XVII. Diseases of the Stomach.

Acute Gastric Catarrh.

Synonyms:—Acute gastritis; acute catarrhal gastritis; gastric catarrh; acute dyspepsia.

Definition:—A catarrhal inflammation of the mucous lining of the stomach, characterized by swelling, general hyperemia and deficient secretion, accompanied with an excessive outpour of mucus and attended with both local and constitutional symptoms.

There is a difference of opinion between different writers as to whether an actual inflammation of the coats of the stomach is or is not present in this disease. The pathological characteristics, however, seem to be those of a mild inflammation in all forms, but they are distinctive only in the severer forms.

Etiology:—The causes which predispose a patient to an attack of this disease are impaired health from any cause, improper surroundings, bad hygiene, imperfect nutrition, a tendency to a malarial or rheumatic condition, and chronic conditions which involve the large glandular organs. It is also apt to occur during the convalescence from acute disease and in patients suffering from chronic nervous disorder. The immediate causes are cold and the taking of improper food. By far the larger percentage of cases depend upon dietetic causes. The habit of rapid eating, without mastication; of eating heavy, indigestible food at all meals; of taking food too highly seasoned with acids or the stimulating condiments, and the taking of canned foods and partially decomposed or tainted meats, or the habit of overloading the stomach, or of drinking a large quantity of fluids during the meal, or of taking the food too hot or too cold, and the excessive use of coffee, are all at times to blame for the occurrence of this disease.

The condition occurs most frequently in adults, with those who are addicted to the use of alcohol, and those who have a tendency to gout, syphilis or tuberculosis.

Symptomatology:—This disease exhibits a somewhat different train of symptoms during childhood than is found in adult life. The symptoms with children are somewhat more active or violent, and the course of the disease is shorter, with a more abrupt and satisfactory termination. The condition is ushered in with fever, accompanied with nausea and vomiting. The child complains of distress in the stomach, which occasionally amounts to an acute pain. The temperature does not exceed 102.5° F. At first the bowels are constipated, but on the second or third day there is a diarrhea, accompanied with colicky pains. The pulse is sharp, hard and quick, the tongue is coated with a uniform white coat, dotted with red spots from enlargement of the papillae. The mucous membranes of the mouth are deep red and dry, and the breath is offensive. The skin is dry and harsh, inclined to eruptions. The urine is scanty, of high specific gravity and high color.

With adults the first symptoms are those of loss of appetite and imperfect digestion. A very common symptom is the sensation of fulness in the epigastric region, when but very little food has been taken. With some patients this amounts to a sensation of distention, producing great discomfort. There is a steady, dull pain during the presence of food in the stomach, with occasional excessive eructations of gas, accompanied with nausea and vomiting. The tongue is heavily coated, and the bowels are constipated. These local symptoms, with proper care, may abate before constitutional symptoms develop. These appear on about the second day. There is headache, which at times is extreme, with lassitude, indisposition, mental dulness, and occasionally nervous irritability. The temperature rises to 103° F. and the pulse is sharp, hard and quick. These symptoms may continue for several days, when, with proper care, they slowly abate, leaving the patient comparatively well, but with a sensitive stomach, which must be treated with care for from ten days to two weeks subsequent to the acute attack. In childhood a complete restoration may occur in two or three days.

Diagnosis:—With children it is frequently with difficulty that this disease, in its early stages, is distinguished from other fevers. Acute enteric fever and other acute infectious fevers, in childhood, may begin with much the same symptoms. Persistent distress in the stomach alone, with local tenderness and vomiting, accompanied with slight fever, are the characteristic evidences. Occasionally with children a rash appears on the second or third day, which may be mistaken for scarlet rash. With adults the diagnosis depends upon the presence of persistent circumscribed soreness, with steady distress in the stomach, accompanied with some febrile action.

Prognosis:—The prognosis is good in all simple, uncomplicated cases. There is a tendency to a recurrence of the disease upon any indiscretion in the taking of food, and recurrences may result in chronic gastritis.

Treatment:—With children it is a good plan to give an enema, or a high colonic flushing at the onset. If there is vomiting, the patient should drink warm water or take a mild emetic in warm water, and thus wash out the stomach. This should be followed with a small dose of the subnitrate of bismuth, and with this aconite and ipecac should be given in small doses. Five drops each of the tinctures of aconite and ipecac, in a four-ounce mixture, should be given in dram doses every half hour until there is some abatement of the fever. In an occasional case the tongue will be pale, thick and broad and coated with a white, moist coat. In these cases our neutralizing cordial—the syrup of rhubarb and potassium compound—is of great benefit. This is sometimes sufficient to cause an abatement of all the symptoms. If the vomiting is persistent with these indications, I would administer, every fifteen minutes, a teaspoonful of a mixture of twenty grains each of subnitrate of bismuth, and ingluvin, in two ounces of water, thoroughly shaken before administration. There is a tradition handed down in our school, from the early days of Dr. Scudder's time, that an infusion of peachtree bark will control vomiting. I have never been able to obtain such a result from this remedy, although I have experimented with it in all forms and with all classes of patients. I have had much better results from ingluvin. or a trituration of ipecac. For the febrile symptoms aconite exercises a satisfactory influence, not only upon the temperature, but through the nervous system upon the gastric irritability as well, and through its influence upon the terminal filaments of the gastric nerves upon the capillary circulation of the mucous membrane of the stomach. Where nausea and vomiting are persistent, five grains each of ingluvin and bismuth subnitrate may be given every two hours.

Where there are evidences of an excessive gastric acidity, neutralizing cordial, or lime water, or the bicarbonate of sodium, should be given freely for from twelve to eighteen hours. If the secretions are deficient and the mucous membranes are dry and red, hydrochloric acid will be indicated. Its best results are obtained from the frequent repetition of doses of from three to five minims, well diluted.

Tf the bowels are constipated, a single dose of magnesium sulphate at the onset will be sufficient, if followed every day with a colonic flushing. Where the tenderness over the stomach is very great, with much pain, libradol, applied for six or eight hours, will give much relief. If soreness only is complained of, antiphlogistine, applied hot, should be kept on for twenty-four hours. In severe cases a mustard plaster may be first applied over the stomach, and occasionally sharp counter-irritation over the dorsal region of the spine will be of immediate benefit.

With adults complete rest to the stomach for a considerable period of time is essential in many cases. In all cases food should be denied the patient for a few hours at the onset, and small pieces of ice should be taken to allay the thirst. Ultimately milk to which a little salt has been added may be given, and later a piece of dry, buttered toast. The patient may drink freely of hot water, or of hot water to which a little milk has been added.

The subsequent care of these patients is important; the diet should be selected with reference to the condition of the stomach in each particular case.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.