Stomach. The Anatomy and Physiology of this organ are treated of in the article DIGESTION (q.v.). See also ABDOMEN, ARTIODACTYLA, BIRD, FISHES, &c.; and INDIGESTION, VOMITING.
DISEASES OF THE STOMACH.—Acute gastritis, or inflammation of the mucous membrane of the stomach, is a very rare disease, except as a result of the administration of an irritant poison; during six years' experience at La Charité (one of the leading Parisian hospitals) Dr Louis made notes of 6000 cases of disease, but did not meet with a single case of fatal idiopathic or spontaneous gastritis. The symptoms which indicate that an irritant poison has been received into the stomach are a gradually increasing sensation of uneasiness or heat, which shortly assumes an acute burning character in the epigastric region. This pain is accompanied with vomiting, which becomes increasingly frequent as the pain augments, and often with hiccup. There is usually extreme tenderness on pressure, and the patient bends his body forward to relax the muscular tension. During the accession of these symptoms there is a marked degree of excitement, as indicated by the acceleration of the pulse and breathing and the heat of the skin. This condition is, however, soon exchanged for one of prostration. The skin becomes cold and clammy, the pulse thready and feeble, and the breathing catching and intermittent; until finally, after a variable period of exhaustion, the patient sinks, usually retaining his mental faculties to the last. Although the above-described symptoms are always more or less present, each irritant poison occasions some special symptom and some characteristic lesion; and the period at which death ensues varies for different poisons.
Sub-acute gastritis, or gastric catarrh, is by no means a rare affection, and it occurs in two distinct forms—'one in which the malady is caused by a constitutional state, the effects of which are shown in a variety of other organs as well as in the stomach; another in which it is due to causes connected chiefly or exclusively with this organ, which is submitted to an irritative process somewhat analogous to that typified by the gastritis of irritant poisoning' (Brinton, On Diseases of the Stomach). The first of these forms is well illustrated in such diseases as smallpox, scarlatina, pneumonia, &c., in which the digestive process is much interfered with, and after death distinct marks of inflammation are seen in the stomach. The other variety, which is often of a chronic form, is well seen in cases of delirium tremens, the affection being sub-acute or chronic, according as it has been produced by a single prolonged debauch, or by a protracted habit of drinking spirits, and the patient's final malady being induced by a deficiency of food or some injury or acute disease. Purely chronic inflammation may be induced by various causes, of which the most common are the abuse of alcoholic drinks, habitual excess in eating, the eating of indigestible food, and the excessive use of irritating medicines. The symptoms are like those of indigestion in a severer form; in fact it is impossible to draw a sharp line of distinction between the two affections.
The treatment of gastritis varies much with each individual case, but the first point is the removal of the cause—to be attempted in cases of irritant poisoning either by the removal of the poison (by the stomach-pump or emetics, as, for example, sulphate of zinc) or by its neutralisation by means of an antidote. In very severe cases leeches may be applied to the epigastrium; but counter-irritants, such as turpentine on a hot moist flannel, or mustard-poultices, are generally of more service. Continuous fomentation with water, as hot as can be borne, often gives great relief, while at the same time iced water, or small lumps of ice swallowed whole, usually relieve the thirst and mitigate the pain. Emeticata of purgative materials, if the bowels are constipated, or of a soothing character (as thirty drops of laudanum in a little starch or gruel), if the bowels are irritable, may be prescribed with advantage. When the stomach begins to be able to retain food, it must be given in the form of a bland liquid, in small doses, at distant intervals. Chronic gastritis must be treated in much the same manner as Indigestion (q.v.). The most essential point of treatment is the due regulation of the diet.
