There are many cases in which much can be done at least to relieve pain. In chronic gastric catarrh, the disease is sometimes intercurrent with some other affection, probably considered to be far more serious. In these cases, pain is often considerably relieved by administering something to "bring up the wind". The simplest remedy for this purpose is hot water. It can generally be given whenever and as often as it is necessary. It causes an expansion of the gas in the stomach, and by this means stimulates the muscles to contract and relieves the organ of the distension which is one of the chief factors in causing the pain. But the hot water also acts as a warm fomentation, and is soothing to the stomach by the direct application of moist heat.

Another useful remedy for gastric pain is bicarbonate of soda in the proportion of half to one teaspoonful in a tumblerful of hot water. There can be no doubt about the soothing influence of this remedy. It neutralizes acidity in the stomach and thereby removes one of the sources of gastric irritation and an element in the causation of pain; but it does more than this: by its combination with the acid it causes a generation of carbonic acid gas, which is also soothing to the mucous membrane, and by raising the pressure of gases in the stomach still further stimulates the muscles and produces eructations, to the great relief of discomfort. There are other remedies of a similar character. These are the various waters, some one or other of which may already be in use. I mean soda-water, Apollinaris, and Perrier. In Apollinaris we have not only bicarbonate of soda, but an abundance of carbonic acid gas in a preformed state. In Perrier we have a water containing not more than 1per cent of minerals, chiefly lime; but there is an abundance of natural gas which makes it as superior to soda-water as good wine is to a mixture of alcohol, cream of tartar and water. There are other waters also, such as those of Vichy, Vals, Bilin, Ems, and Tarasp, which contain bicarbonate of soda but very little gas, and have the same effect when given with an equal quantity of hot water.

In hyperacidity or acid dyspepsia, also, the use of sodium bicarbonate or one of the alkaline waters relieves pain by neutralizing the acid gastric juice. In organic acidity they neutralize the organic acids arising from fermentation. This can be illustrated by adding a little bicarbonate of soda or one of the alkaline waters to a solution of hydrochloric acid, citric acid, vinegar, or lemon juice and water, which contain the same or similar acids to those in the stomach. When this is done, it will be found that the fluid which previously had an acid taste and irritating qualities has become neutral, or alkaline and unirritating. Therefore, while hot water relieves pain by dispersing wind and soothing the irritated mucous membrane, the bicarbonate of soda or alkaline water containing it effects the same purpose by neutralizing the acids which irritate the mucous membrane.

The pain in the stomach may, however, be due to other causes than flatulence and acidity. It may arise from the nature of the food. Suppose it is due to eating radishes, cucumber, lobster, pickles, pork, veal, pastry, or some other article likely to injure a weak stomach. It would do little good in such a case to keep pouring solutions of bicarbonate of soda into the stomach; it is true the soda is a sedative apart from its effects as an antacid, but it would do far more good to encourage the stomach to eject the offending substance. And this remedy is actually adopted in many instances. The pain arising from such foods may be sufficiently great to be called "cramp"; that is to say, the stomach hurts itself by contracting in an irregular manner upon these hard substances, or by attempting to propel them into the intestines. At the same time, the nervous mechanism becomes deranged, the excretion of gas by the gastric mucous membrane is increased, the stomach is thereby distended, and aggravates the symptoms. In such a case the most rational remedy is an emetic. Mustard and common salt are generally handy, and are usually effectual. Let two teaspoonsful of mustard be made into a paste and given in a tumblerful of hot water; it will speedily make the patient vomit. Common salt, a dessertspoonful in the same amount of hot water, is almost equally speedy in its effects. If they do not act, the dose must be repeated. I have generally observed that mustard is the most effectual, but at the same time it is more irritating to the gastric mucous membrane, and is liable to aggravate the catarrh which the irritating food may originate.

Then there is the pain which occurs in an empty stomach, that is, in acute gastritis, acute gastric catarrh, neuralgia, and cancer of the stomach.

In neuralgia of the stomach the pain is very frequently relieved by taking a warm meal of a reasonable and nutritious character. With that remark we can dismiss it for the present.

In acute gastric catarrh the relief of pain is to some extent brought about by keeping the stomach empty, or at any rate allowing only small particles of ice to relieve thirst. The application of warmth over the pit of the stomach is a valuable aid to other treatment. A piece of Gamgee tissue or flannel wrung out of very hot water and sprinkled with a tablespoonful of turpentine will often afford relief. The region may be painted thickly with glycerine of belladonna or opium liniment, covered with Gamgee wrung out of hot water, then a layer of oiled silk, next a layer of cotton wool, and finally a binder to keep it in place. The application of dry heat is useful in some cases, and for this purpose an indiarubber hot-water bottle, or an abdominal hot-water tin, can be used; but the patient often finds the weight too much for her. A light and useful application is a mustard plaster, which can be kept on for half an hour, and afterwards replaced by a layer of cotton wool.

In those excessively severe cases of acute gastritis which are due to powerful irritants, such as poison, also in the acute form due to infective diseases, such as puerperal fever, the inflammation runs very high, and may cause sloughing, possibly the formation of pus in the tissues of the stomach, and abscesses which burst into its cavity, warm applications may still be useful. They may consist of those already named, or linseed and opium poultices, starch poultices, antiphlogistine, etc. But the pain in the stomach is often of a burning character, sometimes described as being "like a fire," and, therefore, cold applications may afford more relief. A cold lead lotion, or the old-fashioned evaporating lotion, would not be despised. But the application of Leiter's tube, with a constant stream of cold water through it, and an ice-bag or pounded ice placed between two layers of flannel, would be more appreciated.

In cancer of the stomach relief from pain may be given by warm applications, but the chief reliance must be placed upon drugs, with careful selection and preparation of the food. Similar remarks apply to the pain of gastric ulcer. It would not do to apply warm applications over the stomach while haemorrhage is going on, and the relief of pain would then depend on the use of cold applications, which would also be the best local application to check the haemorrhage. If, however, perforation is suspected, a warm application would give most relief; antiphlogistine, starch poultices, turpentine stupe, or cotton wool would be useful. Such applications, however, would only be used until an operation is arranged, and is about to be carried out.

The nurse's ingenuity will often be taxed to find the means of relieving pain in gastric cases, but there is probably no class of cases which will better repay her for study than this. The stomach sympathizes with almost every other organ in the body, and, consequently, pain in the stomach is one of the most common complications met with, even when the stomach itself is not at fault, as exemplified in the gastric pains of locomotor ataxy and the gastric crises of Bright's disease.