Case II. April 19th, 1893

B. M. S------, aged 26, merchant, complains for two and a half yearn of digestive troubles. At first patient had lack of appetite, pains after meals, and nausea, but no vomiting. Feeling of weariness and fatigue; constipation. After some continued treatment and a trip to the South the condition of the patient improved for a while; soon, however, it got worse again. During the last two years patient has constantly pains right after meals, with but very few exceptions, and feels very weak. When fasting, patient as a rule feels well.

Status Praesens

Chest organs intact; the gastric region is sensitive to pressure. After drinking half a glassful of water a splashing sound can be produced, extending to one to two fingers' width above the navel. Liver not enlarged. Urine contains neither sugar nor albumin.

April 20th

Examination of the stomach contents one hour after Ewald's test breakfast shows: HC1 +; acidity = 60; admixture of much mucus.

Diagnosis

Gastritis glandularis chronica mucosa.

April 21st

When fasting, stomach empty. Lavage: in the wash-water, three red pieces of gastric mucous membrane. (A fresh specimen in glycerin shows gastric glands.) Spray with silver nitrate.

April 23d

Intragastric galvanization.

April 25th

Lavage: three red pieces of mucous membrane appear in the wash-water. Spray with silver nitrate.

April 27th And 29th

Direct galvanization of the stomach. Patient had to leave New York on account of business and returned on May 17th.

May 18th

When fasting, stomach empty. Lavage: three red pieces of mucous membrane are found in the wash-water. Spray with silver nitrate.

May 20th

Intragastric galvanization.

May 22d

Lavage: two red pieces of mucous membrane are found. Spray with silver nitrate.

May 24th

Patient feels better, has a better appetite, and hardly any pain. Lavage: no pieces of mucous membrane are found. Spray with silver nitrate.

May 26th

Direct galvanization of the stomach.

May 30th

Lavage: no pieces of mucous membrane. Spray with silver nitrate.

June 2d

Intragastric galvanization. Patient feels well and is, therefore, for the present dismissed.

Diagnosis

The diagnosis of erosions of the stomach is made if the above-described subjective symptoms exist and particles of gastric mucosa are frequently found in the wash-water when applying lavage in the fasting condition of the patient.

Treatment

The local treatment of the stomach here plays a great role. The astringent effect of nitrate of silver solutions in similar more accessible affections led me to apply this substance directly to the interior of the stomach. This can best be achieved by means of the spray. It was on this occasion that I constructed the gastric spray apparatus (see Fig. 46, p. 153), and recommended its use in the field of diseases of the stomach.1

In fact, the good result of this method of treatment can frequently be best shown in the affection in question, for after the spraying has been done several times the small pieces of gastric mucosa cease to appear. Associated with the objective symptom there appears an amelioration in the subjective feeling of the patient; the pains grow considerably less or entirely disappear, and the strength increases.

1 M. Einhorn: New York Medical Journal, September, 1899.

The treatment is given in the following way: First, the stomach in a fasting condition is washed out with lukewarm water; when all the water has been emptied, the tube is removed from the stomach. The spray apparatus is tilled with 10c.c. of a 0.1 to 0.2 per cent solution of nitrate of silver, the tube end dipped into warm water and inserted into the stomach (length of tubing 50 cm.); thereupon the whole, or at least the greater part, of the solution in the bottle is sprayed; the bottle is then opened and the spray tube removed from the stomach.

I usually combine the nitrate-of-silver spray treatment with intragastric galvanization, alternately applying the spray or the galvanization. The reason for the use of galvanization in these cases lies in the fact that I had such effective results in two other cases of probable erosions of the stomach, complicated with heart trouble,1 by means of galvanization alone. The methodical application of intragastric galvanization combined with the spray seems to increase the curative effect.

Recently I have used the extract of suprarenal gland (Armour & Co.) - powdering the stomach in the fasting condition, every other day, with about three grains (instead of the nitrate of silver spray) - also with very good results.

In some instances in which the just described local treatment is not feasible, large doses of subnitrate of bismuch (Ʒss. t. i. d., half an hour before meals) may be given with advantage.

As to diet, there is no need for being very rigorous in these cases. Frequent meals, avoiding heavy vegetables, salads, and pastries, is all I ordinarily require.

1 Ma Eiiihorn: New York Medical Journal. July 8th, 1893.

Cold ablutions, light gymnastics, outdoor life are to be warmly recommended.

Of medicaments condurango and nux vomica are frequently, and a good, easily assimilated iron preparation is always, appropriate.

Although these medicaments may be of value as adjuvants, we should rely, in my opinion, mainly upon the local treatment.