A. Acute Gastritis

In the common form of acute gastritis the changes are almost entirely limited to the mucosa. The condition is therefore often termed (1) simple gastritis or gastric catarrh. It is thus distinguished from the rarer and more severe inflammations, in which the changes involve a greater depth of the stomach-wall such as (2) the toxic gastritis resulting from the swallowing of irritant poison, and (3) infectious gastritis due to various bacteria, especially streptococcus.

Simple gastritis is marked off from the other common forms of dyspepsia by its acute onset following on some generally recognizable cause, by the prominence of vomiting as a symptom, and by the appearance of mucus in the vomit. It is often associated with a similar condition in the small intestine, and it is sometimes followed by catarrhal jaundice.

In considering the treatment of simple acute gastritis, it is necessary in the first place to understand the origin of the condition, inasmuch as it is generally avoidable; and in many cases it is easy to lay down a few wholesome regulations which will serve to prevent subsequent attacks. It may follow any error of diet. The taking of a large quantity of indigestible or irritating food is a common cause, and an attack is the more likely to occur if this is bolted either from carelessness or as a result of defective teeth. This is a common cause in children. Indulgence in ices on a large scale may produce it. It is a common result of alcoholic debauch, and it is the natural ending which closes each drink-attack of the dipsomaniac. It may be produced by decomposing food, and is then usually associated with a catarrhal enteritis. It is sometimes noted as an early symptom of some specific fevers. Occasionally attacks of considerable severity occur with fever, pain and tenderness, and it is probable that these are of bacterial origin, though they may end in speedy recovery. It is clear that some people have a natural tendency to develop gastric catarrh on slight provocation, and in these more particularly a regulation of diet is important. In the second place it is necessary for the purpose of treatment to realize, that during the acute stage the gastric secretion is scanty and the power of digestion is imperfect or absent for a time, so that complete starvation is both necessary and physiologically correct. Nearly complete rest to the stomach leads to a rapid recovery. This should be obtained without regard to opposition from relatives.

In severe cases with some collapse a few saline injections per rectum may be given, but this is seldom necessary, as abstinence from food need not be maintained for more than a day or two as a rule. Thirst is a prominent symptom at first. Ice, iced water, or iced champagne are often allowed in small doses at this stage; but though they are grateful to the patient, I think it is better to give hot water in teaspoon doses to the amount if necessary of 10-15 oz. in the first 24 hours. The vomiting is not altogether harmful, and it may be disregarded. Alcohol should be avoided, unless it is absolutely necessary in weakly subjects. In 24 or 36 hours feeding may be resumed on a small scale, milk diluted (4 to 1) with lime-water, soda-water or barley-water being tried at first. Of this mixture 20 or 30 oz. can commonly be taken in the first day. From this time onwards it is a matter of graduated increase of food, until a normal full diet can be established. The materials used at first should be milk with a decreasing amount of dilution, albumin-water (the white of one egg stirred up in 10 oz. of water with a little salt) and whey; and to all of these a little brandy or sherry may be added if necessary. As a rule on the fourth or fifth day carbo-hydrates can be added in the form of arrowroot, toast or rusks, and these with 30 oz. of milk (some of it preferably in the form of blancmange), one or two eggs poached or lightly boiled and some beef-tea or clear soup will form a sufficient diet.

About the third day Boas recommends the following diet: -

8 a.m..... Milk (with tea), 200 grms.

Zwieback, 50 grms.

10 a.m..... Bouillon with egg, 200 grms.

Noon .... Milk-soup, 200 grms.

Toast, 50 grms. 3 p.m. . . . Milk, 130 grms.

Cakes, 50 grms. 7 p.m..... Milk-soup with rice, 200 grms.

Zwieback, 50 grms.

Subsequent extensions by the addition of fish and chicken may be quickly made. At this point if the origin of the attack is clear, final injunctions should be given as regards a healthy diet and the avoidance of future attacks.

In the toxic and infective forms of acute gastritis, both of which involve immediate risk to life, the problem consists in the maintenance of strength with abstinence from food over a much longer period of time. During the early days of imminent danger rectal feeding must be adopted in its most efficient form.