CHRONIC GASTRIC CATARRH. 51 f 



such pauses, enormous quantities are evacuated at one time. In such 

 cases there may be a certain regularity. 



In stricture of the pylorus, the vomited masses almost always con- 

 sist of more or less digested food embedded in mucus, which smell dis- 

 agreeably sour and rancid ; they usually contain quantities of lactio 

 and butyric acids, and frequently sarcina. If there be decided acidity 

 which cannot be checked, with frequent and regular vomiting, there is 

 very probably pyloric obstruction ; the diagnosis becomes more certain 

 3 we can make out a consecutive dilatation of the stomach (which 

 may become large enough to fill the greater part of the abdomen) ; 

 this may sometimes be done by inspection of the abdomen, when the 

 distended stomach may be seen as a convex prominence, extending 

 down to the navel, or even below it. Bamberger calls attention to 

 the fact that where the stomach is very low down, not only the greater, 

 but also the lesser curvature, may be made out as a prominence extend- 

 ing from the cartilages of the false ribs on one side to those on the 

 other, just below the so-called " pit of the stomach," which is sunk in. 

 On moving the skin in the epigastrium, we occasionally observe the 

 region of the stomach to swell up and form a tense tumor. This ap- 

 pearance, along with which the contours of the stomach may be felt, 

 is doubtless due to the tension of the organ over its fluid and gas- 

 eous contents which cannot escape, and to its consequent change from 

 its usual relaxed state to a more spherical shape. The most elevated 

 segments of this sphere become visible on the abdomen, while those 

 lying deeper are perceived only by the touch. This change of the 

 stomach from a relaxed, loose bag, to an elastic, tense, spherical blad- 

 der, is usually accompanied by a disagreeable and more or less painful 

 sensation. Apart from the transitory symptom just described, we 

 notice the slight resistance of the epigastric region, which Bamberger 

 has so well described as feeling like an air-cushion. The prominence 

 of the epigastrium decreases or disappears when the patient has vom- 

 ited freely. In one case, treated at the Greifswalder clinic, on giving 

 the patient an effervescing powder, the region over the stomach, and as 

 far down as the navel, swelled considerably, and the contours of the 

 stomach were clearly marked. Then, if part of the carbonic acid 

 were belched up, the swelling subsided. When the stomach is full 

 of food, the percussion dulness is very extensive ; but if, as is usually 

 the case, it contains a quantity of gas at the same tune, the percussion- 

 sound is particularly full and tympanitic at the prominent places. If 

 the patient changes his position, the solid substances always go to the 

 lower parts of the stomach, and the bounds of the dull and clear per- 

 cussion change. 



The above symptoms render the existence of pylonc constriction 



