The tube should either be long enough, when it has reached the stomach, for its outer end to be lowered below the level of the stomach, or it is necessary to have an extra piece of rubber tubing ready with a glass or other con nector to slip into the outer end of the stomach tube. If so, this added piece must be quite tightly secured, lest the stomach-tube slip off and be swallowed. Some precaution should always be taken to prevent this, unlikely though it be. A piece of cord firmly secured to the tube, without compressing it, would do. But the author prefers to use tubes sufficiently long to obviate the need of any such precau tion. A small funnel is easily fitted on to the outer end to permit of pouring water down the tube into the stomach. Fig. 111 illustrates the tube passed, and how the tube is raised to fill the stomach. To empty the stomach the funnel need only be lowered and inverted over the bucket.
How the Sufferer may be guided in deciding whether it is the Stomach that is at fault.—But this book is designed to be used by many far out of the reach of skilled advice. It would be absurd to suppose that by any amount of reading they could be taught to determine for themselves what it is so diffi cult often for the most skilful physician to decide after careful examination for them.
Nevertheless it is needful to try to give some guidance for such circumstances, and a long experience suggests to the writer that some of the gravest possible mistakes might thereby be avoided.
Seat of Swelling.—If the reader will study Plate XII., he will see the position occupied by the stomach in relation to the ribs and front of the body, and if there be any fulness or pro minence of the belly accompanying his symp toms of indigestion, be will be able to have some idea whether it is in the neighbourhood of the stomach or not, that is, in the region just below the ribs from the end of the breast-bone down to within 3 finger-breadths or so from the navel and to the left.
The Location of Pain or Tenderness.— The patient, lying on his back with head and shoulders slightly raised and pillow behind knees, should next try to locate exactly the posi tion of pain or tenderness by pressing firmly with his fingers. Fig. 112 shows by (lotted circles the chief seats of pain due to stomach disorder, while the seat of pain on pressure in other conditions is indicated by shadings. Ap pendicitis is frequently ushered in by sickness and vomiting, suggesting stomach disorder, and much precious time is lost thereby. If the pain be near the right groin in the locality ndicated in the figure, skilled advice is most irgently required.
The Relation of Pain to Food is very sug 4estive in stomach disorders. The pain or
liscomfort is usually distinctly related to the ;aking of food, beginning soon after a meal, unl lasting till the stomach may be supposed to be empty. In ulceration of stomach it usually begins half an hour or so after the meal, and lasts till near the time for the next meal. In some cases the pain is not marked for 1 hour, and then goes on increasing in intensity till just before the next meal. This suggests ulcer near the pylorus, irritated by the passage of the digested food over it.
If pain, beginning ti hour after a meal, is stopped for a time by a fresh supply of food, it suggests obstruction to the outlet at the pylorus, since the propulsive movements of the stomach become active about the time named after a mcal, and are allayed for a season by more food. In cancer, the pain may have the characters of that due to ulcer, but frequently it Is constant whether food be in the stomach or not.
The Character of Pain should help the judgment. In ulcer and irritable conditions of the stomach it is hot and burning, but in the former case it is, as we have seen, usually localized at a small area, while in irritable conditions, as in chronic catarrh, it is diffuse. In obstruction the pain is cramp-like, and is indeed due to cramp-like movements of the stomach wall endeavouring to force the food through the blocked orifice.
Vomiting occurs in diseases that have no relation to the stomach ; but when due to stomach disorder any digestive pain or dis comfort is usually greatly relieved by the emptying of the stomach. When the stomach is highly irritated, the vomit is very acid, and where there is chronic catarrh the vomit is ropy with mucus. In ulcer the vomit is also highly acid, but it frequently is coffee coloured from admixture with blood. In dila tation of the stomach the vomiting may occur only once a day, or once in two days, but then a very large quantity is ejected, as if the col lection of several meals. If there is bile in the vomit it is a proof that the outlet of the stomach cannot be blocked, since bile should not be able to pass up from the small bowel if it were.
Vomiting also occurs when the stomach is healthy but the bowel is obstructed, and this is certainly the case when the vomit is coloured by and smells of motion.
Eructations of gas point to the stomach as the seat of disorder, and if large and persistent suggest a much distended or dilated stomach, or a very slow digestion.
These are the main facts which would help anyone in arriving at a judgment as to whether the symptoms from which he suffers were due to stomach disease or not.