Etiology

Dilation of the stomach is not a common disease; yet in a large general practice a physician will see a case occasionally. It is characterized by nausea; vomiting sometimes coming on suddenly, and surprising the patient by the amount of material thrown out. The reason for the amount is that there is an accumulation. In all cases there is a certain amount of stricture of the pylorus. In all chronic cases of this disease (and all cases worth mentioning or being classed as cases of dilation of the stomach are chronic), there has been chronic irritation for years perhaps, due to overeating and the formation of acid. The acid in time creates more or less ulceration, and it is the hardening of the tissues that follows the ulceration which produces a strictured condition of the pylorus. When patients who have a diathesis become run down and enervated, they have more tendency to develop the disease which is in keeping with their diathesis, and after that they may take on malignancy.

Symptoms

On percussing over the region of the stomach, the experienced physician will readily detect dilation, and, on palpating from side to side, there will usually be a splashing of the fluids, or contents of the stomach. Where dilation is suspected, the hands should be placed, one on each side of the abdomen, and then brought toward each other suddenly; or one is to be pushed suddenly toward the other, and then immediately the hand that has been kept quiet will go through the same motion toward the other. In this way there will be a splashing sound elicited, which is almost positively diagnostic.

Then, if a hard lump is found a little to the right and above the umbilicus, this will confirm the diagnosis, which is that the patient has dilation of the stomach, with enlargement or thickening, with stricture or cancer, of the pylorus.

If there is blood in the vomitus from any of the vomiting spells, or if the ejecta have the appearance of coffee grounds, this will be a strong indication that the patient has cancer. Then, if cancerous cachexia be added, the diagnosis is without question cancer of the pylorus of the stomach. When there is a failure to pass out the liquefied or digested material, and it is retained, fermenation, with bad breath, will be common. At first the fermentation produces alcohol; later, acetic acid. At this stage there will be little digestion of food. If much butter is eaten , there will be butyric-acid fermentation. One of the most pronounced symptoms of butyric fermentation is a pungent eructation from the stomach, which will scald and make the throat feel very uncomfortable. This is an indication of a lack of hydrochloric acid. Where dilation is found to exist, chemical analysis of the stomach shows a deficiency in hydrochloric acid; lemons, or sour fruits of any kind, will assist the stomach in digesting foods, but the amount of food taken must be limited. Surgery is seldom, if ever, necessary.

Treatment--Try out first the stomach-pump once or twice a day, and fruit for the morning meal; for the evening meal, meat and fresh fruit or salad. Thirst should be controlled by enemas. No water or other table beverages should be used. The stomach-pump will give great relief if used daily, and only solid food given. If the disease of the pylorus proves to be simply a hyperplasia due to irritation, congestion, and inflammation, by removing the irritation with the stomach-pump, feeding nothing but solid nourishment, and keeping the stomach cleaned out, there is a possibility of reducing the inflammation and hardening, gradually reducing the thickened state of the mucous membrane, and restoring the opening of the pylorus to sufficient caliber to allow the food to pass out normally. In these cases an operation for enlargement of the opening, followed by proper care in eating and care of the body generally, may end in perfect recovery, and good health may follow for years to come. The operation should be simply one of enlarging the mouth of the pylorus.

If the case proves to be cancer of the pylorus, an operation may lengthen life or prolong the patient's misery. However, by making an opening from the stomach into the bowels below, the patient will be relieved, but not cured. Some will live one or two months; others may live a year or so. The diet should be raw fruit and raw vegetables.