Pathology.—The essential pathological process in chronic gastritis is a parenchy matous and interstitial inflammation of the secretory glandular structure and finally of the deeper layers of the gastric wall, especially in the pyloric region, which inflammatory process leads to in terference with the various functions of the stomach, and to degeneration, wast ing, or hypertrophy of that organ. Ana tomically, two main forms of chronic gastritis are described: the hypertrophic and the atrophic. The former is largely the result of considerable connective-tis sue increase, tending to give rise to much thickening of the stomach-wall, to mam millation of the mucosa and partial or complete destruction of the glandular elements. The atrophic form is that in which atrophy of the mucous membrane and of the muscularis, with coincident atrophy of the glandular elements, leads to thinning of the gastric wall and sub sequently to either diminution in the size of the stomach or to its dilatation.
Treatment.—Effort should be first di rected to ascertain if the gastritis is sec ondary to disease of another organ, such, for instance, as to obstructive disease of the heart, lungs, or of the liver. Ail ments thus originating chronic gastritis must receive careful attention before the local gastric condition can be improved; otherwise remedial measures directed solely to the stomach will be inoperable. Drugs, such as strophanthus, digitalis, and strychnine for the valvular disease or the emphysema, free purgation to unload the portal circle, are frequently necessary in gastritis due to heart disease as from that arising from disease of the liver. The existence of wasting disease and all sources of malnutrition,—such as tuberculosis pulmonum, chronic malaria, nephritis,—which predispose to chronic gastritis, must be inquired into.
If not directly or indirectly secondary to disease in another organ, the condi tion of the mouth should be ascertained; an examination as to carious teeth, or ab sence of molars (both not infrequently and usually unsuspected causes of gastric disturbances), as to the patient's dietetic and bibulous habits; these and similar underlying conditions, such as any habit of the patient prejudicial to health, must be thought of in order to obtain the best results from treatment. Systematic ex ercise in the fresh air, regularity in eat ing, with sufficient intervals between meals; thorough mastication and saliva tion of food; attention to the condition of the bowels and of the skin: in short, all that depends to general hygiene de mands as much attention as the medicinal treatment itself.
In all cases of gastritis in which the functions of the stomach are seriously affected, especially with the existence of subacidity and the accumulation of a considerable amount of mucus and a tendency to marked stagnation of the ingesta, lavage is of the utmost utility, not only as a cleanser of the mucous membrane, but properly employed as a stimulant to the secretory and motor functions. The tube and the accom panying apparatus such as is made ac cording to the writer's direction, by Tiemann, of New York, should be em ployed in order to obtain the douche effect so important in the treatment of atony and of subacidity. The tube should be used once daily at first, prefer ably on rising in the morning, a half hour or more before breakfast; if dur ing the day, at the time but little of the preceding meal remains in the stomach.
The hot water is preferably medicated with sodium bicarbonate and chloride in the proportion of 2 teaspoonfuls of each to the funnelful (750 cubic centimetres); but with the existence of large amounts of mucus a larger quantity of soda is es sential. Hot (105°) and cool (60°) water are alternately employed. The fluid is passed into the stomach with the intra gastric end just engaging the cardia (ap proximately seventeen inches), and re moved with it further introduced to the most dependent part of the stomach, the distance varying in different individuals, but, approximately in the undilated and unprolapsed stomach, twenty-one inches. The tube is again withdrawn to the for mer mentioned distance on the intro duction of each funnelful, and again re passed for its removal. The hard rubber funnel employed has a capacity of about 750 cubic centimetres. This or a less amount is entered at one time. The writer employed a weak solution of quas sia or calumba in the cool water in cases of subacidity and when little mucus ex ists, with sodium bicarbonate contained in but the first funnelful of water; or so dium bicarbonate is dispensed with and hydrochloric acid in one-half or less decinormal strength is added to the bit ter infusion. This line of treatment al most invariably exerts a marked symp tomatic improvement. If the stomach is very foul, as in carcinoma and rarely in simple chronic gastritis, antiseptics such as saturated solution of betanaphthol, or weak borax, or sodium sulphite or per manganate solution are employed after the first washing with sodium bicar bonate. From 3 to G fnnnelfuls are required to be separately entered and removed with each lavage. The process must not be prolonged if it is debili tating to the patient. Silver-nitrate solution, employed in amount and pro cedure such as the writer directs in the treatment of ulcer, and alumnol are most useful in chronic gastritis, espe cially in the hyperacid and in the mu cous varieties. If for any reason lavage seems impracticable, natural or artificial Carlsbad salts (sodium bicarbonate, 36; sodium chloride, 18; sodium sulphate, 42; potassium sulphate, 3.25; the so dium sulphate is added only if a mild laxative action is desired) may be em ployed, taken in hot solution; or, in mild cases in which a saline water seems indicated as a secretory stimulant, Ger man Kissengen (Rakoczy) or Wiesbaden (Kochbrunner) may be used, as is rec ommended by Boas. These waters con sist essentially of a weak solution of com mon salt and of alkaline carbonates, espe cially that of sodium, and may be re placed by the addition of these salts to ordinary water, the solution preferably being ingested rather warm. The local effects of small doses of sodium bicar bonate and sodium chloride are stimulat ing to the secretion of IIC1, and the so dium chloride, after absorption into the blood, while unquestionably contributing to the formation of the gastric 'acid, is also of utility, both locally and systemic ally, to pepsin-formation and to the transformation of inactive pepsinogen into the active enzyme.