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that those means which would relieve much secondary distress are not used; or, 2ndly, the primary disease may have become so quiescent that this secondary one may be regarded as the only source of disease.
As to the prognosis, it must entirely depend upon the original malady; when that can be relieved, and the congestion diminished, the gastric symptoms are alleviated. Too often the disease is ultimately fatal; but a great deal may be done to remove the distressing symptoms, and to prolong life for many years.
In the treatment we have three means at our disposal:—
1st. To attempt the relief of the congestion,
2nd. To remove the excessive mucus, and,
3rd. To regulate the diet, so that the stomach may not be unnecessarily taxed beyond its capabilities.
Some appear to consider, that because the disease cannot be cured, therefore nothing can be done; this is both untrue and unwise, as well as unjust to the suffering patient; much may be done, and great relief afforded.
To relieve the congestion the bowels should be well acted upon, and to effect this various remedies may be employed.
Purgative enema serve, not only to empty the bowels, but to relieve the portal congestion secondarily through the inferior mesenteric veins. Salt, soap, castor oil, colocynth, turpentine may thus be used; more frequently purgatives will be resorted to as less trying to the patient. Extract of colocynth with henbane, rhubarb pill with henbane, jalap and scammony, are useful aperients; but a free mercurial purge, whether of blue pill, calomel, black oxide, or grey powder, are more effective, and often afford great relief, not only by unloading the bowels and thus diminishing congestion, but by stimulating all the abdominal glands to greater activity. The Podophyllin resin also may be advantageously used with the extract of henbane. Saline purgatives diminish the portal congestion, and in this way the sulphate of magnesia is often of service. Croton oil and elaterium are rarely called for in these cases.
The second object of treatment is to remove the excessive mucus; and although this might be effectually done by vomiting, having previously distended the stomach by large draughts of warm water, still in cardiac disease this would not be an advisable remedy, and in severe chest complaint would greatly distress the patient. Purgatives in their action serve to clear away large quantities of mucus; but this may also be promoted by mineral acids, either the nitro-hydrochloric in combination, or alone. These acids may be combined with purgatives, as for instance, with the compound gentian mixture of the London Pharmacopeia. The saline mineral waters of Cheltenham, Leamington, Carlsbad, Vichy, &c., cautiously given, greatly mitigate some of the symptoms to which reference has been made; and if general anosmia exist with this local congestion, the saline chalybeates may be tried, as Tunbridge Wells, some of the Harrowgate and Buxton Springs, the Brighton Spa, or Schwalbach, Franzensbad. The third object of treatment is to regulate the diet. Solid nitrogenous food requires the complete action of the stomach; and in most of these instances, if the symptoms be severe, it cannot be borne. Soups, and the forms of nitrogenous diet most easy of digestion, may be tried; but generally bland farinaceous food best suits the patient. Milk cannot always be taken, for it often coagulates, and a caseous semi-digested mass produces pain and flatulence. Eggs are more easily digested. As to stimulants of an alcoholic kind, caution is required; malt liquors are generally injurious, they will increase the flatulence and distress; so also sweet and effervescent wines; the astringency of port wine contra-indicates its use also, and if any wine must be given, dry sherry, claret, or burgundy are the best. Brandy and other ardent spirits, although they give temporary relief by stimulating the stomach and relieving the flatulence, do not lessen the portal congestion, and are therefore only a partial benefit; still in some cases they are absolutely necessary.
Inflammation is a term that has been applied to certain associated symptoms of disease; but the unfounded hypotheses that have been made in connexion with it have led to so much misapprehension that we would gladly renounce the word altogether; we feel, however, that it has become so interwoven with medical phraseology, that it is almost impossible to substitute any other term.
When inflammatory action arises in any form, the whole of the structural character of the part affected is altered, as indicated by the modified circulation and character of the blood, by change in the nervcus system, by the condition of the solid structure, and still more by the functions of the organ being interfered with. Thus redness and preternatural heat are excited at the part affected, the sensibility is increased, the structure of the tissues become swollen from the effusion of sero-albuminous or fibrinous products, and the functional energy is lessened. For instance, in inflammation of the stomach every part is changed; the capillary arteries become surcharged with blood, and if the disease be severe and acute, active hyperemia gives place to one of comparative stagnation of blood j the mucous membrane acquires such increased sensibility, that the presence of anything in the viscus causes pain and vomiting; the membranes of the stomach are all thickened, especially when the morbid process has continued for a considerable time, and the function of the organ is more or less checked, for the stomach is unable to dissolve nitrogenous substances, and to form chymous fluid.
It is not only in severe disease that these indications of abnormal action exist; but even in acute dyspepsia the same changes are apparent, although differing in degree; and the remarkable opportunity Dr. Beaumont had of witnessing the interior of the stomach in Alexis St. Martin has elucidated facts of peculiar interest;
\thus he saw tlirough an opening in the side the effects
(produced by ardent spirits upon the mucous membrane;
\ erythematous inflammation was at once set up, and the
I surface of the stomach beeame preternaturally red and congested, and also drier than in health, shewing that the gastric juice was not properly secreted. These changes were transient; but when irritation is persistent, an oedematous state of the membrane from serous effusion is followed by true thickening from fibrinous product; the surface becomes mamillated, and the cellular tissue is rendered more dense and opaque.