Of first importance in the treatment of this disease, as in nearly all other serious affections, is entire discontinuance of all the causes which may have produced it. This is absolutely necessary; and it is impossible to effect a cure unless the patient is willing to deny himself and observe a strict regimen until the stomach is restored to a normal condition. The diet must be restricted to such articles of food as will be easy of digestion, will not overtax the stomach, and do not easily undergo fermentation. Sugar, butter, and condiments of all sorts, must be avoided. Vegetables, flesh foods, and all articles of food known to be difficult of digestion, must be excluded from the dietary. Gross and irritating food of all sorts must be avoided. On this account, cracked wheat, graham flour, and the whole-meal preparations in general, are not well tolerated in this disease, on account of the excessive irritability of the mucous membrane of the stomach. In cases in which there is little or no acidity of the stomach, or heart-bum, bland farinaceous ar tides are the best, such as well-boiled and strained oatmeal gruel, fruits not seedy in character, baked apples, and similar foods.

It is well to avoid the use of meat when the patient can be otherwise sustained. At the most, a little of the white meat of fish or fowls may be used now and then. Soft-boiled eggs, with dry toast, well masticated and softened before being allowed to enter the stomach, agree well with most patients. In cases in which there is great acidity, starchy articles of food must be mostly avoided. For these persons a nitrogenous diet, or a bread and meat diet, is to be preferred. Very little fluid should be taken. No single article of food agrees so well with a large number of persons as milk. Not infrequently the disagreement of this article of food is due to bad association with other foods, as meat, vegetables, and fruits. If meat is taken largely as an article of food, little else should be eaten but well-baked, stale white bread. It is better that the bread should be toasted until brown and crisp. When milk disagrees with a patient, undergoing fermentation or forming large hard curds, it may be mixed with lime-water, in the proportion of one part of lime-water to four of milk; or it may be used in the form of buttermilk. The latter article seems to agree remarkably well with some cases of gastric catarrh. In the worst cases, however, no article is well received by the stomach, owing to the detention in that organ of undigested and partially decomposed food, which readily induces decomposition in whatever is eaten. In these cases one of two things must be done; either the stomach must be allowed to rest until it has become thoroughly emptied, and the mucous membrane has lost something of its irritability, or the stomach must be artificially emptied of its decomposing contents.

The stomach may be given rest by means of nutritive enemata, by the use of which life may be prolonged for an indefinite period. Experience shows that food injected into the rectum, although not digested in that part of the alimentary canal, is carried up into the small intestine by a reversed peristaltic movement of the bowels. We not long ago treated a patient for gastric catarrh to whom it became necessary to administer along with the food some remedies of a peculiar color and flavor, as nothing could be retained by the stomach. We were shortly surprised to hear the patient complaining of tasting the medicine administered. We at first supposed the difficulty to be wholly due to the patient's imagination, but upon examination of the matter regurgitated from the stomach we found it to present unmistakable evi dence of the presence of medicine injected into the rectum a short time before. The patient continued to expel portions of the medicine by the mouth so long as it was employed and for a few days afterward, the quantity gradually growing less. Physiological experiments have now established the fact above referred to, and nutritive enemata may be employed with the fullest confidence that if they are sufficiently nourishing and properly employed in sufficient quantity the patient will be adequately nourished thereby. Any one of the preparations described under the head of nutritive injections may be employed for this purpose. On account of the ease with which it may be prepared, the beef-tea and egg preparation is to be very strongly recommended.

In Germany the stomach-pump is much used in these diseases for the purpose of cleansing the stomach from its decomposing contents, the stomach being washed out each morning before breakfast. The rapidity with which a cure may be accomplished by this means is often surprising. Although to most patients the remedy may seem to be a harsh one, it is by no means so unpleasant as might be supposed, the flexible tube passing into the stomach with very little difficulty after one or two trials. In Fig. 275 is illustrated a method of washing the stomach, preferable to the use of the stomach-pump. A little study of the cut will show the operation of the device. The elevated reservoir contains the tepid water used for the purpose, which passes through the upper tube to the mouth, and thence through the stomach-tube, the upper end of which is shown at a, into the stomach, the water being prevented from passing into the pail below by pressure upon the lower tube with the hand. After the stomach has been filled by this method it may be readily emptied by closing the upper tube by pressure of the fingers, and opening the lower one. The pressure upon the stomach by the abdominal walls will force the liquid through the lower tube into the pail, thus starting the current, which, acting upon the syphon principle, will quickly empty the stomach. By repeating this process several times, the stomach may be thoroughly washed. In a short time the patient learns to perform the operation himself, and each morning washes his stomach as he would his face. We first saw this method employed by a patient suffering with cancer of the stomach who came under our care. This measure is, of course, necessary in only the most severe cases, and should be employed only under the supervision of a skillful physician.

Fig. 275. Improved Stomach Pump

Fig. 275. Improved Stomach Pump

In cases caused by frequently taking cold or long exposure to a damp, chilly climate, the patient should be treated with warm baths, and should take great pains to clothe the body, especially the trunk, very warmly, extra clothing to be worn over the stomach and bowels. Such general measures of treatment should be adopted as will improve the general tone of the system, as the general application of electricity, massage, tonic baths not too frequently repeated, etc. Wearing the moist abdominal bandage, called by the Germans the vmschlag, will be found very excellent in many of these cases. The bandage should be worn night and day for two or three weeks, until a slight eruption appears on the skin, when it may be discontinued for a few days to allow the eruption to disappear. There is no advantage in establishing large, suppurating sores about the body, as was done in the old-fashioned water-cure practice and is still recommended and practiced by some unscientific hydropaths. Hot fomentations over the stomach for a few minutes just before or just after a meal are useful for these cases. Probably the best of all simple measures is the use of alternate hot and cold applications to the spine, just back of the stomach. A celebrated London physician recommends the use of large linseed poultices covering the stomach and bowels an inch thick, to be worn during the night. We have never found it necessary to resort to this method, believing that the same effect is obtained by the use of the abdominal bandage. In cases of great acidity of the stomach the patient will often find much relief by the use of finely pulverized charcoal, or charcoal crackers. The dry pulverized charcoal is, however, much the best. It may be taken as powder, or stirred in a little water. A tablespoonful of charcoal taken immediately after the meal will frequently prevent acidity.

Not infrequently decomposition of the food may be prevented by eating one or two charcoal crackers after the meal. The charcoal should be freshly burned to be of any value; hence that found at the drug-stores is rarely of much utility. In obstinate cases of chronic catarrh of the stomach the application of galvanism in the form known as central galvanization is a very excellent measure of treatment.