II. If the muscular wall of the stomach has so lost its tone that it is unable to keep hold of the food, so to speak, and maintain its churn ing movement, serious forms of indigestion will arise.
This lack of movement will become most significant when the time comes for the food to be propelled towards the pylorus and into the bowel. In marked degrees of it the stomach will cease to behave as an active organ, assist ing digestion by its rhythmical action and finally emptying itself completely. It will behave as a lifeless sac into which food is tumbled, and which bulges out in proportion to the amount thrown in. In such a stomach digestion cannot go on normally, because it is necessary for normal digestion that digested portions be removed as soon after they have become fluid as possible, and this cannot be done because the propulsive movements of the stomach are deficient; and in the next place the stomach is never properly emptied.
III. The gastric juice may not be defective, and the muscular tone of the stomach may be sound to begin with, yet if the digested food cannot leave the stomach because the pylorus is narrowed or blocked, the whole digestive process is upset. A person may be born with a pylorus narrower than usual (this is dis cussed under diseases of children) and digestive troubles may be constant from birth up. But the narrowing may be brought on by ulcera tion, by the pressure or obstruction of a growth, or by inflammatory adhesions. Sooner or later, according to the degree of obstruction, the symptoms of such a condition become so marked and severe as to make it impossible to set them down as due to simple indigestion.
Broadly speaking, these three general condi tions will include all cases of indigestion, from the simplest to the most severe, which have their origin within the stomach.
How then can the physician tell which is which? It is only necessary to indicate this in the briefest possible way.
The Methods of' Detection of Stomach Disease in use by a Physician.—If the patient be laid upon his back, with his head and shoulders slightly raised, and the knees supported by a pillow under them, and the abdomen is then uncovered, an experienced eye will observe whether the shape of the abdomen is that of health, or whether it bulges unduly in the region of the stomach.
By laying his hand over this region, and moving his fingers in a trained way, according to the method called palpation, aided by tap ping on a finger of the flat hand with a finger of the other, one may be able to make out whether the stomach occupies its usual position and is of the usual size. The fingers, pressed deeply, may be able to feel the presence of any unusual fulness or solidity, and detect whether there is any pain or tenderness, and the phy sician's knowledge of locality will enable him to surmise at what part of the stomach the pain, if any exist, is produced.
The Use of the Stomach-Tube to Deter mine Stomach Disease.—But modern methods have placed in the physician's hands far more valuable means of diagnosis. For he may pass into the stomach, through the mouth and gullet, a soft rubber tube by which some of the stomach contents may be removed. These contents are then filtered and submitted to a variety of tests to determine the amount and chemical nature of the acid present, and the degree of activity of the gastric juice as regards pepsin. The various reactions will also enable him to tell quite accu rately whether abnormal substances are pre sent, or whether any abnormal fermentation is going on. Some of the contents may also be submitted to microscopic examination, and the presence of organisms, as well as of matter, blood, &c., may thus be detected. Further, through the tube, water may be passed into the stomach, and the quantity it can hold be thus determined. The ordinary capacity is from to 2 pints. This water may then be siphoned off, and, the tube still remaining in position, the patient may be laid flat on a couch, an elastic ball may be attached to the outer end of the tube, and air may be pumped into the stomach till it is fully blown up, when its shape and size will be fully revealed by the way in which it bulges out the belly-wall.