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that in the lung, and be detected after death; whereas, we never find tubercular deposit or strumous ulceration in the stomach, and the utmost that can be noticed is the fatty degeneration or atrophy occasionally found in phthisical patients, although not exclusively in them. Too often have we found that most important time has been lost during early phthisis by this error of supposing that the disease is “all stomach.”
In this state of functional disturbance of the stomach, preceding or accompanying phthisis, there is unusual irritability of the mucous membrane. As Dr. Theophilus Thompson has shewn, the state of the gums is peculiar, a red injected line of congested mucous membrane being observable along the margins of the teeth; nausea, loss of appetite, disrelish for fatty substances, pain at the scrobiculus cordis may also co-exist; severe vomiting may be followed by cough, and after a time by hæmoptysis, and the general signs of tubercular disease of the lung.
It is during this early stage of phthisical disease that reinedial measures are of inestimable value. Far better is it at this period to seek to invigorate and strengthen the system by change of climate and generous diet, than to wait until disease has become firmly established; for too often patients are removed from the comforts of home when the strength is entirely exhausted, and they are sent away to die among strangers, and in foreign lands.
We more frequently have sympathetic disturbance of the heart from functional disease of the stomach than the converse, namely, stomach irritability from heart affection, except that consequent on passive venous congestion.
In the disease of the supra renal capsules, which received so much attention from Dr. Addison, and which is generally associated with discoloration of the skin, irritability of the stomach is one of the characteristic symptoms; and although in some of these instances, we have found superficial ulceration of the stomach, and a condition of the mucous membrane indicative of more than mere functional change, namely, arborescent vascularity; still, we are led to regard the very intimate connection of the stomach by means of large nervous filaments with the semi-lunar ganglion, and the same ganglion with the supra renal capsules by still larger branches, as an important fact in explaining the irritability of the stomach in the observed cases of disease of the supra renal capsules.
In the sympathetic disturbance of the stomach from disease of the kidney, we do not refer to instances of Bright's disease and albuminuria, in which the changed character of the gastric secretion leads to vomiting and other signs of stomach disturbance; but we would notice cases of calculus in the kidney, in which vomiting is a constant and characteristic symptom, though evidently not connected with simple disorder of the stomach, for patients often state, that when the pair has subsided, they can digest a hearty meal, as we have before said, and we have had cases brought before us of this kind mistaken for ordinary abdominal colic.
That diseases of the uterus and of the urino-genital organs set up vomiting, is a fact familiarly knowl Many persons, during the whole period of utero-gestation. suffer severely by this sympathetic disturbance, and a greater number are affected during the earlier months.
Any abnormal congestion and inflammation about the ovaries, may lead to similar gastric distress; and in men, disease of the bladder, prostate and testicles, induce almost corresponding symptoms.
In the treatment of these forms of sympathetic disease, correct diagnosis is of the utmost importance, for it is worse than useless to direct the whole attention to the stomach, when it is only secondarily involved. Our chief concern then must be with the cause of the complaint; thus, in disease of the brain, if we can diminish the cerebral mischief, the gastric will soon subside. Still, although the stomach is not primarily implicated, and its structure is not changed, it is in an unfit state to digest an ordinary meal, and great care should be used to lessen the quantity of the diet, and to tax the energy of the organ, only by bland and unirritating diet.
Medicine may also assist in quieting even this secondary irritation, and in enabling the stomach to tolerate
the presence of food. Effervescent medicines, carbonic acid, &c., appear to act directly upon the nerve filaments of the stomach, and to diminish sensibility. Hydrocyanic acid, with alkalies, acts also as a sedative, and lessens irritability, so also bismuth.
In renal calculus, alkalies with rest are the most likely measures to afford relief, after having quieted the pain by chloroform, ether, or opium. Sometimes the inhalation of chloroform may be advantageously used, especially if the improved method be employed, namely, of mixing the chloroform with atmospheric vapour, in definite proportions, before the inhalation; the object to be sought for is, by so diluting the chloroform as to allow of its very gradual absorption, and in this way pain may be removed without narcotising the patient; or a free dose of Battley's sedative solution of opium may be combined with tincture of henbane and chloric ether. Belladonna may also be tried. The hypodermic method of employing morphia is a valuable means of quickly subduing the intense pain. In utero-gestation, on the contrary, mineral acids, with chloric ether, are perhaps the most effectual means of relieving vomiting, although too often ineffective whilst the cause remains.
In these instances of gastric irritation from uterine activity, the bowels should be gently acted upon, and the effervescing citrate of magnesia constitutes both a grateful and effective remedy. Much may be done, however, by careful regulation of the diet, the disturbance is sometimes quieted by the repeated administration of small quantities of food; and in all cases large meals should be withheld, and all external pressure upon the stomach itself taken away.
In young persons, especially those affected with hysterical susceptibility, with dysmenorrhoea or leucorrhoea, a state of extremne irritability of the stomach is sometimes induced. The contact of any substance with the mucous membrane is followed by its instant rejection, and this may take place without previous nausea or pain; and what is still more remarkable, there may be very little emaciation, although this condition have existed for many weeks or months. Sometimes pain at the scrobiculus cordis exists, but more frequently the pain is of a neuralgic kind, and is situated beneath the left breast; the pulse is irritable, the tongue has generally more or less injection of its papillæ, and the bowels are confined. It is to this state that Sir Henry Marsh has applied the term of “regurgitative disease;" because the food is rather regurgitated than vomited. These cases require careful watching and treatment; they nearly all after a time completely recover. These cases may, however, be associated with gastric ulcer, when the pain and more persistent symptoms of that state will be also present.
The first question is as to the food, which must be of a bland and easily digestible kind, as soup, muttonbroth, soda water with milk, farinaceous food. If these