DISEASES OF THE STOMACH. 



Where chronic gastric catarrh is obstinate, we should try soda water 

 or the natural soda waters of Ems, Salzbran, Selters, and Bilin, as well 

 as the waters which, besides carbonate of soda, contain sulphates of the 

 alkalies and earths or chloride of sodium. The use of the waters of 

 Karlsbad and Marienbad has the most wonderful results. The highest 

 recommendation that could be given for them is the fact that they are 

 recommended by pprties whom no one can accuse of being easily de- 

 ceived by therapei itic results : the learned professors of the Vienna 

 and Prague schoolo prize the use of the warm springs of Karlsbad as 

 the best remedy for chronic gastric catarrh, and even for chronic ulcer 

 of the stomach. Moreover, the numerous cases where obstinate jaun- 

 dice was cured by the use of the waters of Karlsbad were almost 

 always those where it was due to gastro-duodenal catarrh. There is 

 no reason to delay this treatment until the catarrh of the stomach and 

 duodenum has caused jaundice, or to suppose that it will be less effi- 

 cacious if this complication be wanting. If the circumstances of the 

 patient permit, the treatment may be followed out at Karlsbad or 

 Marienbad ; at these places the anecdotes of the frightful results from 

 errors of diet during the use of the waters so terrify the patients that 

 the diet required by chronic gastric catarrh will be certainly adhered 

 to while there. Even after returning home, the patients subject them- 

 selves to the strictest regimen for months, fearing that the waters 

 may revenge themselves even yet for the slightest errors of diet. If 

 obliged to use the waters at home, it makes little difference from which 

 of the Karlsbad springs they come, as they vary little except in their 

 temperature, and they may be warmed to any desired extent. In 

 Karlsbad the springs of lower temperature, as the Schlossbrunnen and 

 Theresienbrunnen, are most frequently used in chronic gastric catarrh. 

 If there be no coincident obstinate constipation, soda water will often 

 succeed quite as well, provided it be properly used, i. e., if the patient 

 diets the same as at Karlsbad. After eating but little, and not very 

 late, the night previous, he must drink the soda water in the morning 

 while fasting, and must not breakfast for an hour after the last glass 

 of water, so that the medicament may not be mixed with the ingesta, 

 but may act undiluted on the gastric mucous membrane, and on the 

 mucus covering it. The results from this treatment are the most bril- 

 liant that are ever attained in medicine. 



The ter-nitrate of bismuth and the nitrate of silver have a great 

 reputation in the treatment of chronic gastric catarrh. These metallic 

 salts may be beneficial, both by arresting decomposition in the stomach 

 and by their great astringent action on the hyperaemic and relaxed 

 mucous membrane. I have used these remedies in my clinic in very 

 large doses (bismuth nitrat. gr. x, argenti nitrat. gr. j ij, at once). 



