AND ABSORPTION 39 



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. 



If these means are not successful, it is very desirable 

 to perform laparotomy and to explore the stomach, 

 duodenum, appendix, 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. 

 Paterson cured 17 out of 24 cases of epigastric pain 

 in which the stomach and duodenum were normal 

 but the appendix was diseased ; the Mayos in similar 

 cases cured 84, and greatly improved 7, out of 115. 

 It might be well to do a gastrojejunostomy at the 

 same time ; one of Paterson's failures was subse- 

 quently relieved by this means. This operation will 

 often lead to a permanent cure of pain, vomiting, or 

 haematemesis, even when no abnormality can be 

 found. The important point is that it is not right 

 to do the short-circuiting operation on a normal 

 stomach without also exploring the appendix and 

 gall-bladder. Soltau Fenwick states that of 112 

 cases of hyperchlorhydria, in 34 the stomach and 

 duodenum were normal ; in 22 of these the appendix 

 was at fault, and in 12 gall-stones were present. In 

 9 cases appendix trouble complicated gastric or duo - 

 denal ulcer. In 66 patients an ulcer was present in the 

 stomach or duodenum ; 4 of these were malignant. 



