518 DISEASES OF THE STOMACH. 



very probable, but we can only ascribe this to simple hypertrophy of 

 the walls of the stomach, when we can exclude the other and more 

 frequent forms of stricture, particularly the cancerous and the cica- 

 tricial stricture, not unfrequently left after the healing of a chronic 

 ulcer. 



The prognosis of chronic gastric catarrh agrees with what we have 

 said of its course. Stricture of the pylorus must be classed among the 

 frequently fatal diseases, for patients with this disease always die, 

 sooner or later, of marasmus or dropsy. 



TREATMENT. Of all serious chronic diseases, chronic gastric catarrh 

 probably gives the best result from rational treatment. 



As we have described, in the first part of this chapter, the injuries 

 which, according to the duration of their action, induce acute or chronic 

 gastric catarrh, we may, hi speaking of the causal indications for treat- 

 ment, refer to that description, and we have little to add to' it. These in- 

 dications are rarely fulfilled by the use of an emetic, as there are rarely 

 any injurious substances in the stomach that can be considered as 

 keeping up the disease. On this point we often meet opposition. It 

 is difficult to convince the patients that the pressure they feel is not 

 excited by " something heavy on the stomach," and that an emetic 

 would bring no relief, but rather would make matters worse. The 

 causal indications urgently require the forbidding of all spirituous 

 liquors, if then* continued use has caused, and is keeping up, the affec- 

 tion. This command will rarely be obeyed ; nevertheless, we must 

 not weary of repeating it. Temperance lecturers, who also demon- 

 strate the terrifying results of brandy-drinking on the stomachs of 

 topers, usually preach to deaf ears, it is true, but they attain some un- 

 deniable results, and these should encourage the physician to persist 

 in his advice. In the chronic catarrh caused by repeatedly catching 

 cold, or by the action of a moist, cold climate, the indication is to ex- 

 cite the activity of the skin by warm clothes, warm baths, and similar 

 means. Such cases are not at all rare ; and, even at Greifswald, pa- 

 tients who have come here without preparing for the damp, windy 

 climate, by dressing more warmly, are often affected with chronic gas- 

 tric catarrh, which is better in summer, worse in winter, and is not 

 cured till the causal indications are properly attended to. When the 

 disease results from congestion, the causal indications can rarely be 

 fulfilled. 



Dietetic rules are also of the greatest importance in fulfilling the 

 indications of the disease. It is not possible to keep the patients 

 fasting throughout this tedious complaint, but we should most care- 

 fully select then* food, and urgently insist on its exclusive use. The 

 more precise the rules, the more carefully they will be followed, and, 



