Liquids must be sparingly partaken of, especially with the meals. Not over ounces of fluid should be taken at a time. Buttermilk or one of the many preparations of komnyss, if agreeing, may be taken instead of water, if desired. Coffee and tea, especially with milk and sugar, are objectionable. Alcohol is bet ter avoided; but, if weakness is decided, a wine of good body or a small amount of dilute spirits is allowed.
In cases in which free HC1 is much diminished in amount it may be neces sary to administer predigested foods, such as is mentioned in the treatment of chronic gastritis or to give with the meals a sufficient quantity of papain to aid the digestion of the proteids taken. The combination mentioned in the treat ment of chronic gastritis is of value here. Or HC1 may be administered with or without pepsin, but with full doses of either strychnine or the tincture of nux vomica, and also in combination with a simple bitter. Excepting strychnine or nux vomica, drugs are of little utility in dilatation except to meet symptomatic conditions. 11 yperchlorhydria and by persecretion necessitate the use of alka lies several hours after food, as detailed in the treatment of acid gastritis.
The remedy of greatest value is lavage, but more especially the stomach-douche. its systematic, intelligent, long continued use, with coincident careful dieting, etc., stomachs at first regarded as hopelessly insufficient have been re stored to even more than a fair measure of usefulness. A tube must be employed that will not only insure removal of the stomach-contents, but will also allow the douche-effect in lavage. Alternate hot and cold water, plain or medicated, is used as cited in the treatment of chronic gastritis, the tube so employed that the water is projected from a height of three to five feet above the patient's head, the intragastric extremity just engaging the cardia. For the proper use of the tube the distance not only of the cardia from the incisors must be ascertained, but also that of the most dependent part of the stomach when this viscus contains about a litre of fluid. A graduated reservoir placed at a sufficient height and with a bulb attachment to obtain the valuable effect of intermittent projection of the hot and cold water is of extreme utility. The writer's two-way tube or
that of Gross, of New York, employed with such a reservoir, or connected with graduated flasks manipulated by an air pump, is of great use in douching the stomach in cases of dilatation and in chronic mucous and subacid gastritis. In treatment by the tube not over SOO cubic centimetres must lie entered at one time, however tolerant the stomach may be, and the amount entered and that removed must be compared. The best time for the application of lavage or the douche is in the morning at least a half hour before food is taken.
Intragastric faradism and the inter rupted galvanic current are of some value in the treatment of atonic dilatation, but not of the extreme use claimed by cer tain so-called stomach specialists. The writer's ten years' large experience with intragastric electricity enables him to speak with some authority on the subject.
Pereutaneous application of galvanism and faradism, electromassage, and mass age are also of utility in the way of im parting tone to the relaxed abdominal wall. For technique of these methods see the writer's article on treatment of dilatation of the stomach ("System of Practical Therapeutics," vol. p. 963, et seq.). With pronounced bulging of the £pigastrium, especially if coincident pro lapse exist, a cushion pad suitably con fined, constantly worn by day tends to relieve sensations of fullness and weight present.
The treatment of constipation occur ring in dilatation of the stomach is on lines similar to that given in the treat ment of chronic gastritis. Lavage and the stomach-douche are of the greatest value in this connection, and massage, electromassage, and percutaneous abdom inal galvanism and faradism are also of use.
The surgical treatment of dilatation of the stomach, such as that of gastropli cation, or gastrorrhaphy, for reducing the size of the stomach in simple atonic dila tation; and, for remedying a stenosis of a pylorus the result of a cicatrix, or of an hyperplastic sphincter, Loretta's digi tal divulsion; or, preferably the pyloro plastic operation of Heineke-Mikulicz; resection of the pylorus, and the opera tion of gastro-enterostomy are discussed in another section.