CHRONIC GASTRIC CATARRH. 521 



given like the alkaline carbonates, on an empty stomach, before break- 

 fast. Most patients bore these doses very well ; severe pain, nausea, 

 or vomiting never occurred, and there was diarrhoea in only a few cases. 

 But the results were very varied ; while in some cases there was very- 

 rapid improvement, in others there was none, and I was unable to find 

 any cause for difference between them. 



In chronic gastric catarrh we sometimes dare not continue the mild 

 diet ; on the contrary, slightly-seasoned and salty food is much better 

 borne than unseasoned and unirritating. When this state of " atony 

 of the gastric mucous membrane " occurs, we should carefully prescribe 

 preparations of iron and mild stimulants. The Eger Franzbrunnen, 

 and even the chalybeate waters of Pyrmont, Driburg, or Cudowa, are 

 better borne, and do more good than those of Karlsbad and Marienbad. 

 When the mucous membrane is in this state, the best remedy is, ipe- 

 cacuanha, gr. ss j, pulv. rhei, gr. iij iv, in pill, to be taken before 

 meals, as recommended by Sudd. The tinctura rhei vinosa, Hoff- 

 mann's visceral elixir, ginger, calamus, etc., do good in these cases; 

 but we must beware of going too far in the use of these remedies, or 

 of giving them in improper cases, or too large doses. 



The symptoms rarely require the application of leeches or cups to 

 the epigastrium ; they are only to be used when there is great pain. 

 Difficult as it is to understand, the pain is almost always relieved by 

 the abstraction of blood. In those cases where the hyperaemia and 

 catarrh of the stomach are symptomatic of great abdominal plethora, 

 depending on compression of the portal vein, or obstruction to the 

 flow of blood from the hepatic veins, surprising results are often ob- 

 tained by an abstraction of blood from the anastomoses of the portal 

 vein by applying leeches at the anus. Narcotics, which are almost in- 

 dispensable in treating ulcers of the stomach, are rarely required in 

 chronic gastric catarrh. Emetics may be employed under the circum- 

 stances in which they were advised in acute gastric catarrh, but we 

 must be more careful with them, as we do not know that ulceration 

 may not have occurred already. The constipation which almost always 

 exists is to be treated by enemata or laxatives ; the medicines most 

 used are rhubarb and aloes, and, in obstinate cases, extract of colo- 

 cynth. Several of these articles are usually combined ; the officinal 

 (in Germany) and much-used compound extract of rhubarb contains 

 aloes, rhubarb, and jalap. Budd says, also, that aloes and colocynth 

 act chiefly on the rectum, and irritate the stomach but little, so that 

 they are the best purgatives in chronic gastric catarrh; he warns 

 against the use of senna and castor-oil. 



