Present Condition. July 22d, 1895

Chest organs normal. The palpation of the abdomen does not reveal any pathological condition. The splashing sound can be easily produced in the gastric region, and extends downward to about two fingers' width below the navel. Knee reflex present. Urine does not contain any sugar or albumin. Besides the above-described attacks of vomiting, patient complains of a feeling of heaviness in his gastric region about one hour after meals, and of slight constipation.

July 23d

Examination of the gastric contents one hour after Ewald's test breakfast: HC1+, acidity = 100, free HC1 = 86.

October 8th

Patient is in bed suffering from one of the attacks mentioned; he has vomited several times during the day and is suffering from intense pain. On inspection the abdomen is slightly sunken; on palpation the whole gastric region is found extremely sensitive and painful to pressure. The hands and also the face (particularly nose and forehead) are somewhat cold; pulse, 110; temperature, 98° F. The vomited matter consists of a pretty clear fluid with an abundant admixture of mucus; no food particles can be discovered in the liquid. On chemical examination free HC1 as well as pepsin and rennet are found present in large amount. Patient complains of intense thirst. Under the administration of opiates he grew better and was able to leave his bed after three days.

Case II

George N. J------, 42 years of age, merchant, suffered for five years from frequently appearing attacks of pains in the region of the stomach. These attacks were usually accompanied by vomiting of highly acid substances; they recurred once every three to four weeks and lasted about three days. During the attack the patient felt miserable and down-hearted, suffered from severe pains; was not able to eat anything and vomited frequently. When the attack was over he felt perfectly well, except that his sleep was somewhat disturbed.

The physical examination shows: Chest and abdominal organs intact; the patellar reflex present; stomach not dilated (the site of the stomach having been determined by gastro-diaphany).

August 31st, 1891

One hour after test breakfast, HC1 + , acidity = 00.

The patient was directly gastro-faradized for a period of two months. He had no attack during the time of treatment, nor any thus far after it was discontinued; sleeps well and feels stronger and full of life.

Diagnosis

The diagnosis of gastrosuccorrhoea con-tinua periodica can be made by the above-described symptoms, in connection with the examination of the vomited matter (which is found to consist principally of clear gastric juice without admixture of much food), or with the examination of the stomach in the fasting condition by means of the tube (which results in the withdrawal of a considerable quantity of clear gastric juice). Inasmuch as similar attacks of gastrosuccorrhoea may occur as a consequence of either an open ulcer or a cicatrix within the stomach, the pylorus, or the duodenum, it will be necessary to exclude such organic affections before making a diagnosis of continuous periodic gastric flow, which we consider to be a nervous affection. It will also be of importance to exclude organic spinal or cerebral troubles, which may cause a similar disorder of reflex origin.

Prognosis

The prognosis of pure gastrosuccorrhoea continua periodica is, as a rule, not bad. In many instances it is possible either to make the attacks less severe, or in some instances to effect a cure by rational treatment.

Treatment

It will always be advisable to analyze the gastric juice of the patient during the free intervals. If hyperchlorhydria is found this will have to be treated (see p. 331), even if there should be no subjective complaints; for hyperchlorhydria is frequently, although not always, the cause of such attacks. At any rate, a hygienic way of living should be inaugurated by the physician. I am in the habit of prescribing a good-sized dose of bromide as soon as the patient feels an attack coming on, and find that occasionally it may be cut short at the very beginning. In some instances the attack, although not interrupted in its progress, is thereby rendered less severe. When the attack has appeared the patient must be kept in bed. A hot-water bag is placed over the gastric region, and if the pains are severe an opiate, either alone or in combination with belladonna, is administered. During the first day of the attack no nourishment whatever should be given. A teaspoon-ful of cold water or a small ice pill can be administered from time to time, especially if the patient is very thirsty. The next day small quantities of milk, matzoon, or egg water, one or two tablespoonfuls, are given every hour.

On the third day the quantity of nourishment may be increased to half a cupful at a time administered every two hours, and besides the above liquid food the white of a hard-boiled egg chopped up fine may also be given (one or two eggs a day). On the fourth day meat (scraped, raw, or broiled) may be tried, and afterward the diet gradually arranged as for cases of hyperchlorhydria. The system of diet as laid down here for every day from the beginning of the attack will certainly depend upon the condition of the patient, and will have to be modified accordingly. As there is always constipation during the attack, it will be best to move the bowels on the second or third day, either by a glycerin suppository or by a large injection of water (a quart of water and a teaspoonful of salt), or an injection of sweet oil (one pint).