322 



The Stomach 



act, so that an emetic should be administered in plenty of warm water. 

 Vomiting may be caused by irritation of the pneumogastric filaments 

 in the pharynx as well as stomach, or even in the brain itself, as in 

 cerebral disease, or in a sea-voyage. Free expectoration of bronchial 

 mucus is excited by vomiting ; thus in certain chronic pulmonary con- 

 gestions an emetic is useful. In vomiting the tonsils are compressed 

 by the superior constrictor, and in acute quinsy an emetic may thus 

 effect the bursting of a tonsillar abscess, or, after amputation of tonsils, 

 may check troublesome oozing. 



The close association between the stomach and brain is exemplified 

 by sea-sickness and by the vomiting which occurs on the return of 

 consciousness after cerebral concussion. But irritation of the gastric 

 filaments of the vagi is often misinterpreted by the brain as the re- 

 sult of pulmonary unrest ; and so arises the ' stomach cough.' When 

 vomiting is long-continued the bile-stained contents of the duodenum 

 are voided, and, later, the lower part of the small intestine is emptied ; 

 the ejecta then have a stercoraceous odour ; but in so-called ' faecal 

 vomiting ' the large intestine is not being emptied : this is prevented 

 by the ileo-caecal valve. 



Eructation is that form of vomiting which is accomplished by the 

 muscular coat of the stomach alone without the help of the diaphragm 

 or of the abdominal walls. 



Post-mortem digestion of the stomach affects its hinder wall, and 

 chiefly in those parts which depend on either side of the vertebral 

 column, that is where the gastric juice collects. The dissolution caused 

 by an irritant poison would not affect these pouches only and avoid 

 the rest of the lining of the stomach. 



In stricture of the pylorus the stomach becomes much dilated, 

 and, as nutrition fails, the patient becomes so thin that the hardened 

 valve may be at last easily felt through the abdominal wall. If the 

 growth happen to lie over the aorta the pulsations are apparent above 

 the umbilicus, but the tumour feels solid and does not expand laterally 

 as an aneurysm would. Sickness comes on much later after food has 

 been taken in pyloric than in cardiac stricture, for in the former case 

 the food may remain in the stomach until, in the ordinary course, it 

 should be passing into the duodenum ; as it tries to force its way 

 through the pylorus pain may be intense. The stomach becomes 

 enormously dilated in pyloric stenosis and may spread through the 

 chief part of the abdominal cavity. 



The condition of the stomach after death from pyloric stricture is 

 like that of the bladder in the case of enlarged prostate, or of the left 

 cardiac ventricle in aortic obstruction, the distended organ being not 

 only dilated, but considerably thickened. 



Food accumulating undergoes decomposition, and the patient is 

 troubled with wind. If forcible dilatation of the contracted pylorus be 

 not considered expedient and in some cases it has answered well 



