Stomach. 215 



disease of these organs acts on the stomach. Reflex gas- 

 tric neuroses are the frequent accompaniments of uterine 

 disturbances as seen in the gaseous distention, the vomit- 

 ing, or the pain in the stomach, that is often present dur- 

 ing menstruation ; or in the vomiting of pregnancy, or in 

 that resulting from instrumental dilitation of the cervix, 

 etc. Not only do the heart, lungs and abdominal organs 

 reflexly affect the stomach, and vice versa, but the head 

 and the extremities are influenced, to some extent, by ner- 

 vous association with the stomach ; cramps in the legs, for 

 instance, in cholera ; anaesthesia and neuralgia of the fin- 

 gers in dyspeptics (probably of angeio-spastic origin), 

 migraine (angeio-spastic), dimness of vision, frontal head- 

 ache, etc., from disorders of the stomach. Even the skin 

 may be involved, as in urticaria from gastric disturbance, 

 ance. 



Operative work on the stomach. Operations may 

 be performed on the stomach for perforation, the 

 result of a gastric ulcer, or, for excessive or continu- 

 ous hemorrhage which threatens a patient's life in 

 hsematemesis. In the operation for perforation, an inci- 

 sion is made in the median line, and after exposing the 

 stomach, this organ is drawn out of the abdominal wound, 

 if possible, and the ulcer sought for. Should the ulcer 

 not be found in the anterior wall, then the posterior sur- 

 face will need to be explored, and this may be done by 

 dividing the lesser omentum between two sets of ligatures 

 and turning down the upper border of the stomach. After 

 identifying the ulcer, it should be infolded so as to shut it 

 off from the peritoneal cavity. This is done by means of 

 Lambert's sutures, which include all the coats- of the stom- 

 ach with the exception of the mucous membrane, in such 

 a manner that serous membrane is approximated to serous 



