742 



STOMACH 



period at which death ensues varies for different 

 poisons. 



Sub acute gastritis, or gastric catarrh, is by no 

 means a rare affection, and it occurs in two distinct 

 forms 'one in which the malady is caused by a 

 constitutional state, the effects of which are shown 

 in a variety of other organs as well an in the 

 stomach ; another in which it is due to causes 

 connected chiefly or exclusively with this organ, 

 which i- submitted to an irritative process some- 

 what analogous to that typified by the gastritis of 

 irritant poisoning' (Brinton, On Daeafu of the 

 Stomach ). The first of these forms is well illus- 

 trated in such diseases as smallpox, scarlatina, 

 pneumonia, &c., in which the digestive process is 

 much interfered with, and after death distinct 

 marks of inflammation are seen in the stomach. 

 The other variety, which is often of a chronic form, 

 is well seen in cases of delirium tremens, the 

 affection being sub-acute or chronic, according as 

 it has been produced by a single prolonged 

 debauch, or by a protracted habit of drinking 

 spirits, and the patient's final malady being in- 

 duced by a deficiency of food or some injury or 

 acute disease. Purely chronic inflammation may* 

 be induced by various causes, of which the most 

 common are tue abuse of alcoholic drinks, habitual 

 excess in eating, the eating of indigestible food, 

 and the excessive use of irritating medicines. The 

 symptoms are like those of indigestion in a severer 

 form ; in fact it is impossible to draw a sharp line 

 of distinction between the two affections. 



The treatment of gastritis varies much with each 

 individual case, but the first point is the removal 

 of the cause to be attempted in cases of irritant 

 poisoning either by the removal of the poison ( by 

 the stomach-pnmp or emetics, as, for example, 

 sulphate of zinc) or by its neutralisation by means 

 of an antidote. In very severe cases leeches may 

 be applied to the epigastrium ; but counter-irri- 

 tants, such as turpentine on a hot moist flannel, or 

 mustard-poultices, are generally of more service. 

 Continuous fomentation with water, as hot as con 

 be borne, often gives great relief, while at the 

 same time iced water, or small lumps of ice swal- 

 lowed whole, usually relieve the thirst and miti- 

 gate the pain. Enemata of purgative materials, 

 if the bowels are constipated, or of a soothing 

 character (as thirty drops of laudanum in a little 

 starch or gruel), if the bowels are irritable, may be 

 prescribea with advantage. When the stomach 

 begins to be able to retain food, it must In- given in 

 tin 1 form of a bland liquid, in Miiall doses, at dis. 

 taut intervals. Chronic gastritis mu-t be ti>- 

 in much the same manner as Indigestion (q. v. ). 

 The most essential |M>int of treatment is the due 

 regulation of the diet. 



Ulcer of the stomach is the most important of 

 the idiopathic diseases of that organ, l>tli from its 

 frequency, from the facility with which it may in 

 some cases le detected during life, from the "fact 

 that nt any ]>eriod of its protracted course it may 

 prove suddenly fatal, ami from its lieing usually 

 curalile. The lirst ami most characteristic symptom 

 of this disease is pain, which comes on very soon 

 after the ingestion of food, and lasts for an hour or 

 two; vomiting often ensues, with such relief that 

 the sufferer sometime., ^ets into the habit of 

 inducing it himself. The place of most com- 

 mon appearance and greatest intensity of the 

 | >ain is the centre of the epigastric region, but 

 it is sometimes higher, lower, or to one side, 

 and occasionally in the back. The pain in 1ml h 

 the epigastric and the dorsal region is almost 

 always much increased by pressure ; also by food 

 and drink, especially by t lie ingestion of hard and 

 indigestible sulistjincea. The pain, vomiting, and 

 want of nourishment lead of course to much 



enieeblement. The disease is sometimes termin- 

 ated by the occurrence of perforation, ending in 

 rapidly fatal peritonitis ; mid if this accident does 

 not occur, the dyspeptic symptoms may become 

 complicated by ^Hemorrhage from the stomach, 

 sometimes so rapid that it distends the stomach 

 and adjacent small intestine with a single pi-h, 

 and causes fainting and almost immediate death, 

 but more commonly occurring as a slow ami inter- 

 mittent drain of blood, giving rise to ana-mia. In 

 some cases, however, symptoms are either absent 

 altogether or so slight that no attention is paid 

 to them, till the presence of the ulcer is revealed 

 by one of these accident-. If death from the 

 above causes (inanition, perforation, or haemor- 

 rhage) does not terminate the disease, the symp- 

 toms frequently subside in something like the 

 inverse order in which they occurred, and re- 

 covery, often after many years' Buffering, ensues. 

 Brinton states that this lesion may lie detected 

 in (on an average) 5 per cent, of persons dying 

 from all causes ; that it occurs twice as fre- 

 quently in females as in males, and that it is 

 specially a disease of middle and advancing life 

 twenty -seven being the average age in female- 

 and forty-two in males. Nothing is known with 

 certainty regarding the causes of this disease, 

 except that advancing age, privation, mental 

 anxiety, and intemperance so frequently coincide 

 with it that they may be regarded in some 

 degree as producing it. But it is particularly 

 frequent as a complication of Chlorosis (q.v. ). 

 In relation to treatment strict attention to diet is 

 of the first importance. When the symptoms are 

 urgent the patient should maintain the recumbent 

 position, and should be fed on cold or lukewarm 

 milk thickened with biscuit-powder, given in doses 

 of one or at most two tablespoonfuls at regular 

 intervals of from ten minutes to an hour. The 

 pain is often relieved by the application of a mus- 

 tard-poultice or blister to the painful spot ; and 

 benefit is frequently derived from the internal 

 administration of bismuth (in doses of ten grains), 

 either given alone or combined with the compound 

 kino powder (in five-grain doses). When there is 

 haemorrhage small lumps of ice may be swallowed ; 

 and if all food is rejected by vomiting, nutrient 

 injections must be thrown into the lower bowel. 

 Aperients ure sometimes required, but they must 

 be given with caution ; and if castor-oil can lie 

 taken without increasing the pain or vomiting, it 

 is the most harmless remedy of its class. 



Cancer oft/it stomwli is obscure in its symptoms, 

 frequent in its occurrence, and always fatal in its 

 termination. The typical course of this di-ea-c is 

 thus sketched by llriiiton : 'An elderly person 

 perhaps hitherto free from dyspepsia begins to 

 suffer from a capricious, and soon a diminished 

 appetite, which is hy-and-by associated with occa- 

 sional nausea, or even vomiting, and with a sense 

 of uneasiness or distention of the stomach. \\\- 

 complc.\ion, already pale and unwholesome, next 

 acquires a muddy, yellowish, or faint greenish hue. 

 His gastric symptoms now increase; often by a 

 sudden and marked augmentation, which corre- 

 sponds to what is in other eases their lirst ap| 



ance. Vomiting, if already present, becomes n ; 



frequent and urgent ; local uneasiness dee|H-ns into 

 pain ; and lioth these symptoms are excited or 

 increased by taking food. At a somewhat later 

 period ha'inorrhage generally occurs, usually but 

 scanty in amount, and therefore depending to a 

 great extent on casual circumstances for its detec- 

 tion. AlKiut this time a tumour often becomes 

 perceptible near the middle of the epigastric region 

 of the lielly. As the local symptoms increase the 

 cachexia of the patient also augments, and i evi- 

 denced not only by the colour already mentioned. 



