538 DISEASES OF THE STOMACH. 



the gastric juice, we could not explain the action of the narcotics, 

 which Jaksch says is often magical ; but, if it depends on tension of 

 the walls of the stomach, we can readily understand the effect of nar- 

 cotics, which, besides their anaesthetic effect, retard the movements of 

 the stomach. Stokes declares that morphia is the only trustworthy 

 remedy in the treatment of chronic ulcer of the stomach, and thinks 

 that all the other remedies which are highly spoken of are only effect- 

 ual when combined with a narcotic, as is generally done in using sub- 

 nitrate of bismuth. Very small doses (fa J gr.) of morphia usually 

 suffice, and it is not necessary to increase these. Jaksch saw a woman 

 take the same sized dose of morphia more than a hundred times with- 

 out its efficacy diminishing. Morphia is preferable to extract of hyoscy- 

 amus or belladonna, which are also recommended. When the epigas- 

 trium is very sensitive to pressure, a few leeches or wet cups fulfil the 

 indications. If these do not answer the purpose, blisters, or pustulat- 

 ing plasters left for some time on the pit of the stomach may be of 

 use. Among the symptoms deserving particular attention, we may 

 have obstinate vomiting. The narcotics, particularly morphia, seem 

 to be of aid in this symptom also. If they do no good, small pieces 

 of ice or mouthfuls of ice-water are sometimes beneficial, and occasion- 

 ally where all else fails we may give creasote (gtt. jv. to | vj. of 

 water, in tablespoonful doses), or tincture of iodine (gtt. ii. iii. in 

 sweetened water). Finally, in the course of chronic ulcer of the stom- 

 ach, hsematemesis or peritonitis may require special treatment ; but 

 we will speak of this in the chapters devoted to these subjects. 



CHAPTER VII. 



CARCINOMA OF THE STOMACH. 



ETIOLOGY. Among the internal organs, the stomach is the one 

 most frequently affected with carcinoma; it is usually affected pri 

 marily ; more rarely it is secondary to cancerous degeneration of othei 

 organs, or is propagated from them to the stomach. 



The cause of cancer of the stomach is just as obscure as that of 

 cancer elsewhere. In some families it seems to be hereditary: tho 

 father of Napoleon I., his sister, and himself, died of this disease. In 

 regard to the influence of sex, age, and employment, we may say that 

 men are more frequently affected than women ; that it is most frequent 

 between the ages of forty and sixty years, while before forty it is rare, 

 and before thirty it very exceptionally occurs ; finally, that no class of 

 people escape it entirely. If cancer of the stomach be more frequent 

 in the inferior classes than in the higher, it is because the former are 



