In speaking of htematemesis (Chap. VII., Div. II., 3), the different forms of hemorrhage were enumerated: and it may be here added that, when pre ceded by local symptoms referable to the stomach, that which occurs early in life, and is abundant and more florid, is probably caused by simple ulcera tion ; that which is seen in advanced life, and is small in quantity and grumous in appearance, is probably connected with malignant disease. If the blood have been brought up at some previous period, and the symptoms continue stationary, we may feel considerable confidence that the disease is not can cerous.
c. Gastritis.—The occurrence of idiopathic gastritis is so rare in clinical medicine that practically it need scarcely be referred to. It indeed, only known as the consequence of the ingestion of some irritant, probably of the nature of an acrid poison ; but in rare instances it has followed the taking a draught of cold water when the body was much heated by exercise, or has been caused by indigestible food.
Both the simple ulcer and the thickening of the pylorus with out malignant growth have been referred by some pathologists to chronic gastritis : but they have been unable to point out any characters by which the gradual changes can be recognized, be fore they have reached the points at which we have attempted, though so ineffectually, to make them subjects of diagnosis.
The symptoms of acute gastritis may be seen as part of more general inflammation of the peritoneum, when the stomach is intolerant of the least portion of food or drink Lthese again may be closely simulated by sympathetic irritation of the stomach in inflammation of the brain.
d. Dilatation must be noticed, as it is found in cases in which, from the duration of the disease, there must always be some doubt as to the existence of organic lesion. It is probably con nected, when of great extent, with some degree of obstruction to the pylorus, but may, likewise, be a consequence of habitual dis tension and loss of muscular power. In its minor form it gives rise to extraordinau tympanitic resonance over the whole of the lower part of the left side of the chest, as high as the axilla ; in its more aggravated condition it forms a sac which almost fills the abdomen, and has even given rise to the idea that the patient was laboring under mites. In the former case, the complaint of pain on the left side will naturally lead to percussing the chest ; and the tympanitic sound extending below the edges of the ribs, as well as above, taken in conjunction with the slow progress of the ailment., can leave no doubt as to its true character. In the
latter there is generally a history of occasional vomiting, when very considerable quantities of fluid have been brought up ; and if this have occurred recently, extensive tympanitic resonance will be observed extending over the epigastrium and left side generally ; if for some days there had been no vomiting, we find distinct fulness below the epigastrium, of a rounded form, extend ing in the direction of the umbilicus, and passing thence towards the left hypogastric or lumbar region, superficuslly tympinitic, . but accompanied by deep fluctuation, with gurgling noise on move ment, which has been mistaken for succussion.
Latterly, a valuable aid to diagnosis has been obtained from the discovery of the microscopical 8arcina ventricull in the vomited matter, which always betrays a great tendency to ferment. This appears at present to indicate no more than a retardation of the food in the stomach, with a want of power completely to empty its contents ; and we are consequently led to 'associate its existence with the probability of a condition of dilatation, especially that which acknowledges thickening of the pylorus as its cause.
§ 8. Functional Disorders of the Stomach. —Dyspepsia proper, accompanied by its multifarious symptoms, can only be safely predicated when, after careful weighing of other possible states of system, we find a remaining amount of disturbance which we have failed to account for in any other way. And hence it is a rational conclusion that dyspepsia does coexist with different states which, while sufficient to account for some of the symptoms, leave others unexplained. It stands in close relation to most diseases of the abdominal viscera, either as their cause or their effect ; and it may be associated with almost every chronic ailment, so as to make it difficult to determine, when we are satisfied of the coexistence, what their exact relations are to one another. Such, for example, is its combination with anaemia and hysteria ; in both quite as frequently the cause as the consequence of the general state ; in both alike demanding distinct recognition and separate treat ment.