The frequent use of saline laxative waters, especially those containing so dium chloride and bicarbonate, besides their laxative salts (preferably sodium sulphate), are of distinct service in syn ergizing the effects of lavage in cleansing the stomach of mucus, promoting a healthy condition of its walls, and in fluencing its functions generally for good, even when lavage alone promotes regular alvine evacuations through its stimulating effect on the gastric and the intestinal peristole.
Silver nitrate, save employed as a wash on the empty clean stomach, the writer does not regard as of utility. Bismuth subnitrate and subgallate and zinc oxide are of no special service in the treatment of chronic gastritis. In the form char acterized by hyperchlorhydria bismuth is of value, as it is when gastric hyperms thesia and actual pain are prominent symptoms. It should be given on the empty stomach in doses of S to 30 grains, and codeine, hydrocyanic acid, cocaine, hyoscyamus, or belladonna may be com bined with it, as in the treatment of the pain of nicer. The best result from its use is following lavage. In cases of super acidity an alkali or a combination of alkalies, such as is recommended in ulcer, is called for to be administered at a period in gastric digestion when pepton ization has advanced and an amount of free IIC1 over that required for the com pletion of digestion becomes evident. The dose should be based upon the de gree of acidity, ascertained by examina tion of the stomach-contents, after not only the bread trial-meal, but one of mixed food. it being recalled that the de gree of discomfort originating from the hyperacidity may, with heightened gas tric sensibility, be out of proportion to the actual extent of acidity. Here even more than in simple hyperchlorhydria too full a dose of antacid must not be habitually given soon after a meal.
In most cases of subacidity there is no remedy of more service alone or in com bination with a simple bitter than HC1. Its uses in chronic gastritis are many; in acting not alone as a digestant. but also in stimulating the formation of pepsin and perhaps its own secretion; in assist ing in the transformation of the inactive proenzvmes existing in the gland-cells into the active ferments; and in inhibit ing fermentative processes which con stantly occur in this disease when stag nation of food is usual. A combination
of pepsin with it is unnecessary, since, when HCl can be of any utility as a di gestant, the pepsin already exists in suffi cient quantity in the gastric tubules, needing only the presence of HC1 to bring it into activity. The pepsin-secret ing cells are so much more widely dis tributed in the stomach and in so much greater number that. it is almost invari able in cases in which HC1 is absent other than those of complete gastric atrophy that pepsin can still be readily obtained from the stomach in quantities sufficient to act as a digestant by means of the use of HC1. The question of pepsin-and }ICI administration in diseases of the stomach has been before entered into in detail in a paper by the writer (They. Gaz., Feb. 15, '93), a reprint of which will be sent on application.
As a secretory stimulant, IICl may be given in small doses (10 to 15 minims of the dilute acid) shortly before meals, or preferably in larger post-prandial ones, that advantage may also be taken of its ability to assist digestion. The writer commonly gives'/_ drachm to 2 drachms largely diluted with water in divided doses at intervals of ten to twenty min utes, the initial dose being taken a half hour after meals; or the acid may be taken through a small stomach-tube in a single dose of from 1 to 2 drachms. This last is the writer's favorite mode of administering the acid in cases of neu rotic subacidity accustomed to the tube. In cases in which HCl is practically not secreted through atrophy of the gastric tiffiules its administration can be of no utility.
The bitter tonics—such as nux vomica (or strychnine), quassia, ealumba, eon durango, and gentian—synergize the action of IIC1 as secretory stimulants, and are of value (although less here than in functional [nervous] subacidity and stony) in imparting tone to the weakened muscularis. Their utility is snore marked when administered before than after meals.
Intragastric electricity, but especially faradism, the writer regards (in ten years' experience with it) of value in cases of subacidity and loss of gastric motor tone.