Page:The Principles and Practice of Medicine.djvu/190

174 degree of uniformity in its effects must be established. If other things being equal, it fails more frequently than it succeeds, its curative powers are at least very problematical ; and if failure is the rule and success the exception, no reasonable person will place confidence in it. But it is not alone on account of its inefh'cacy that paracentesis is objectionable. There is little doubt that it often hastens 'the fatal termination, sometimes by causing peri- tonitis of which I have seen more than one instance but more frequently by favouring the rapid re-accumulation of the fluid.

Cancerous formations.-Cancerous disease of the peritoneum is not uncommon as a secondary, though very rare as a primary disease. It often extends from an organ to the portion of peritoneum which forms its outer coat or investment; or com- mencing in the sub-serous tissue in the neighbourhood of the spinal column, involves the membrane in front of it. Hydatid formations have also occasionally been met with.

Situation of the stomach.—The stomach is situated in the left hypochondriac, epigastric, and part of the right hypochondriac regions. Its left extremity is in relation with the spleen, pancreas, left kidney, and supra-renal capsule ; its right or pyloric end with the liver, lesser omentum, and pancreas. In front the stomach is separated by the diaphragm from the last six ribs. When distended with gas, it renders the greater part of the leftside of the chest tympanitic, and sometimes displaces the heart upwards.

.—''Inflammation of the mucous membrane of the stomach.-Acute, subacute, chronic''. .—Acute gastritis is rare, unless caused by an irritant poison.

Symptoms.—It is characterized by burning pain and tension in the epigastric region, a pinched and anxious face, a small pulse, and some, though not marked, febrile disturbance. After