The search for a specific remedy has produced a long list of drugs, each of which at one time or another has been supposed to exercise a controlling influence upon the course of the disease; but from the hard soap advocated by Van Swieten to the infusion of violets of the present day, one and all have failed to'check the progress of the morbid growth. It is therefore necessary to direct medicinal treatment to the relief of the various symptoms as they arise.
This is chiefly to be combated by frequent changes of diet and by the use. of lavage. In the early stages of the complaint the various bitters are occasionally of value; but they seldom agree for long, and their injudicious administration is apt to aggravate the tendency to gastritis. Condurango is a favourite remedy with many practitioners, on account of its stomachic properties, and is best prepared according to the directions of Friedreich. Half an ounce of the bark is macerated for twelve hours with twelve ounces of water, after which the fluid is reduced by boiling to half its bulk and strained. One tablespoonful of this solution combined with syrup of orange is given three times a day between the meals. Others prefer the infusions of gentian, calumba, quassia, or chiretta, with or without the addition of nux vomica, while in some cases the cautious administration of arsenic seems to improve both the appetite and the general condition. The fact that most cases of carcinoma of the stomach are attended by a diminished secretion of hydrochloric acid naturally suggests the administration of this drug as an aid to digestion. It is chiefly of use when the growth affects the cardiac or central region of the stomach ; but in pyloric stenosis it often appears to increase the pain and vomiting, owing to its irritant influence upon the inflamed gastric mucosa. Occasionally the use of pepsin, lactopeptine, or papain seems to increase the powers of digestion. Chlorate of sodium in doses of sixty grains three times a day was recommended by Huchard, and is sometimes of value.
When this symptom continues severe in spite of careful dieting and lavage, recourse must be had to sedatives. If it chiefly occurs after meals, a mixture containing carbonate of bismuth, bicarbonate of sodium, and dilute hydrocyanic acid will often diminish its intensity, or a pill composed of belladonna, conium, and stramonium may be given immediately after food. Cocain is sometimes of use when the growth is situated near the cardia. At a later period opium is almost always required. Codeine, nepenthe, and the compound tincture of chloroform and morphine are less apt to disturb the digestion than other preparations ; but when vomiting prevents the administration of drugs by the mouth, hypodermic injections of morphine and atropine are invaluable. This method is also the best fitted to procure sleep.
The treatment of this symptom varies with its cause. When, as is usually the case, it arises from obstruction of the pylorus, the daily employment of lavage combined with a dry form of diet is at once the most appropriate and successful mode of treatment. In all cases the administration of antiseptics in an alkaline solution is valuable in preventing excessive fermentation of the food. For this purpose carbolic acid is the most useful, and may be given either in the form of the glycerine preparation (8-12 min.) or the pill. Occasionally full doses of resorcine, hyposulphite or sulphocarbolate of sodium, creasote, or a minim of the tincture of iodine every hour, also afford relief. During an attack of acute gastritis the irritability of the stomach prevents the administration both of food and medicine, and under these circumstances the patient should be confined to bed and cold compresses be applied to the epigastrium, while the nutrition is maintained by rectal feeding. If retching is an urgent feature of the case, a third of a grain of calomel may be placed upon the tongue every three hours, and a sixth of a grain of acetate of morphine may be given by hypodermic injection once or twice a day. The emesis which occurs soon after food, and is preceded by violent pain, is best controlled by morphine or nepenthe before meals and the repeated application of a small blister to the epigastrium. Chloroform, hyoscyamus, cocaine, and glycerine have also been recommended for this purpose, but their effects are variable and usually disappointing. The regurgitation of food that arises from a stricture of the cardiac orifice must be treated by gavage and rectal feeding. The distressing nausea which is sometimes a prominent feature of disease of the body of the stomach may often be relieved by the use of a mixture containing soda, hydrocyanic acid, and bromide of potassium, taken half an hour before a meal.
Acid eructations depend upon abnormal fermentation of the food, and usually subside as soon as the stomach is washed out night and morning. When this is impossible, bicarbonate of sodium with calcined magnesia may be prescribed with an antiseptic, or a bismuth lozenge may be swallowed occasionally. Sometimes charcoal biscuits, or powdered charcoal and iodoform enclosed in a cachet, serve to alleviate this troublesome symptom.
Severe haemorrhage is rare, and when it occurs must be treated like that arising from simple ulcer. The patient is confined to bed and fed exclusively by the bowel, while an icebag is applied to the epigastrium in order to control the movements of the stomach. If necessary a small dose of morphine may be given by hypodermic injection. The frequent small losses of blood that arise from general oozing from the surface of the growth require to be arrested, on account of the profound anaemia which they occasion. For this purpose ergot, hamamelis, gallic acid, perchloride of iron, alum, or calcium chloride is usually recommended, but acetate of lead combined with extract of opium, in the form of a pill, is usuaUy more efficacious. The recent introduction of the suprarenal gland has provided an admirable haemostatic for this and other forms of haematemesis, and excellent results follow the administration of the dried and powdered substance, in doses of five grains, every four hours, or of a decoction of a similar strength.
In every case the tendency to constipation requires to be corrected in the early stages of the complaint. One or two teaspoonfuls of the phosphate or tartrate of sodium dissolved in warm water may be given each morning before breakfast, either by the mouth or through the tube after lavage, or one of the natural aperient waters may be prescribed. With the progress of inanition salines are apt to induce exhaustion, and should be omitted in favour of the liquid extract of cascara, the syrup or compound infusion of senna, or a mild pill containing pcdophyllin and rhubarb. Occasionally the daily use of a glycerine injection or suppository is sufficient. Mercury and drastic purgatives should always be avoided.