Causation

Acute gastric catarrh is commonly due to dietetic errors, although it is also excited in other ways. The dietetic causes are:

1. Food taken in too large quantity.

2. Food too hastily swallowed or "bolted".

3. Food in itself irritant or too highly seasoned with sauces, condiments, fats, etc.

4. Food which has undergone decomposition, such as " high " game or fish, overripe cheese, sour milk, or improperly canned vegetables.

5. Alcohol habitually consumed in excess and in concentrated form, or a combination of drinking beer and wine or liquor, or drinking beer in excess with improper food.

It may be caused by corrosive poisons. Many individuals appear to have special weakness or irritability of the stomach, so that attacks of gastric catarrh are excited in them by conditions which would prove insufficient in others.

Excessive consumption of food beyond the wants of the system and out of proportion to the gastric juice is often an exciting cause of gastric catarrh, especially in children. This food need not in itself be indigestible. Such cases may result, for example, from eating large quantities of meat hash or of ice cream. Favourable circumstances are also present in anaemia, nervous exhaustion, convalescence from protracted illness, and in fevers, in all of which conditions the gastric juice, and especially its hydrochloric acid, is apt to be diminished in amount or temporarily absent. In these cases digestion is retarded far beyond the ordinary limits, and the retained food decomposes by abnormal fermentation, thus becoming both a mechanical and a chemical irritant to the mucous membrane.

Symptoms

The chief symptoms dependent upon the local inflammation of the stomach are severe vomiting, nausea, pain, weakness, and fever.

Dietetic Treatment

Acute inflammation of any structure is best treated by rest, and the stomach forms no exception. Hence total abstinence from food and great reduction in the quantity of fluid imbibed is often curative after an interval of twenty-four or thirty-six hours. The irritation is maintained by ill-advised attempts to give food at frequent intervals with the object of supporting the strength. The attacks, from the very nature of their causation, often occur in robust people who can well afford to forego nourishment for a few hours or until the nausea and pain cease. To others who have been enfeebled by continued illness or in whom the acute attack produces alarming prostration, enemata and stimulants and predigested albuminous food must be given.

The vomiting and nausea are allayed by cracked ice, small quantities of iced champagne, carbonic-acid water, plain soda water, cold lime water sipped in doses of a tablespoonful at a time and at intervals of fifteen minutes. Strong black coffee is also serviceable. These symptoms may also be relieved by hot poultices and turpentine stupes, or spongiopiline soaked in hot water and sprinkled with a few drops of laudanum placed over the epigastrium (Fagge).

The thirst should not be met by large draughts of water, which only distend the stomach and excite vomiting. It may be relieved by sucking a piece of sliced lemon or by placing a few drops of mineral acid, such as dilute phosphoric or dilute hydrochloric acid, in a small tumbler of cold water and sipping it from time to time. Thirst may be lessened in some cases by holding water in the mouth for a few moments without swallowing it, for a certain amount of fluid is absorbed directly through the buccal mucous membrane. If large quantities of fluid have been vomited, a simple enema of salt and water (fifteen grains to the pint) may be injected into the rectum, where it is soon absorbed.

When nourishment is first taken by the mouth, it must be fluid and carefully prepared, so that it will either undergo prompt absorption or pass into the duodenum for digestion. It must be administered only in small doses - half an ounce or an ounce at a time. Pancreatinised milk, or cold milk diluted with an equal volume of lime water or soda water or alkaline Vichy, milk whey flavoured or added to beaten white of egg, beef extracts, peptone solutions, black coffee, expressed meat juice, and beef tea properly made, are all recommended. Most broths contain too much fat or oil. Milk given alone or undiluted soon curdles in the stomach, and is promptly ejected in large tough coagulae. Many persons either actually cannot digest milk, or more commonly think they cannot, and avow a violent distaste for it, declaring that it leaves a perpetual bad taste in the mouth and causes headache and nausea. Their experience is usually based upon the use of undiluted and unprepared milk, and with tact and perseverance they can be got to retain and digest prepared milk very well. (See Milk Predigestion, p. 79.) Some patients prefer warm milk diluted with water and flavoured with a little cinnamon, a taste of coffee or caramel, or they may take barley water and rice water.

If patients cannot drink milk they may be allowed mutton, veal, or chicken broths from which the fat has been removed.

It is best to forbid all alcoholic fluids, even champagne, unless the patient is so exhausted that some stimulation becomes necessary, in which case brandy diluted with soda water may be given in small quantities, or it may be added to beef tea or arrowroot gruel. It is important always to aid the recovery of the digestive organs by absolute bodily and mental quiet.

Convalescence

In convalescence the diet must be very slowly increased; otherwise relapses may follow very easily. After some degree of improvement has been reached, the gastric mucus accumulates with more butyric-acid fermentation, and the vomiting and other symptoms return.

At first but one article at a time should be added to the fluid food, gradually replacing it. Broths may be thickened by beaten or dropped eggs, crumbled toast, or scraped beef or chicken. Later plainly cooked meat, such as broiled tenderloin steak, chicken, a tender chop, squab, or a bit of broiled fresh fish with lemon juice may be allowed with dry toast and rice pudding.

It is well to give dilute hydrochloric acid (ten to fifteen drops) with two grains of pepsin after each meal. When the illness has been very severe the patient must be cautioned to be careful in eating for several weeks after the acute symptoms have subsided lest a relapse or gastric dilatation occur. Alcoholic subjects will probably not heed this warning, but it should be given none the less.