vomiting of muco-serous matter tinged with bile and often with blood, the act causing in- tense suffering. The thirst, though not always present, is often so great as to be almost in- supportable. The pulse is frequent, small, and wiry. The temperature of the skin is gener- ally considerably raised. The bowels are con- stipated 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 treat- ment does not involve much medication ; rest, cooling drinks, light bland food, and the ad- ministration of nourishing enemas with some- times small quantities of opiates, are the chief reliances. Lime water and milk may some- times 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 at- tended 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 ap- proaches the acute character, the symptoms are heightened in proportion. Rest, absti- nence from food for a time, bland and nutri- tious diet, regulation of the intestinal evacua- tions by enemas, the application of sinapisms or other counter-irfitants or of warm water dressings over the epigastrium, and the admin- istration of demulcents, as flax-seed tea, and also small pieces of ice, are ordinarily indi- cated. Subacute gastritis is frequently con- nected with acute dyspepsia, in which case it te often designated by the indefinite term " bil- ious attack," although the term is generally an improper one, as the liver is not usually par- ticularly 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 ad- ministration of anodynes, particularly chloro- form. Chronic gastritis may come on gradu- ally, or it may follow the acute or subacute form. Its symptoms are liable to be mistaken for those of functional disorder which consti- tute 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 dis- eases of other organs. The treatment is rest of the organ, gentle exercise of the body, nu- STOMACH (DISEASES OF THE) 397 tritious but easily digestible food, tonics, coun- ter-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 thick- ening of the coats of the organ. It is prob- ably 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, scarce- ly 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 dis- ease, and also its appearance in other organs, are diagnostic. It is generally regarded as chiefly occurring in hard drinkers. The treat- ment is abstinence from spirits and other stimu- lants, and a nutritious and well regulated diet. Softening of the stomach may be the result of inflammation, but there are cases of non-in- flammatory origin. The softening may be con- fined to the mucous coat, or it may involve all the others. Non-inflammatory softening is probably sometimes caused by defective nu- trition of the membrane. Ulceration of the stomach is one of the sequel of acute gas- tritis, 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 diam- eter. The disease may prove fatal from per- foration, from hasmorrhage, 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 nu- trition. 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 lanci- nating pains of cancer, and vomiting is fre- quent, although less so than in simple ulcer. Blood is often found with the vomited mat- ter, generally having the appearance of coffee grounds, and sometimes contains purulent mat- ter. These symptoms are accompanied by pro- gressive anaemia and loss of weight. Degen- eration of the gastric follicles has been found a more frequent affection than was formerly suspected, and is the accompaniment of many
