Dilatations of the stomach may be primary, due to disease of the structure of the gastric walls. In these cases there is, as a rule, no mechanical interference at the outlet of the stomach, or such interferences are secondary to some obstruction at the outlet. The causes of this obstruction may be scars from old tric ulcers; especially cancers; tive chronic gastritis; or any peritonitic flammation which may constrict the stomach from the outside. which result in nericystic inflammation may constrict the roan of the bowel immediately below the stomach in such a man ner that it is indistinguishable from an obstruction of the pylo rus. Five such cases are reported in (Progressive Medicine,' by Prof. J. C. Hemmeter, December 1903, p. 45. So the cause of a dilated stomach is not always to be sought within the stomach itself.
A knowledge of displacements and dilations of the stomach neces sarily precludes a knowledge of its normal position. This is admirably depicted in the accompanying illus trations where it is seen that the larger end of the stomach, or the blind pouch, may extend higher than the fifth rib, on the left side, thus reaching up behind the apex of the heart. This readily ex plains the distress felt about the heart, and also the irritable heart action in some forms of gastric disturbance. The dorsal view of this illustration also shows the cor rect or normal relations of the 10th rib just referred to in connec tion with gastroptosis. When the is Aat•Ir4sael /11. 41/1.1.4•1141. 10th tip sticks out like that of the 11th rib in this illustration. The same illustrations also demonstrate the anatomical fact that only a very small portion of the stom ach is palpable through the soft part of the abdominal wall, when it is in normal • posi tion, because the larger part of it is concealed under the ribs and under the liver. So that the simple fact that we can see or feel a large part of the entire stomach projecting through the abdominal wall, when it is distended, is a suffi cient evidence that the stomach is out of place. The stomach can be made visible through the abdominal wall by distending it artificially with carbon dioxide by means of an effervescent mixture containing tartaric acid and bicarbonate of soda. Hemmeter was the first to propose and use a method for locating and determining the size of the human stomach by successful use of the (Boston Medic. and Surgic. Journal 1897), and later another method for recognizing gastric ulcer by means of radio graphy of Digestive Diseases,) Ber lin 1906).
The remaining organic diseases of the stomach necessitates all the intricacies of chemi cal and microscopical diagnosis for their detec tion. They include the various forms of acute and chronic gastric catarrh or, as they should preferably be called, the forms of acute and chronic gastritis, the various types of gastric or peptic ulcers, the various tumors of the stomach, especially cancer, which is becoming more and more frequent. Then there are numerous dis eases of a general nature, such as tuberculosis, typhoid fever, glanders, lymphadenoma and syphilis, to be considered in the study and treat ment of disorders of the stomach.
When ever there is an organic disease of the stomach present it should be sought after with all the resources of modern clinical diagnosis. There should be no dallying with so-called stomach panaceas. Quite a number of the so called incurable gastric diseases which have been allowed to go on to destruction of the glandular layer and absolute loss of peristalsis of the stomach are not incurable in themselves, but have become so from neglect, maltreatment, or procrastination. And even in those cases in which the practitioner is at present helpless, the rapid progress of medical art, especially as ap plicable to digestive diseases, promises a sub stantial gain in the near future.
Bibliography.-- Hemmeter, 'Diseases of the Stomach,' in which there are 1,288 separate publications arranged categorically in separate chapters to which they refer especially, and over 1,000 references in the text; Ewald, 'Diseases of the Stomach,' translated into English by Morris Manges; Boas, (Diagnostik und Thera pie der Magenkrankheiten); Riegel, (Erkran kungen des Magens,> being Vol. XVI of Nothnagel's 'Encyclopedia on special Pathology and Therapy); Stockton. (Diseases of the Stomach' ; Fleiner, 'Krankheiten der Ver dauungsorgane> i Einhorn, 'Diseases of the Stomach' ,• Martin, (Diseases of the Stomach' ; Abercrombie, (Investigations on Diseases of the Stomach); Habershon, (Diseases of the Abdomen); Rosenheim, (Pathologic u. Therapie des Verdauung apparate ; Pick, (Magenkrank heiten' ; Brouar del et Gilbert, 'Traits de Medecine et de Therapeutique,' Vol. IV; Mathieu, (Traite de Maladies de l'Estomac> Hemmeter, (Organic Diseases of the Stomach' ; Leo, der Bauchorgane' ; Robin, (Traite de Therapeutique appliquee,> fast. XII (article on indigestion by G. LeMoine).