CHRONIC GASTRIC CATARRH. 523 



existing ulcer of the stomach were almost always so plain that the 

 dependence of the dilatation upon a cicatricial stricture of the pylorus 

 could not well be doubted ; moreover, Kussmaul has seen cases of 

 unmistakable cancerous stricture of the pylorus, in which decided 

 benefit, although no cure, has been derived by this treatment. Com- 

 plete closure of the pylorus is never seen, even when every thing has 

 ceased to pass from the dilated stomach into the duodenum, and 

 when the patients remain for weeks without alvine evacuations, and 

 every second or third day vomit immense volumes of acid liquid, 

 sometimes mixed with blood, we find post mortem that the pylorus 

 is still sufficiently patulous, so that it seems strange that liquid should 

 not have passed through it during life. 



We may at least infer, from this observation, that the enfeebled 

 condition of the gastric muscles has much to do with the retention 

 of the contents of a dilated stomach. The internal pressure sustained 

 by an ektatic and overfilled stomach is so great that the demands 

 upon its muscular coat are considerably increased. Now, a continu- 

 ous strain induces myopathic palsy of the gastric muscles just as in any 

 other muscles ; and, moreover, the chronic catarrh of the stomach, 

 which exists in nearly all such affections, also in many cases results 

 in myopathic disease of its walls. 



Whether the benefit derived from use of the stomach-pump be due 

 to the unloading of the gastric walls, or to the improvement of the gas- 

 tric catarrh with consequent restoration of muscular tone, this much is 

 certain, that in the course of a few days or weeks the necessity for the 

 pumping diminishes. The only untoward event that I have ob- 

 served during application of the instrument and this is extremely 

 rare is the sucking of a bit of the mucous membrane into the 

 openings of the tube. To protect the patient from the injury 

 which might thus be inflicted, as soon as traction upon the piston 

 becomes in the least degree impeded, it must be pushed forward 

 again, and a little water or air must be thrown into the stomach 

 before the pumping may be resumed. [To avoid the dangers of the 

 stomach-pump, it has been suggested that the patient should drink 

 freely of warm water, and the physician then introduce a stomach- 

 tube with a long rubber tube attached to the upper end ; if the 

 patient now cough, the contents of the stomach should flow through 

 the tube as through a siphon. 



KtissmauPs article was published in the " Deutsches Archives " 

 for 1870, page 455. In his treatment the stomach is first emp- 

 tied (even after vomiting it may contain quarts), then washed out 

 with warm Vichy water. The patient may subsequently drink 



