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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