Absorption

Most writers assert that the absorption is retarded. It seems to me, however, that this rule does not apply to all substances. On examining the absorptive power in several cases of chronic gastric catarrh with the potassium iodide test, I could not see any marked departure from the normal.

I subjoin two cases of chronic gastric catarrh, one representing a mild and the other a more advanced form of this affection:

Diagnosis

Mrs. L. W------, about 20 years of age, suffered for about four years from frequently recurring digestive disturbances (poor appetite, pains in the region of the stomach and in the abdomen). She had 18 been treated by several competent physicians, sometimes with good results. Several months before consulting me the general health of the patient was impaired; the complaints, however, had greatly increased during the past six weeks. She suffered from pains in the region of the stomach, and could not eat sufficiently, for soon after partaking of the food she had a sensation of being laced; she could not sleep, and was troubled much with repeating and flatus; during the summer she lost in weight considerably.

Status proesens: Patient has a pale appearance and frail structure; color of lips and cheeks pale; tongue coated; chest organs normal; abdominal wall relaxed; the abdomen slightly distended; the epigastric region somewhat painful on pressure; the splashing sound can be produced below the left margin of the ribs down to a point three fingers' width above the navel.

One hour after the test breakfast: HC1 = 0; lactic acid+5 acidity =60; erythrodextrin + much; mucus present.

When fasting, stomach is found empty; lavage brings up very little mucus.

Treatment: Nux vomica, HC1, gymnastics, cold washing and rubbing of the body, and direct gastro-faradization.

Soon after the beginning of this treatment the patient felt better; she could partake of more food; the pains first decreased in severity, and soon disappeared almost entirely. The patient gained during treatment (six to seven pounds) and acquired a healthy color.

Case II

Henry K------, 33 years of age, suffered for ten or fifteen years from "spitting of water." By this phrase the patient meant to express the belching every day, or at least every other day, of a considerable amount of a tasteless fluid from the stomach into the mouth, which he then expectorated. Sometimes this occurred ten or twelve times during the day. For the last eight or nine months the patient had this spitting after each meal. Appetite never good, although the patient could partake of each meal. When a boy he was strong and stout, but has been thin since his twentieth year. Sleep good; bowels moved every other day, but not regularly. During the last thirteen years there has been from time to time vomiting (i.e., the ejection of the whole meal). Before the vomiting the patient has a sensation of oppression.

The physical examination of the chest organs reveals nothing abnormal. The stomach reaches down to within two fingers' width of the symphysis, as shown by gastrodiaphany and splashing sounds.

One hour after the test breakfast: HC1 = 0; acidity = 14; rennet ferment+. (Similar results have been obtained by examination on several other occasions).

Course

The duration of chronic gastritis is a very long one.

Very frequently there are exacerbations of the symptoms, even when the condition was apparently almost entirely subdued. Indiscretions in diet are especially liable to cause a recurrence. Often, however, a rational treatment effects the disappearance of all the symptoms, and the condition of perfect euphoria may last for years and years.

Diagnosis

In the diagnosis of chronic gastritis the following points demand attention:

1. The long and progressive course of the disease.

2. The symptoms above described.

3. The decreased secretion of gastric juice (low acidity), which in some may be combined with an undue amount of mucus.

Differential Diagnosis

It is quite easy to distinguish between primary and secondary chronic gastritis. The latter accompanies many organic diseases of vital organs. The recognition of the principal ailment shows the true nature of the affection. It is more difficult to differentiate between chronic gastric catarrh and other lesions of the stomach: ulcer, cancer, neurosis, achylia gastrica. Chronic gastritis is never accompanied by very severe pains, and thus presents a contrast to ulcer and cancer. Absence of a circumscribed spot painful to pressure in the gastric region also speaks against ulcer. There is no haema-temesis, and as a rule no marked emaciation in chronic gastritis, while in ulcer and cancer these two conditions are frequently met with. It is quite difficult to differentiate between chronic gastritis and gastric neuroses of a depressing nature. The symptoms may be alike in both, especially the diminished gastric secretion. These neuroses may sometimes be recognized by the discovery of other nervous symptoms. Sudden changes in the chemical condition of the gastric contents speak in favor of the existence of a neurosis.

Changes in the subjective symptoms, their entire disappearance for a few days, and then their sudden reappearance, either in the same form as before or in a changed manner, are also characteristic of a gastric neurosis. Chronic gastritis, on the other hand, shows, as a rule, more or less consistency in the conditions of the gastric juice as well as of the other symptoms. While changes in the subjective sensations of the patient may occur, they are, however, less abrupt and less pronounced than in the neurosis. Achylia gastrica is recognized by the total disappearance of gastric juice, i.e., by the absence of hydrochloric acid and both ferments, rennet and pepsin. Although chronic gastritis may terminate in such a condition (a disappearance of juice), it is nevertheless more practical to separate achylia gastrica from gastric catarrh, as there are several other conditions which lead to this affection, and as it requires a different treatment.