinoma. This point is in a measure established, though it has not the pathogno- monic importance Boas sought to give it. Lactic acid is occasionally found in non-malignant cases, as in one of our present series. On the other hand, repeated examination may fail to show it in cases of carci- noma, as we have found. We need not enter more fully upon this con- troversy now. Suffice it to say that lactic acid when present is an indi- cation of stagnation. The amount of urine is another indirect evidence of motor insufficiency. Yon Mering's investigations and the subsequent clinical observations