Diseases of the stomach : including dietetic and medicinal treatment / by George Roe Lockwood ... ; illustrated with 126 engravings and plates.

Lockwood, George Roe

Date:: 1913

Credit: Diseases of the stomach : including dietetic and medicinal treatment / by George Roe Lockwood ... ; illustrated with 126 engravings and plates. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$the greatest and most convincing description of the condition studied radiographically, the duodenum ma}' writhe vigorously for as long as nine hours to force the bismuth emulsion past the point of angulation. The stomach also contracts in these cases as though struggling against abnormal obstruction, although the bismuth meal passes freely through the pylorus. Symptoms.—Pain and vomiting are commonly observed, the pain being due to the efforts of the duodenum to empty itself during the period of its greatest distention. Vomiting may occur at this time and presents the characteristics in some instances of duodenal regurgita- tion, the ejecta being copious, bile-stained, and occasionally containing pancreatic ferments. The symptoms are not permanent but gradually pass away when the patient lies down and the downward traction on the jejunum ceases. A few days' rest in bed will usually be sufficient for the time being to effect temporary cure; the discomfort, however, reappears after the reassumption of the upward posture, especially toward the close of the day. -Pain during the late afternoon or e\en- ing is regularly worse than that in the morning. Intermissions in the se\'erity of the complaint, or even complete absence from all discom- fort for a number of days may occur during the course of the malady. Jordan (loc. cit.) has reported an interesting case with radiographic findings so instructive and con^'incing that it may be well to cite it in this connection. A single woman, aged thirty-two years, had suffered from dj'spepsia troubles for one and a half 3'ears, and during this time had lost nearly 14 pounds in weight. There were loss of appetite and nausea, but no vomiting. She complained of pain in the region of the gall-bladder, saying that she felt there was something distended or gorged in that region which would burst if she tapped it. The distended feeling was also felt in the corresponding point of the back. The attacks of pain were intermittent and were oftentimes absent for days. The patient's general condition was characteristic of intestinal stasis. She was sick and depressed; her hands and feet were cold, her complexion muddy in contrast to her former clear skin; the breasts showed the nodular condition of chronic mastitis; the stomach was elongated and dropped, but normal in other respects. Bismuth emulsion passed through the pylorus. The duodenum was found to be much elongated and dilated to more than double its normal diameter, except the first part, wliich seemed to be the seat of cicatricial contraction. The duodeiuim was undergoing ])()werful peristaltic contractions, amounting to strong writhing movements; this continued for seven or eight minutes without a particle of bismuth being able to pass through into the jejunum. The writhing duodenum was observed$