Treatment

In the treatment of ischochymia it is necessary, first of all, to ascertain the cause of the stagnation of food in the stomach.

If this be due to a far-advanced stenosis of the pylorus, or to a commencing occlusion of this opening malignant in its nature, surgical interference (pyloroplasty operation, pylorectomy, or gastroenterostomy) is indicated. If we have to deal, however, with commencing benign stenosis of the pylorus, or a genuine relaxation of the muscular coat of the stomach, palliative treatment should first be given a trial, and in the event of its failure an operation is demanded.

The palliative treatment in the milder cases consists in the employment of a fluid or semifluid diet (milk soups, with finely ground farina, meat broths with egg, egg and milk) lavage of the stomach in fasting condition, followed by spraying with a one-per-mille solution of nitrate of silver, and in the administration of medicaments which prevent fermentation. Among these may be used benzonaphthol, salol, bismuth, and resorcin. I frequently give:

℞ Resorcin......................................... 4.0

Bismuth, subnit.................................. 20.0

Aq. dest.......................................... 200.0

S. One tablespoonful in a wineglassful of water three times daily, half an hour before meals.

Olive oil, three to four ounces t. i. d. half an hour before meals, has been recently recommended by Cohn-heim.1

In severe cases (frequent vomiting, violent pains, intense burning sensations) it is advisable to keep the patients in bed for about three weeks, and to nourish them for five days exclusively per rectum (besides the nourishing enema rectal injections of water, as recommended by Unverricht, are of great benefit when thirst is present and the amount of urine decreased) and then slowly and gradually adopt a milk diet, as in ulcer of the stomach - in this condition, however, much more cautiously and slowly.

Thus, for example, on the sixth day I give only two tablespoonfuls of milk every hour, on the seventh day three tablespoonfuls, on the eighth day four table-spoonfuls, etc., until I have reached 100 c.c. every hour; then I give 200 c.c. every two hours, and increase to 300 c.c. On every other morning I determine by washing out the stomach in the fasting condition whether it is empty.

In this manner it is frequently possible to adapt the stomach, first to a light, and later to a heavier diet. The patients then increase gradually in weight and appear completely well. Yet they cannot be regarded as entirely healthy, because we must be constantly prepared for a recurrence of the old affection.

1 Cohnheim: Arch. f. Verdauungskrankh., 1899, p. 405.

Moreover, in cases in which it is not possible to remove the ischochymia by palliative measures, the patient may sometimes maintain a comfortable existence under use of regular washings out of the stomach and the maintenance of a light and rather fluid diet. Such patients, however, are menaced by many dangers and can enjoy but few of the luxuries of life, and for this reason the clinician should insist that an operation is to be regarded as the only correct procedure.

In benign stenosis of the pylorus the application of massage (ten minutes twice daily) to the gastric region can be warmly recommended. Likewise the administration of alkalies in existing hyperacidity, and the application of the galvanic current when there are severe pains may be profitably tried.

Cancerous stenosis of the pylorus hardly admits of any treatment. Condurango given when there is anorexia, and chloral hydrate (a tablespoonful of a three-per-cent solution every two to three hours) when pains exist, as has been recommended by Ewald, are the most reliable and efficient medicaments.

In ischochymia due to atony of the gastric muscles the treatment should consist of lavage, direct faradization of the stomach, and the administration of frequent but light meals.