Ulcer of the stomach is the most important of the idiopathic diseases of that organ, both from its frequency, from the facility with which it may in some cases be detected during life, from the fact that at any period of its protracted course it may prove suddenly fatal, and from its being usually curable. The first and most characteristic symptom of this disease is pain, which comes on very soon after the ingestion of food, and lasts for an hour or two; vomiting often ensues, with such relief that the sufferer sometimes gets into the habit of inducing it himself. The place of most common appearance and greatest intensity of the pain is the centre of the epigastric region, but it is sometimes higher, lower, or to one side, and occasionally in the back. The pain in both the epigastric and the dorsal region is almost always much increased by pressure; also by food and drink, especially by the ingestion of hard and indigestible substances. The pain, vomiting, and want of nourishment lead of course to much enfeeblement. The disease is sometimes terminated by the occurrence of perforation, ending in rapidly fatal peritonitis; and if this accident does not occur, the dyspeptic symptoms may become complicated by hæmorrhage from the stomach, sometimes so rapid that it distends the stomach and adjacent small intestine with a single gush, and causes fainting and almost immediate death, but more commonly occurring as a slow and intermittent drain of blood, giving rise to anæmia. In some cases, however, symptoms are either absent altogether or so slight that no attention is paid to them, till the presence of the ulcer is revealed by one of these accidents. If death from the above causes (inanition, perforation, or hæmorrhage) does not terminate the disease, the symptoms frequently subside in something like the inverse order in which they occurred, and recovery, often after many years' suffering, ensues. Brinton states that this lesion may be detected in (on an average) 5 per cent. of persons dying from all causes; that it occurs twice as frequently in females as in males, and that it is specially a disease of middle and advancing life—twenty-seven being the average age in females and forty-two in males. Nothing is known with certainty regarding the causes of this disease, except that advancing age, privation, mental anxiety, and intemperance so frequently coincide with it that they may be regarded in some degree as producing it. But it is particularly frequent as a complication of Chlorosis (q.v.). In relation to treatment strict attention to diet is of the first importance. When the symptoms are urgent the patient should maintain the recumbent position, and should be fed on cold or lukewarm milk thickened with biscuit-powder, given in doses of one or at most two tablespoonfuls at regular intervals of from ten minutes to an hour. The pain is often relieved by the application of a mustard-poultice or blister to the painful spot; and benefit is frequently derived from the internal administration of bismuth (in doses of ten grains), either given alone or combined with the compound kino powder (in five-grain doses). When there is hæmorrhage small lumps of ice may be swallowed; and if all food is rejected by vomiting, nutrient injections must be thrown into the lower bowel. Aperients are sometimes required, but they must be given with caution; and if castor-oil can be taken without increasing the pain or vomiting, it is the most harmless remedy of its class.
Cancer of the stomach is obscure in its symptoms, frequent in its occurrence, and always fatal in its termination. The typical course of this disease is thus sketched by Brinton: 'An elderly person perhaps hitherto free from dyspepsia begins to suffer from a capricious, and soon a diminished appetite, which is by-and-by associated with occasional nausea, or even vomiting, and with a sense of uneasiness or distention of the stomach. His complexion, already pale and unwholesome, next acquires a muddy, yellowish, or faint greenish hue. His gastric symptoms now increase; often by a sudden and marked augmentation, which corresponds to what is in other cases their first appearance. Vomiting, if already present, becomes more frequent and urgent; local uneasiness deepens into pain; and both these symptoms are excited or increased by taking food. At a somewhat later period hæmorrhage generally occurs, usually but scanty in amount, and therefore depending to a great extent on casual circumstances for its detection. About this time a tumour often becomes perceptible near the middle of the epigastric region of the belly. As the local symptoms increase the cachexia of the patient also augments, and is evidenced not only by the colour already mentioned, but also by debility and emaciation, and at last by prostration, which ends in anasarca, delirium, and death.' But any or all the distinctive symptoms may be absent. 'There are indeed some cases in which the most acute observer cannot do more than suspect the presence of the disease.' In the treatment of this formidable disease more good is done by careful attention to the diet than by any medicine. Good milk or strong beef-tea thickened with biscuit-powder may be given in the same manner as recommended in ulcer; and milk mixed with a little old Jamaica rum will sometimes stay on the stomach when everything else is vomited. If there be pain, opiates must be administered, either in the ordinary way, as enemata, or hypodermically, the latter having the advantage of having less tendency to induce constipation.
Hæmatemesis, or Vomiting of Blood, is a serious and important symptom of disease affecting the stomach. It may occur by the ulcerative destruction of the walls of a comparatively large blood-vessel in gastric ulcer and in cancer; but it generally is of the kind termed capillary, and happens under various circumstances, of which the following are the principal. It may take the place of some habitual hæmorrhage, or, in other words, be vicarious. Thus, it may possibly take the place of the menstrual discharge. It is often caused by disease or injury of the stomach; for example, it frequently occurs after the ingestion of strongly irritant poisons, or even an inmoderate dose of alcohol into the stomach. It may be a consequence of disease in adjacent viscera, occasioning an overloading of the veins of the stomach—e.g. enlargement of the spleen, obstruction of the portal circulation depending on disease of the liver, enlargement of the uterus in the advanced periods of pregnancy. It may result from changes in the composition of the blood, such as occur in scurvy, purpura, and yellow fever. The treatment must be directed against the disease on which the hæmorrhage depends rather than against the mere symptom; but from whatever cause it arises, if it is proceeding to a dangerous extent the patient should be kept perfectly quiet in bed, and should swallow small pieces of ice. Hot applications may also be applied to the extremities with the view of directing the blood to those parts. The medicines most likely to be of service are acetate of lead, gallic acid, dilute sulphuric acid, and oil of turpentine; but they should only be given on medical authority.