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Diseases of the Oesphagus and Stomach

patient, pain, symptoms, sensations, conditions and symptom

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DISEASES OF THE OESPHAGUS AND STOMACH - no longer guided by the objective phenomena which serve for such clear indications in the affections of the mouth and pharynx. we now come to a class of diseases which for their complete in vestigation require, more than all others, perhaps, the exercise of sound judgment and careful discrimination. Making up, as they do, the largest portion of the sum of minor ailments which medi cine is called on to remedy, individually, their importance, with one or two exceptions, is not great ; and consequently the oppor tunity of studying them in hospital practice is but small, while that little is too often neglected, from the necessity the student feels of giving his short period of study to the graver or more acute diseases presented to him.

The common disorders of the digestive canal may be said to be but three, dyspepsia, constipation, diarrhoea. And yet in each of these conditions how much remains behind—how much to guide our practice if we but knew it----how much that is as yet obscure if not quite inexplicable! It is quite beyond the scope of our present plan to enter into all the details connected with so complex a subject as dyspepsia; it must suffice to point out the leading features by which symp toms may be referred to the stomach, and the general characters by means of which one form may be discriminated from another, and so that class of remedies be selected which may reasonably be deemed most suitable. It will probably be advantageous to consider the more severe diseases before inquiring into those which are less important.

Much of the uncertainty that attends our knowledge of disorders of the stomach is caused by the necessity of relying so much on the sensations of the patient, since in many cases no anatomical lesions have been clearly asso ciated with the symptoms detailed. The practitioner is consequently obliged to theorize as best he may on the d priors effects which he would expect from faulty secretion, deficient muscular action, and nervous irritability ; and to contrast these inferences with sensations, the real import of which he can only guess at, because the descriptions of the patient are generally's° faulty, that in asking questions he often suggests the very answers he receives. A

dyspeptic physician is very likely thus to mislead both himself and his patient, by rendering their sensations into the language of his own ailments.

The information we derive is obtained from three distinct sources, the sym pathetic affections of the head, and those of the chest, and the symptoms more directly obtained from the stomach and abdomen. In the head, pain, vertigo, partial blindness, temporary derangement of function, &c. In the chest, cough, and especially palpitation, local pain, &c. For the grounds of dis tinction by which these functional disturbances may be recognized, reference must be made to the chapters on the diseases of those organs ; here suffice it to say that the symptom generally stands alone ; there is no other traceable to the same region, such as there certainly would be were the single symptom a sign of disease there : more especially, it is transient, and generally of fre quent recurrence, so that a patient perhaps complains of palpitation when heart and pulse are alike quiet and normal at the time of examination, to be again excited by the same sympathy which had previously caused it.

But, in addition, some other symptom, or rather train of symptoms, will be found in connection with the stomach ; loss of appetite or vomiting, sense of weight, distension or pain, either referred directly to the stomach or distinctly aggravated by the opposite states of either fasting or repletion, combined generally with irregularity of the bowels, constipation, or relaxation, or an alternation of both conditions. The seat of the pain or uneasiness varies a little within certain limits; but there will generally be no difficulty in assigning it to its proper source, by investigating the conditions and signs of disease in adjoining organs, which might by possibility give rise to similar symptoms.

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