The examination of the patient should always begin with a thorough examination of his chest, for very often persons complaining of digestive troubles really suffer from diseases of other organs; while sometimes affections of the stomach exist in connection with other diseases of organic nature. After having ascertained the condition of the thoracic organs a special examination of the abdominal organs should then be instituted.

Inspection

The general appearance of the patient very often affords us an idea of the nature of his illness, especially with regard to its severity, whether we have to deal with some serious trouble or with an affection of only a functional character. The emaciated and sallow look of a patient suffering from cancer and the well-nourished rosy face of a patient with a neurotic disturbance of his digestion are striking examples of what can be made out by a mere glance.

We must inspect first the oral cavity and inform ourselves about the condition of the teeth, gums, tongue, uvula, and pharynx. Defective and carious teeth sometimes give origin to gastric disorders.

In olden times the tongue was regarded as a mirror of the stomach, so that every gastric affection was judged by the appearance of the tongue. Although nowadays we know that there are conditions in which the stomach is diseased and still the tongue has a normal appearance, and vice versa conditions where the stomach is in no way affected and still the tongue heavily coated, it is nevertheless true that many gastric affections go hand-in-hand with changes in the appearance of the tongue. The tongue may at times be thickly furred or may appear very shiny and gray; sometimes it may show indentations around its margin, sometimes again it may look red and dry like leather.

In the pharynx we sometimes discover catarrhal conditions or swollen follicles.

The uvula is sometimes very much elongated and may in this way give cause to some reflex digestive troubles.

The inspection of the neck will sometimes disclose a swelling to the left of the larynx, which increases after partaking of food and may be due to a diverticulum of the cesophagus.

The inspection of the abdomen should never be neglected. The contours of the stomach are at times visible in patients with thin abdominal walls, and especially if the stomach is either extraordinarily large or displaced downward. Osier1 not long ago laid much stress upon this simple method of examination, and ascertained that in many instances we can make the diagnosis of a dilated stomach by mere inspection. I can corroborate Osier's view, as I have had occasion in several instances of making a diagnosis of ectasia ventriculi by the mere visible outlines of the stomach. Tumors may sometimes be seen and recognized as such. Their position will already give us a clew as to what organ they belong. By attentive inspection we sometimes notice peristaltic waves passing from left to right over a large area in the upper part of the abdomen, which are caused by the muscular action of the stomach. If these waves are intense in character and persist for some length of time, then we have to deal with the condition called "peristaltic restlessness" of the stomach.

Smaller peristaltic waves may be seen occasionally in the lower part of the abdomen and be due to a peristaltic movement of the small intestine.

1 W. Osier: "Lectures on Diagnosis of Abdominal Tumors." New York Medical Journal, 1894.