The surgery of the stomach : a handbook of diagnosis and treatment / by Herbert J. Paterson.

  • Paterson, Herbert J. (Herbert John), 1868-1940.
Date:
1914
Catalogue details

Licence: In copyright

Credit: The surgery of the stomach : a handbook of diagnosis and treatment / by Herbert J. Paterson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    hours. In most cases the pain is referred to the epigastrium, usually to the right of the middle line. Some of my patients stated that the pain radiated downwards to the right iliac fossa, while, with less definiteness, others said that the pain radiated downwards. In one interesting case the pain radiated to the left iliac region, and at the operation the caecum and appendix were found in the left iliac fossa. This radiation of the epigastric pain to the lower part of the abdomen is a most important diagnostic symptom, and in my experience, is one which never occurs in gastric, or duodenal ulcer. Occasionally very definite hunger pain is a symptom. Sour eructations and vomiting are present in considerably more than half of the cases. Flatulence and a feeling of distension after food is a very constant feature. Haemorrhage occurs as an occasional symptom (15 per cent, of my cases), and I think there can be Httle doubt that the haemorrhage comes from the gastric mucous membrane. In one case, in which I opened the stomach, the whole of the mucosa was studded with numberless bleeding-points. The interior of the stomach was in the condition described as weeping blood. Probably this condition of the mucosa is due to the irritation of hyper-acid gastric juice, or to the continual presence of gastric juice in the fasting stomach (hyper-secretion). Periodical Exacerbations.—^A noteworthy feature of these cases is, that in many instances (67 per cent.), there is a periodical exacerbation of the symptoms. As a rule the patients are not quite well during the interval between the attacks, but suffer from discomfort and flatulence after food. Another striking feature is the long history in a large number of the cases. The average duration of illness in my cases is six years, although in one or two of them there was an interval of one or two years between the attacks. Tender-