2. When The Patient Is Drinking

When The Patient Is Drinking we can hear, by putting our ear to the abdominal wall corresponding to the gastric region, a kind of dripping sound, arising from the passing down of the fluid along the gastric wall. By mapping out exactly the spots over which the sounds can be heard while the patient is drinking we may at times be able to determine the contour and size of the stomach and form an idea whether the organ is enlarged or not.

3. O. Rosenbach

O. Rosenbach1 has suggested that the size of the stomach may be ascertained by giving the patient some water to drink and then blowing in some air by means of a stomach tube. As soon as the end of the tube reaches the level of the water and air is blown in, a bubbling sound arises, which can be heard by placing the ear over the corresponding part of the abdominal wall. and the exact site marked out. As soon as the end of the tube is above the level of the water one can hear only the air striking the stomach wall, but unaccompanied with the bubbling sounds. By alternately raising and lowering the tube the height of the level of the fluid can be approximately determined.

1O. Roeenbach: "Der Mechanisnius und die Diagnose der Magen-insufficienz." Volkmann's "Saraml. klin. Vortrage," 1878, No. 153.

4. The Succussion Sound

This sound was first described and utilized for diagnostic purposes by Hippocrates. The method consists in shaking the patient and listening. If the stomach is considerably enlarged and contains liquid and gas, splashing sounds are produced and can be heard at quite a distance from the patient. Such sounds also occur under other circumstances if the patients change their position, for instance, when turning from one side to another in bed, and give rise to considerable annoyance.

5. Gurgling Sounds

Gurgling Sounds may be heard when the stomach, which does not contain any liquid but some air or gas, suddenly contracts. Thus every one is acquainted by personal experience with the sound generated in the stomach when one is very hungry. As the Germans say: "The stomach growls".

G. Respiratory Sounds

Sounds arising synchronously with inspiration. These are heard especially in cases of gastric dilatation or of gastroptosis, or where the stomach occupies a vertical position, particularly in women who wear corsets. The sound may assume two characters, according to its mode of production: One sound is produced during the act of inspiration by the gliding of the abdominal wall over the stomach when distended with gas. It is similar to the sound that is produced by the cello, and may perhaps be explained by reason of the gas being compressed and forming a resounding surface which is set into vibration by the movements of the abdominal wall. The second sound is caused by the rise and fall of liquid during the act of respiration. It has a somewhat splashing or squirting character. These sounds are very frequently met with and especially heard in ladies' society.

7. Sizzling Sounds

These can be heard only on direct auscultation, and are produced by gas forming quickly in the stomach. They are normally found after the introduction into the stomach of bicarbonate of soda and tartaric acid, carbonic-acid gas being set free and giving rise to these sounds. Pathologically they are developed spontaneously and are a positive sign of fermentation going on in the stomach and consequently of stagnation of food.

8. Ringing Sounds

These have been described by Laker' in a case of dilatation of the stomach. They are synchronous with the heart sounds and can be heard at quite a distance from the patient.