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Arch Intern Med (Chic). 1911;VII(2):246-251. doi:10.1001/archinte.1911.00060020113008.
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The coincidence of two such interesting features as these in the same patient is unusual enough to warrant the case being reported somewhat in detail.

Patient.  —An engineer, aged 39, was seen on Feb. 26, 1910. The family history and the patient's past and personal history were negative. The habits of the patient were good.

Present Complaint.  —Some eight months before, the patient noticed a belching of gas, sour or bitter, usually after meals. There was never any localized pain or any pain with reference to food, but rather a general abdominal distress "due to gas" relieved by belching or by pressure and massage over the epigastrium. The bowels had been obstinately constipated, requiring enemas to move them. The appetite had been good, but food causes distress on account of the belching and eructation following. Weakness had been progressive, and for the last month the patient had been almost


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