VOL. 7.

Original Articles.

T

The

HERE are two principles of human nature that assume importance in certain fields of medicine. One is a leaden-footed conservatism, a strain of timidity inherited from the cave-dweller, a spell of diffidence under which men gaze in apprehension while the patient loses, his single opportunity of escape. other is a frenzy for exploitation, for subverting nature, for engaging in hazardous enterprises without quite knowing why, without duly estimating the loss and the uncertain gain. It is a misfortune when a physician exemplifies the former and a surgeon the latter of these principles.

Ocasionally there is one who speaks not like a doctor, but like a partisan; as though all surgeons were exploiters and all exploiters were admirable as though all physicians were hope less myopics and obstructionists. From this teaching one would suppose that the physicians and surgeons were opponents.

It is impossible for the surgeon successfully to fence in for working the field both of the physician and himself; and when the work of the physician is slighted, it is not for the best interest of the patient. There is a tendency to classify a certain group of diseases as surgical that were formerly considered medical. They should properly be considered both medical and surgical. Any other course will leave the situation like that of a ship in which the cargo shifts either to port or starboard. Such is not the spirit displayed in one of the most readable and sensible of modern medical books, "The Surgical Aspects of Digestive Disorders," by Drs. Mumford and

Stone of Boston.

There are some curious anomalies in affections of the stomach, amongst which are the following

instances:

*Read before the Medical Society of the County of Kings, November 20, 1906.

No. I.

Much complaint is made of the stomach when that organ is without actual disease.

Troubles remote from the stomach express themselves through stomach symptoms.

When a patient suffers from an excess of digestive activity, he complains of indigestion. When a patient suffers from a most complete form of gastric indigestion, he often makes no complaint of the stomach whatever.

Of the patients presenting themselves at a medical clinic for stomach trouble, the majority are suffering from nerve wear, mental strain, or physical stress which results in functional gastric disturbance.

Finally, the symptoms produced by grave structural disease of the stomach may closely resemble in symptomatology a functional disturbance. Such cases, whether acute or chronic, need the study of competent internists-often the surgeon in association.

Achylia gastrica, relatively common among the more serious stomach diseases, has the following peculiarities: The appetite is usually good, the stomach has practically no digestive power, the motor activity is exaggerated and the organ is usually found empty a short time after the ingestion of food. In early or mild cases, the bowels are usually somewhat confined, and for that reason the food remains sufficiently long in the intestine to admit of fair digestion and absorption in that organ. In severe cases the patient suffers from a sort of "post prandial" diarrhea; in other words, a dejection almost invariably follows a full meal, and the stools are lienteric. It is a disease that is worthy of discussion at this time, for the reason that, in some respects, a victim of achylia gastrica bears a close resemblance to a patient in whom a gastroenterostomy has been performed.

To begin with, we should remember the fact that in mild cases the bowels are usually confined. Even though patients complain somewhat of symptoms of auto-intoxication from this mild, constipation, it is best not to use purgatives. An enema should be employed for emptying the lower bowel, but the small intestine should be both allowed and encouraged to act slowly. The patient should be taught to practice most careful mastication for obvious reasons. He should be given hydrochloric acid, not because he can take enough to influence materially the gastric digestion, but for the reason that a certain amount of