With the occurrence of frequent vom iting, not checked by the use of lavage, a diet for the time limited to peptonized milk-gruel, iced Mellin's food, expressed meat-juice, or koumyss, much as is rec ommended in the treatment of ulcer, must be employed.
For the relief of gastric pain, should codeine, hydrocyanic acid, and bismuth not be of avail, morphine, or the deo dorized tincture of opium, should be un hesitatingly employed. For the relief of the impaired motility and the accom panying gastritis, besides the employ ment of the most essential lavage, certain stomachics, the chief of which here is condurango, are of service. Condurango has been found of such usefulness in gas tric carcinoma that once claims of a spe cific effect were made for it. Pain and vomiting seem sometimes to be lessened by it and appetite promoted. The orig inal formula of Friedreich's was: macer ate ounce of eondurango-bark for twelve hours in 13 ounces of water; sub sequently evaporate by boiling to half this quantity. Strain and administer ounce three times a day. A fluid extract of condurango may be employed in doses of 20 minims. To the condurango the following may be added, useful in all cases attended with stony and dimin ished gastric secretions:— Dilute hydrochloric acid, 10 to 15 minims.
Dilute hydrocyanic acid, 1 to 2 minims.
Tincture of nux vomica, 3 to 10 minims.
Spirit of chloroform, 5 to 10 min ims.
Tincture of orange, 20 minims.
Fermentation occurring in the stom ach-contents is usually obviated by lavage with antifermentatives, such as sodium sulphite, betanaphthol, boric acid, thy mol, etc., used in dilute solution. With the presence of organic acids in any amount, occasioning pyrosis and other symptoms of fermentation, antacids, such as sodium and calcium carbonate, and magnesium carbonate, or dried magnesia, may be given, combined with charcoal, betanaphthol, menthol, etc. A drop or two of oil of cajuput, or a portion of a minim of oil of peppermint or anise, may be added to each powder.
Constipation is relieved by the use of lavage, and one of the vegetable laxatives, such as cascara, rhubarb, or aloes (aloin), mentioned under chronic gastritis and under dilatation. For the anaemia, an iron preparation, preferably the albu minate or peptonate, or the saecarated carbonate (in dose of a small teaspoonful three times daily), or arsenic (the acid or the alkaline solution) may be given.
Gastroptosis.
Synonyms.—Enteroptosis; nephropto sis; Glenard's disease.
In this disorder there occurs a down ward displacement of the stomach and of the right kidney and perhaps one or all of the other abdominal viscera. Gle nerd's disease is a common affection in women, and not infrequently is encoun tered in spare, ill-nourished men. The causes are various: tight lacing; child bearing; debilitating diseases, etc. So many cases are encountered in young women who have neither laced nor borne children that other causes little under stood must be operable. The disease may be symptomless, as I have noted in a number of eases, but commonly various general (neurasthenic) and local (dys peptic) symptoms occur. The diagnosis
is the recognition of the usually com bined condition: gastroptosis and ne phroptosis. The loose right kidney is usually easily grasped in these subjects by bimanual palpation, the patient semi recumbent or recumbent, with head and shoulders supported by a pillow and knees semiflexed. The patient is directed to maintain a condition of relaxation of the abdominal wall and to take a full inspi ration. Toward the end of the inspira tory act the kidney can usually be easily grasped and held between the two hands. The left kidney, less frequently loose, can be similarly palpated. The dropped stomach is recognized by the measures outlined in the symptoms and diagnosis of dilatation. Air-inflation and the use of the gastrodiaphane tend to readily estab lish the diagnosis of dropped stomach.
Treatment.—This consists in develop ment of the flabby abdominal muscles and conversion of the condition of nega tive intra-abdominal pressure into that of a positive one, in order to obtain natural support for the prolapsed organs. The intelligent use of graduated exer cises, with or without apparatus, is most important in this particular. The use of a cushion-pad or bandage, if such is prac ticable, sometimes tends to relieve symp toms.
Attention should be directly paid to the digestive symptoms: Removal of con stipation and gastric atony; regulated wholesome diet, such as will not only agree with the stomach, but enable flesh to be gained. Intragastric and percu taneous faradism is of value.
Functional Diseases of the Stomach and the Gastric Neuroses.
There is a large class of gastric dis orders which must still be regarded as functional, and which are commonly grouped, collectively, among the gastric neuroses. Most of these affections are without present discernible minute an atomical alteration. Their existence seems to be dependent upon a strong neurotic taint, and to have had origin as a part of a general or local pronounced neurasthenic state.
Certain affections classed with the neu roses, such as hyperchlorhydria and con tinuous absence of the gastric secretory function (achylia gastrica), stand on the border-line, as it were, between the func tional and organic diseases of the stom ach. In a large number of eases of hyper chlorhydria there exists a proliferation of the acid-secreting cells, or of the gland cells as a whole, and in a large number of cases of achylia gastrica now on rec ord without preceding history of either a neurosis or suggestive of gastritis, the indications are that actual atrophy of the mucosa exists, probably as a result of a latent glandular gastritis. These, and especially the last named, have no place among the neuroses, although commonly considered with them.
The neuroses of the stomach are con veniently grouped into the sensory, the secretory, and the motor. The following convenient classification is practically that adopted by Boas:—