Surgery of the stomach / by Walter G. Spencer.

  • Spencer, Walter George, 1858-1940.
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Surgery of the stomach / by Walter G. Spencer. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    AuscuUalion. -This is chiefly of service in recognising the gurgling sound made by fluid falling from the cesophagus into the stomach which is delayed in oesophageal obstruction. Also, in an hour-glass stomach, fluid has been heard passing from one pouch to the other. Vomit or lVashi?igs.—T\\Q examination of the vomit, considered in relation to the time of the previous meal, although important, does not yet allow of precise conclusions. Generally speaking, malignant disease diminishes the acidity of the gastric juice, which is thicker and more ropy with mucus, and shows lactic acid. But dyspeptic conditions attended by atrophy of the glands of the mucous membrane, with or without dilatation, also cause a diminution of hydrochloric acid with an increase of lactic acid, also of butyaac acid. Generally speaking, in simple conditions the hydrochloric acid is normal in amount, or there may be a marked increase. Delayed Dii^estion or Gastric Digestion is delayed beyond several hours in pyloric obstruction, and there is an excessive secretion of fluid which has a sickly odour like fermenting wine-lees. Micro-organisms.—Most important observations have been made on the long and short bacilli, also on the sarciiice and other organisms found in the stomach, but as yet no decisive conclusions have been reached. There are other methods more elaborate and of less certain value and expediency which are generally applicable only in a few cases, as they are apt to be a source of discomfort to the patients. IVashing otet, or Lavage of the Stomach. —patients are in no way troubled by the passing of an oesophageal tube and the irrigation of the stomach ; they become used to it or learn to do it for them- selves. But others object strongly, it repels them from undergoing further treatment, and may cause mai'ked shock. Generally speaking, it is better to confine oneself to the examination of the vomit rather than promote discomfort or worse. If the patient is fed for a few days before the operation, largely by the rectum, and during the last twelve hours entirely so, the natural antiseptic action of the hydro- chloric acid is able to assert itself. If the patient is not disturbed, the contents of the stomach may be removed after a meal, e.gtwelve hours after an ordinary meal, or six hours after a test meal of soup, meat, bread and a glass of water. If undigested materials are found after this interv'al it is evident that digestion is distinctly delay^ed— there is gastric stasis. Artificial Di.stension.—.^s an addition to percussing the outlines of tlie stomach, the organ has been artificially distended. This has been ilone by giving a patient 40 to 60 grains of bicarbonate of soda,