114 STUDIES IN CLINICAL PHYSIOLOGY 



measures as rest in bed, milk diet, and lavage. Pawlow 

 on theoretical grounds recommends fats and oils to 

 check the flow of the gastric juice. These measures 

 are of course not applicable in the presence of an acute 

 ulcer causing haemorrhage. 



If these means are not successful, it is very desirable 

 to perform laparotomy and to explore the stomach, 

 duodenum, appendix, kidney, and gall-bladder. If 

 gastric or duodenal ulcer is present, gastrojejunostomy 

 is of course indicated. If no abnormality can be 

 discovered in either stomach or duodenum without 

 opening into them (which is seldom if ever called 

 for), it may be that some adhesions or kinking of the 

 appendix may be found, and removal of the organ 

 will effect a cure in many of the cases but not all. 

 It is shown by Paterson, the Mayos, Sherren, and 

 others that about 75 per cent of the many hundreds 

 of cases of dyspepsia without ulceration treated by 

 removal of the appendix are cured. It might be 

 well to do a gastrojejunostomy at the same time ; 

 one of Paterson's failures was subsequently reheved 

 by this means. This operation may lead to a 

 permanent cure of pain, vomiting, or haematemesis, 

 even when no abnormahty can be found.* The 

 important point is that it is not right to do the 

 short-circuiting operation on a normal stomach 



* Tbis-statement has been denied by one or two reviewers of the 

 first edition, but is nevertheless persisted in. Admittedly the 

 results are not so good as when a definite ulcer is found, but out of 

 ten cases treated by gastrojejunostomy in which nothing was 

 discovered, six were much improved years afterwards. See A. 

 Rendle Short, " End-results of Operations on the Stomach and 

 Duodenum," Bristol Med.-Chir. Jour., 191 1, p. 220. 



