Diseases of the stomach may be classed as inflammatory, structural, and functional. Gastritis or inflammation of the stomach may be acute, subacute, or chronic. It is always attended by certain symptoms, but they are also mostly the symptoms of other diseases. Vomiting is frequent and persistent, but is of itself not sufficient evidence, nor when associated with pain in the epigastric region. The following combination of symptoms may be considered as diagnostic : intense pain of a burning character over the epigastrium, together with shooting pains in the chest, unaccompanied by the physical signs of pulmonary disease, nausea, and vomiting of muco-serous matter tinged with bile and often with blood, the act causing intense suffering. The thirst, though not always present, is often so great as to be almost insupportable. The pulse is frequent, small, and wiry. The temperature of the skin is generally considerably raised. The bowels are constipated except in cases of poisoning. - Acute gastritis is caused by traumatic injuries and by irritant poisons; also by excessive indulgence in alcoholic drinks. Over-eating and the eating of indigestible food are also causes.
The treatment does not involve much medication; rest, cooling drinks, light bland food, and the administration of nourishing enemas with sometimes small quantities of opiates, are the chief reliances. Lime water and milk may sometimes be taken better than almost anything else. Wine may be given by the mouth or spirits by the rectum. - Subacute gastritis is generally more or less transient. When attended with considerable fever, the. affection is sometimes called "gastric fever;" but this term is indefinite, and is also applied to cases of what are called " abortive typhoid fever," in which the symptoms for the first few days are like those of typhoid fever and then cease. It is often the consequence of errors in diet, either of over-eating or of eating improper food, and frequently follows a debauch. There is tenderness in the epigastric region and a furred tongue. Pain in the head is often a prominent symptom, frequently accompanied by nausea. The pulse is usually feeble and the extremities cold. If the inflammation approaches the acute character, the symptoms are heightened in proportion.
Rest, abstinence from food for a time, bland and nutritious diet, regulation of the intestinal evacuations by enemas, the application of sinapisms or other counter-irritants or of warm water dressings over the epigastrium, and the administration of demulcents, as flax-seed tea, and also small pieces of ice, are ordinarily indicated. Subacute gastritis is frequently connected with acute dyspepsia, in which case it is often designated by the indefinite term "bilious attack," although the term is generally an improper one, as the liver is not usually particularly implicated. There is congestion of the mucous membrane of the stomach, in which that of the intestines finally participates, with active diarrhoea and sometimes severe colic. The treatment includes the unloading of the stomach and bowels, with sometimes the administration of anodynes, particularly chloroform. - Chronic gastritis may come on gradually, or it may follow the acute or subacute form. Its symptoms are liable to be mistaken for those of functional disorder which constitute dyspepsia. The causes are errors in diet, poisonous or irritating substances, excessive drinking of alcoholic liquors, poverty of the blood, irregularity in the circulation, and diseases of other organs.
The treatment is rest of the organ, gentle exercise of the body, nutritious but easily digestible food, tonics, counter-irritants, bathing with after friction of the skin, and sometimes the administration of pills of nitrate of silver or of powders of subnitrate of bismuth. - The structural diseases of the stomach are induration, softening, ulceration, cancer, degeneration of the gastric follicles, and dilatation. Induration or sclerosis of the stomach is due to a morbid fibrous growth in the submucous areolar tissue, involving thickening of the coats of the organ. It is probably caused by chronic inflammation of the submucous areolar tissue. The affection may involve a part or the whole of the organ. When limited in extent the pylorus, is the part usually affected, a condition liable to produce stricture and render the case dangerous from retention of food. It is a rare affection, scarcely ever attacking those who are under 40 years of age. Its symptoms are liable to be mistaken for those of cancer, but its long continuance without the rapid progress of cancerous disease, and also its appearance in other organs, are diagnostic. It is generally regarded as chiefly occurring in hard drinkers.
The treatment is abstinence from spirits and other stimulants, and a nutritious and well regulated diet. - Softening of the stomach may be the result of inflammation, but there are cases of non-inflammatory origin. The softening may be confined to the mucous coat, or it may involve all the others. Non-inflammatory softening is probably sometimes caused by defective nutrition of the membrane. - Ulceration of the stomach is one of the sequelae of acute gastritis, but it may follow inflammation limited to the space of the ulcer. The ulcer varies in size, sometimes being so small as not to be easily found, or it may be an inch or more in diameter. The disease may prove fatal from perforation, from haemorrhage, or from inanition. Its duration is variable, and it is often curable. The treatment should include as much rest as possible for the stomach consistent with nutrition. - Cancer attacks the stomach about as frequently as it does other parts, but it is in this situation nearly always primary; that is, the affection does not make its appearance previously in any other part. The pylorus is the situation mostly attacked, and the disease does not then usually pass into the duodenum.
When however the cardiac end of the organ is the seat, the cancer generally also more or less affects the oesophagus. The cancer is generally of the hard variety known as scirrhus. The affection is attended with the peculiar lancinating pains of cancer, and vomiting is frequent, although less so than in simple ulcer. Blood is often found with the vomited matter, generally having the appearance of coffee grounds, and sometimes contains purulent matter. These symptoms are accompanied by progressive anaemia and loss of weight. - Degeneration of the gastric follicles has been found a more frequent affection than was formerly suspected, and is the accompaniment of many cases of dyspepsia. The treatment should be mainly constitutional, including good air and nutritious diet. - Dilatation of the stomach is usually caused by obstruction of the pylorus, but it sometimes, though rarely, occurs without it. The organ often becomes enormously distended, and tilled with undigested and fermented matter, and the muscular coat exceedingly thin. Regulation of the diet is the proper treatment. - The most important functional diseases of the stomach are dyspepsia and gas-tralgia. (See Dyspepsia.) G-astralgia is a painful nervous affection, sometimes of the most excruciating nature.
It often accompanies dyspepsia, and sometimes the structural diseases. When existing alone and in an acute form, it may be caused by the presence of obnoxious ingesta. It sometimes results from malaria, frequently accompanies intermittent fever, and is sometimes associated with gout. It rarely attacks old persons or those under the age of puberty. Prof. Alfred Stille states that it is often produced by chewing tobacco. The remedies during the attack are anodynes. Morphine may bo given by the mouth or by hypodermic injection. Bismuth has been used, it is said, with good results, but it is not generally relied on. A few drops of chloroform with water often give speedy relief. The general treatment will depend upon regulating the bodily functions and the diet. When of a malarious origin the preparations of quinia are indicated, in full doses.