The examination of the patient begins with the narration of the course and symptoms of his trouble past and present. The history must state how long the trouble has existed, whether it began gradually or suddenly; and the supposed cause of the ailment. We have to inquire whether the disease has constant-ly progressed or whether it has been interrupted by free intermissions. We have further to inquire whether the symptoms have always been the same or whether they have changed in character since the beginning of the trouble. It is important to know whether there has been loss of flesh and whether this has been continually increasing. We should inquire also as to the condition of the bowels, whether there is constipation or diarrhoea or both interchangeably.

Present condition: The patient should be requested to describe the symptoms he complains of. As this, however, is not done very accurately by the patient himself, we shall find it frequently necessary to cross-examine him. The important points to which attention should be directed in our cross-examination are as follows:

The Appetite

Is there loss of appetite? Does the appetite come when the patient begins to eat? Does the appetite disappear when the patient has taken a few mouthfuls of food, or is there a perfect aversion for food? The loss of appetite is designated by the word "anorexia." If there is a perversion of appetite - that is, appetite only for unusual substances - we speak of "parorexia." If the appetite is increased - that is, if the patient becomes hungry soon after a meal - we speak of "bulimia." If the patient takes large quantities of food, much more than normal, but at his regular meals, we speak of "polyphagia." If there is no feeling of satiety no matter how much the patient takes, then we speak of "acoria".

Thirst

Inquire whether the patient becomes thirsty more frequently than usual or whether there is no desire whatever for drinks.

Taste

Inquire whether the taste in the mouth is all right or whether it is bitter, sour, or sticky, and if there is such abnormal taste, at what time it is mostly experienced.

Deglutition

Does the food pass into the stomach without difficulty or not? If not, state whether the difficulty is experienced only after ingestion of solid substances or also after fluids.

Abnormal Sensations

How do you feel after meals? Do you feel bloated? Do you experience a feeling of fulness or pressure in your gastric region? Do you feel sleepy or giddy, and if so for how long a time?

Belching

Do you belch much and if so, when? Does it occur only after a meal or also in the morning when the stomach is empty? Do you belch so much that it inconveniences you in society, or that it keeps you from your business? Is the belching connected with some bad smell, or is the gas that comes up odorless, inoffensive?

Regurgitation

Does the food come up into your mouth? If so, state whether it is sour or not, and whether this frequently occurs and how long after meals. If the food that comes up is spit out we speak of "regurgitation," but if it is chewed and swallowed we speak of "rumination." If only some sour fluid comes up, then we speak of "water brash".

Pyrosis

Do you experience a burning sensation at the pit of your stomach, and when? Is it half an hour after a meal, or is it three hours or so afterward? How long does this sensation last?

Pains

Pains when experienced at the pit of the stomach are called cardialgia; if in the gastric region, gastralgia. Pains are the most frequent complaints met with in all kinds of digestive troubles. They may be of a severe nature so that the patient is obliged to stay in bed, or they may be of only a light character so as merely to inconvenience the sufferer. When does the pain appear? Does it come right after eating or does it occur an hour or two or three afterward? Does it exist when the stomach is empty and is it appeased by the ingestion of food? How long does the pain last? Does it remain all the time, or only a short while, or does it come and go independently of the food taken? If it follows the ingestion of food, is it more intense after partaking of certain coarse, indigestible aliments? Is the pain circumscribed and felt only at one spot or does it extend all over the gastric region? Does it radiate to the back and shoulder blades? Does the pain come on suddenly or slowly, and does it gradually increase?

Nausea

Is the nauseous feeling present only in the morning or after each meal, or does it appear after certain foods (as meats)?

Vomiting

Inquire whether the patient vomits; if so, how often this occurs, whether daily or only once in two or three weeks. Does the vomiting occur soon after a meal or at other times? Does it occur in the middle of the night? Do you vomit large quantities? If so, of what do they consist? Is it only food or is it simply an acid watery fluid? Does the vomited matter contain food from previous days? Does it contain much bile? Does it smell when it is vomited or has it an acid, disagreeable taste? Was there ever any blood in it? Fresh blood looks red, while digested blood that has been in the stomach a much longer time has a coffee-brown color. Is the act of vomiting connected with much exertion or does it take place easily? Do pains exist before vomiting and disappear after its cessation?

Bowels

Inquire whether the bowels move every day or not. Are they constipated? Is the patient always obliged to take some aperient and what is the nature of the aperient? Is there diarrhoea? State how many movements a day and the character of the stools, whether they are very watery or whether there is some admixture of mucus or blood. Does the diarrhoea appear after each meal? Does it alternate with periods of constipation?