chief therapeutic in dications are: removal of the exciting cause; checking the gastric irritability, and giving rest to the diseased organ. The first is met by the evacuation of the stomach-contents, which usually is spon taneous. Should emesis not occur and if occurring not be efficient and the presence of undigested food in the stom ach be suspected, vomiting should be in duced, as by the free ingestion of warm water containing sodium bicarbonate. Vomiting not being excited in this man ner, or, after, emesis continuance of the local symptoms indicate that the stomach has not been efficiently emptied, a resort should be had to the stomach-tube or to an unirritating emetic. The stomach tube is preferable in that by it after the removal of the stagnating ingesta, a thor ough cleansing of the mucous membrane can be accomplished. Alternate hot (105° F.) and cool (65° F.) water is used, to which is added sodium bicarbonate at first and subsequently an antiseptic, such as a weak permanganate solution, boric acid, betanaphthol, or thymol. Should an emetic seem more expedient than the use of the tube, ipecac (1 to 5 grains), or, preferably, apomorphine hydrochlo rate grain by the mouth or '/„ to hypodermically) may be ad ministered. Subsequent to the com plete evacuation of the stomach-contents a laxative, preferably calomel, is usually indicated. The observations of Beau mont on St. Martin indicate that calomel has an influence little short of specific on the mucous membrane inflamed through dietetic errors or alcoholic ex cess. Its influence seems to he both local, due to its sedative and antiseptic effect, and systemic through its chola gogic action. Calomel is administered in a full single dose of from 2 to 5, or, in exceptional cases, 10 grains; given dry upon the tongue or preferably in trituration with milk-sugar or sodium bicarbonate. If vomiting occurs soon after its administration the dose must be repeated. A saline laxative, such as effervescing magnesia citrate, is adminis tered in from six to eight hours after ward, provided a full action of the bowel in the meanwhile has not been obtained.
Following evacuation of the stomach contents, gastric irritability, should it continue, is best allayed by the total withdrawal of all food for a limited time; confining the patient to bed; the appli cation of counter-irritants in the form of sinapisms or a small blister to the epi gastrium, and the administration of a few doses at hourly or half-hourly inter vals of: dilute hydrocyanic acid, 1 to 2 drops; bismuth subnitrate, 5 to 10 grains; in diluted mint-water. Or there may be used a powder containing cocaine hydro chlorate, to grain; codeine phos phate, grain; cerium oxalate, 2 to 5 grains. Cerium oxalate alone, in doses of 5 grains given dry upon the tongue, at intervals of one-half to one hour, is often singularly efficient in checking vomiting after the contents of the stom ach have been evacuated. Carbolic acid, grain, in combination with a small dose of bismuth, exhibited in dilute mint water, is useful. Strontium bromide in
cases in which a nervous element exists is often of value. It or another bromide salt, in combination with chloral, may be administered by the rectum. Morphine may have to be resorted to hypodermic ally, if the nausea and vomiting continue despite the use of the above remedies after the stomach has been completely evacuated. The ingestion of bits of ice or of small quantities of iced carbonated water allays thirst and tends also to check the nausea and vomiting. Washing out the stomach with hot and cold water alternated will often prove efficient.
For the control of gastric pain codeine internally, combined with dilute hydro cyanic acid, and with cocaine, should be used. Externally, turpentine stupes, or spongiopiliu first immersed in hot water and then rinsed, is indicated. For fur ther details see the treatment of gastric pain in ulcer.
The nourishment should be of the lightest character while the acute symp toms continue. If the patient is well nourished and the attack has arisen from dietetic discretion, as is usual, for a day or two almost complete abstinence from food is indicated. During this time pep tonized milk or milk diluted with a car bonated alkaline water may be given in small quantities at moderately frequent intervals, or a preparation of koumyss may be tried. In other particulars the diet suggested in the treatment of gastric ulcer is applicable here.
Phlegmonous, or Purulent, Gastritis.
This rare disease may occur idio pathically or as a complication of an other disease, such as typhoid fever, small-pox, puerperal fever, pymmia, etc. Two forms are described: a diffuse puru lent infiltration of the stomach-wall and a circumscribed, localized abscess, as a result of which last a purulent tumor of some size develops which subsequently opens into the stomach, externally, or into the peritoneal cavity.
Symptoms.—The symptoms are those of a septic process plus those of the local inflammation, which last may be alto gether masked by the height of the sys temic disturbance. There is high fever resembling in its character that of a severe septic infection. It is associated with great prostration of strength, delir ium, and, if a fatal issue is imminent, coma; jaundice may occur. There is nearly always localized epigastric pain and dry, heavily-furred tongue; vomit ing, meteorism, and diarrhwa are usual. Death results in most cases in from a few days to two weeks. Recovery is un likely unless the abscess perforates ex ternally or into the stomach.
Diagnosis.—The separation of phleg monous gastritis from perigastritis, sub sequent to perforation of a latent gastric ulcer, acute pancreatitis, hepatic abscess, and acute poisoning is difficult, and most often impossible.
Treatment.—Little can usually be done even though the affection be presumed to be recognized. Endeavor should be made to control the vomiting and the gastric pain by the use of remedies sug gested in the treatment of simple acute gastritis and in the treatment of gastric ulcer. Morphine is here more often in dicated.