OBSTRUCTION FROM THE OUTLET OF THE STOAIACH.—Pyloric stenosis is monly originated either by a contracting cicatrix of a healed ulcer situated near the pylorus or by carcinomatous tion of the pylorus. Simple hypertrophy and hyperplasia of the pylorus ciated with ulcer and cancer sometimes occurs, and naturally tends to produce dilatation. This, in the writer's ence, is not an uncommon cause of tation in certain cases of long-continued hyperchlorhydria. The writer has had two examples of this recently under observation. In one continuous hyper acidity with hypersecretion had caused attacks of very painful and obstinate nocturnal pylorospasm, for which he sought relief. Considerable dilatation of the stomach, symptoms of which had not been evident to the patient, was then found to exist. Apparently in certain eases, and more especially in the debili tated and nervous, chronic hvperchlor hydria will lead to the production of dilatation solely through maintaining a tendency to spasm of the pylorus, evi dently caused by the irritation of the superacid gastric juice. In one case ob served by the writer, notwithstanding a marked hyperplastic and hypertrophied pylorus, which, operation disclosed, had greatly narrowed its calibre, a searching examination in life and finally the post mortem showing demonstrated that no abnormal increase in the gastric capacity had occurred, although impairment of gastric motility, with stagnation of in gesta, had existed for some time. The stomach was actually symptomatically dilated, although of normal capacity.
A growth within the stomach, such as a polypus; or without, such as a car cinoma of the head of the pancreas; or obstruction by the pressure from an en larged gall-bladder (from calculus, for instance) and the like, stenosing the pylorus or a segment of the duodenum, especially the superior horizontal portion, or obstruction in the same manner by the presence of cicatricial bands or divertic ula, will originate dilatation of the stomach.
Numerous instances of congenital nar rowing of the pylorus are now on record. It should be remembered that this is a cause of dilatation of the stomach in in fants.
Treatment. — Attention to diet is of prime importance here. Fluids and all food tend to remain unduly long in the stomach. For this reason the former must be partaken of sparingly and the latter in an easily digested and more or less concentrated form. Carbohydrates and fats, which are digested chiefly in the bowel, and which have a tendency to undergo fermentation in the stagnant stomach, are to be permitted only with discriminating caution, as must liquid elements, which furnish small nutrition in great bulk. The diet in cases of dila tation is much that already described in the treatment of chronic gastritis: tender meats, thoroughly divided before eating or made into patties; beef, mutton, or fowl, free from fat and fibrous structure. A limited amount of farinaceous sub stances must be allowed, as they are craved by the patient, who cannot expect to continue long without variation on a too-restrieted dietary. The best farina ceous substances are those containing the least amount of starch and sugar. Maca roni; stale, white, or, preferably, light whole-wheat bread; and some of the fresh green vegetables, such as young pease, asparagus-tips, and tomatoes, may be permitted, provided symptoms of in digestion are not induced or aggravated by their use. With absence of hyper chlorhydria, tender-bodied sweet grapes, the juice of oranges, and a small quantity of stewed fresh or dried apple may he allowed. Thirst-creating food must be avoided.
The amount that may be eaten at a meal, and the proper intervals between meals. can be only gauged by the use of the stomach-tube to ascertain the con dition of the gastric functions. While the amount eaten at one time must not be excessive, yet the interval between meals should be such that no consider able portion is still present in the stom ach when a second meal is taken. Meals succeeding each other too rapidly is the cause of most of the dyspeptic symptoms in these cases. It is the fruitful cause of carbohydrates disagreeing through the inhibiting and even lethal effect of the accumulated free HC1 on the ptyalin in gested with the food or on the diastasic preparation administered.