Acute Gastric Catarrh

The principle of rest here occupies the first place. In acute gastric catarrh, during the first two or three days, in which, as a rule, there is a total loss of appetite, only very little nourishment in liquid form should be given, containing principally amylacea, barley or oatmeal soup, bouillon, weak tea, water. As a rule, one must not force a patient to take food during the first or even during the second day of sickness. The anorexia in these conditions is a wise arrangement made by nature in order to give the stomach rest. If there is thirst, beverages may be taken in small quantities, and must be neither very cold nor very warm. As soon as the appetite reappears one may give some toasted bread or zwieback, milk, soft-boiled eggs or oysters, permitting after a while small quantities of bread and meat, and then passing slowly to the ordinary diet.

Ulcer Of The Stomach

During the rest cure of von Ziemssen-Leube give liquid diet, consisting principally of milk, for two or three weeks. As is well known, Cruveilhier' first recommended milk for the purpose, and even now there are some physicians who limit themselves to milk alone. As a rule, however, it is appropriate to allow, besides milk, milk in combination with barley, oatmeal, or rice water. In addition to this, the different peptone preparations are here in place. I administer Rudisch's sarcopeptone, manufactured in this country, on account of its being palatable and highly nourishing. Valentine's and Wyeth's beef juice, tropon, plasmon, somatose, and the like may all be used for the same purpose.

One may give most appropriately every three hours one to two cupfuls of milk with the addition of the above-named decoctions (four times daily) and sarcopeptone (twice daily). The patient must not drink these fluids, but eat them with a spoon. In case of hemorrhage of the stomach during the first three or four days, it is not permitted to give any food whatever by the mouth; instead, the patient must be fed by the rectum. Ewald has proven that the large intestine has the ability of digesting and absorbing albuminates even without special previous preparation; therefore the following may be given as a nutritive enema:

1. Three to five eggs are mixed with 150 c.c. of sugar water (30 gm. of grape sugar dissolved in 150 c.c. of water), a small quantity of common table salt is added, and the whole mixture well beaten; one may add also a small quantity of starch solution or mucilage.

2. One-half pint of milk with two eggs and 50 gm. of grape sugar added.

1 "Anatomie Pathol.,"1829-85.

3. One and a half tablespoonfuls of somatose or peptone dissolved in a cupful of water.

The food enemata have to be given three or four times daily. It is necessary that the fluid should be at the temperature of the blood, and that it should be injected by means of a fountain syringe and a soft-rubber rectal tube. Each morning before giving the first nourishing enema a cleansing enema of 1,000 c.c. of lukewarm water has to be administered, in order thoroughly to cleanse the large intestine and make it more fit for absorption. In order to facilitate the retention of the feeding enema W. Gilman Thompson 1 suggests the following procedure: Upon withdrawing the tube, if there is danger that the injection will not be retained, a soft compress or folded towel should be pressed up firmly against the anus for twenty minutes or half an hour. In case of thirst the patient is allowed to take small pieces of ice into the mouth from time to time. Thirst and hunger, however, may be entirely relieved by nutrient enemata alone. "In an obstinate case of gastric hemorrhage in which absolutely nothing, not even water, was given by the mouth for more than a week," W. Gilman Thompson 2 says, "I questioned the patient in regard to her sensations of hunger and thirst, and she told me that they were entirely relieved after the first twenty-four hours' use of nutrient enemata.

The mouth and tongue were not dry and she did not lose weight during this period." Three days after the disappearance of blood one slowly and cautiously begins the liquid diet.

1 W. Oilman Thompson: "Practical Dietetics, with Special Reference to Diet in Disease," New York, 1895. 2 W. Oilman Thompson: l. c.