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Latest revision as of 17:17, 27 June 2017

ULCER OF STOMACH Mary K. - Aged 32 - Domestic - Native of Ireland Admitted June 28, 1906 PREVIOUS HISTORY: Since a child troubled with stomach; pain after eating followed by vomiting which relieved pain. Since in this country (2 yrs.) these symptoms have grown worse. Pain in epigastrium, also felt in back; when most severe radiates into left and right side of abdomen. Pain worse on pressure, relieved by soda bicarbonate, by vomiting, or by lavage. Frequent sour eructations, considerable flatulence. Bowels very constipated. HABITS: 6-8 cups of tea q. d. PRESENT HISTORY: During past two days has had frequent hematemeses, any exertion bringing on an attack. Has grown very weak, fainted several times. To-day had typical tarry stool. No many at any time. PHYSICAL EXAMINATION: Female--small frame. Facies--very anxious and pale; skin "clammy," extremities cold. Pulse--rapid, feeble, low tension. Heart--soft systolic murmur over entire precordium, 2nd pulmonic relatively accentuated. Abdomen--no tenderness anywhere. Slight muscular rigidity in epigastrium, area of stomach tympany increased. Blood--Hmb. 38%, R. B. C. 2,470,000. W. B. C. 17,200. Polys. 71%. Lymphocytes 28%, Eosinophiles 1%. Many nornoblasts. Red cells--small, pale in center, many poikilocytes, Vomitus.--"Coffee ground" contains large amount of blood--no free acid. June 28, 30.--Stools are tarry. Hmb. is 36%. July 1.--Has no pain, feels very weak. Some nausea, though no vomiting. July 5.--Feels decidedly better, now only complains of lack of food and drink. Is taking food well. Still marked blood reaction in stools. July 8.--Hmb. 43%. July 10.--Hmb. 38%. Marked blood in stools. Only complains of weakness. July 11.--Test meal. Free H Cl 22; total acid 34. Marked blood reaction. July 15.--Hmb. 41%. Still blood in stools. July 20.--Hmb 41%. Blood reaction very faint in stools. Taking food very well. Has no pain or distress. July 3.--Hmb 43%. Negative blood reaction in stools for first time. July 27.--Hmb 44%. Looks much better in respect to color than Hmb. indicates; still no blood in stools; no gastric symptoms. Feeling perfectly well and wishes to get up. August 4.--Hmb. 52%. Face looks fatter, evidently is gaining weight. Enjoys food very much. Bowels are very constipated. August 8.--Was up to-day for first time. A little dizzy but no bad effects. Weight 95 1/2 pounds. August 16.--Hmb. 58%, weight 102. Eats more than ever before in life. No stomach symptoms. August 25.--Hmb 66%. Still no blood in stools. August 27.--Weight 109 1/2. Has been up and about since August 8, gaining strength steadily. Now on ordinary diet. Absolutely no gastric symptoms.