In most cases of dilatation, there will be but very little pain, but where there is stricture of the pylorus, it is usually preceded by ulcer and excessive secretion, which are both painful.

Fig. VI. Side view of male figure.

A shows prominence due to dilated stomach, without abdominal distention B shows abdominal distention common in obesity, etc. Both conditions frequently exist in same person.

Fig. VIII. A Cardiac opening of the stomach. B Normal pyloric end. C Constricted pyloric end. D Gall bladder. E Opening of gall bladder into intestines. F Greater curvature of the stomach. G Lesser curvature. H Outline of dilated stomach. I Folds of stomach J douodenum.

Figure VII shows natural stomach, and dotted lines indicate a dilated stomach due to stricture of the pylorus. In these cases the outlet of the stomach is narrowed by ulcers or inflammations, until the stomach is unable to empty. These can only be helped by surgical operation. In ordinary dilatation there is but little pain, but a feeling of fullness and weight at the stomach is almost constantly present. There is also frequent belching of gas, which begins two or three hours after meals. Sour liquid or food will often be brought up with the gas and "heartburn" will likely be a common symptom. The general symptoms of dilatation can hardly be enumerated. Appetite may be very good, excessive or poor. Tongue usually coated; person may be thin or corpulent; often the latter. Constipation is persistent, but sometimes alternated by diarrhoea. The feces are fetid, because of the putrefaction it has undergone. Dull head-ache and nervousness are common, and frequently there is great sensibility to cold. Exertion quickly exhausts.

Persistent insomnia is a strong indication of a dilated stomach, and vertigo, unusual vision, dropsy of the limbs, numbness, cold extremities, flushing of the face, night sweats, asthma, neuralgia, eczema, arc due to poisonous matter taken into the blood from putrefying- food. One of the most alarming and sometimes fatal effects due to dilatation is palpitation of the heart. The enlarged stomach presses the diaphragm upward against the heart, causing heart failure. Many cases of sudden death in the night are accompanied with the announcement that the person ate a hearty supper, which probably caused the stomach to be distended with gas, and that in turn displaced the heart and caused heart failure. Too many people imagine that because their digestive organs do not double them over with pain, that they are all right, whereas if their food supply and digestion were all right, and the waste eliminated there would ordinarily be no distressing symptoms of any kind, except from contagious diseases.

Diet. The diet must be free from bacteria, and of a character that does not quickly ferment. As a general rule, the digestive secretions will be deficient in a dilated stomach. This is especially true of chronic cases of long standing. Where the pylorus is partly contracted, so that the outlet of the stomach is reduced, there will likely be excessive secretion, and then the stomach has to contend with its own acid, and those due to excessive fermentation. These cases however, are not the ordinary ones. When the stomach is dilated, plain milk will usually disagree. It should be taken with a teaspoon, and each spoonful kept in the mouth a while (a minute or two). The food should be dry, and no drinks taken with it. All starchy food should be cooked an extra long time, and cereals should be both boiled and roasted. Fresh doughy bread must be avoided entirely, and all bread should be thoroughly baked, and should then be sliced, and baked again. Sugar and sweet fruits, sweetened pastry, syrup, preserves, jellies, and all sweetened foods, must be kept out of the dietary. Cooked, roasted, ground and crushed cereals, should be substituted as far as possible for bread, so as to avoid the yeast ferment and baking powders. Granose biscuits are as good a food for dilated stomachs as can be found.

All cured meats and preserved foods are to be avoided, also all fried foods. Meat and eggs can only be partaken of in small quantities, and must never be fried. Peas and beans will be too solid, unless ground. So will nuts, but finely powdered nut meal with sour fruits will often agree better than any other food. Such stimulating foods as cooked onions without fat may be useful. Finely ground wheat bran will be a great aid, as it stimulates the digestive organs without obstructing or causing an excessive irritation. All stale fruits or other foods, except bread, are likely to ferment quickly, and are therefore not suitable. Rancid butter, or hot butter is bad under any circumstances, and particularly so for slow stomachs. Sterilized cream, nut oils, and the fat of ham or bacon, should be the only fats used. All free fats are objectionable, and this excludes all gravies. Malted gluten can always be used, and malt tea is an aid to starch digestion. The patient must be encouraged to eat plenty of food, as too little food means loss of strength, to resist disease. This can be accomplished by variety of foods and use of flavors.

It would seem to be hardly necessary to say that, pickles, pastry, condiments, tea, coffee, tobacco and beer should be left for those who have no regard for their own welfare. In the beginning, the dietetic treatment of dilatation it is essential to first cleanse the stomach. This should be done with a siphon, but if it is not done, the next best process is to eat a light dinner, a light supper, and then, on the following morning, drink a half pint or more of alkaline mineral water, an hour before breakfast, and then knead the stomach and abdomen for at least twenty minutes. If mineral water is not obtainable, a suitable substitute should be prescribed. No headway can be made as long as there is foul matter in the stomach. Hot water drinking will usually do more harm than good, because the stomach is already too much relaxed. After the stomach is cleansed, the mouth should receive attention. The food must not be contaminated by decaying matter in the mouth. Lemon juice will cleanse the tongue and membranes, but it should not be swallowed. For the teeth, any suitable wash may be employed or soap, and a brush will answer. The teeth must be kept in condition to masticate the food, and they must be well used for that purpose.

After the stomach and mouth are thoroughly cleansed, begin the diet with sterilized or pasteurized milk and malted gluten; or a soft boiled egg with granose biscuit or some other whole wheat food, that has been twice cooked. Meals must be regular and not closer than eight hours apart, except in acute attacks. Exercise, baths and pleasant surroundings are all important aids, and should be combined with regular habits. Every patient must be impressed with the fact that the diet and habits are far more to be relied on than drugs. The notion that chronic stomach troubles can be cured by drugs alone cannot be too quickly dispelled.