MO TO It NEUROSES. — llypermotility (peristaltic unrest of the stomach); atony, or motility; rumination (merycism) and regurgitation; eardiospasm; incontinence of the pylorus; pylorospasm; nervous eructations; pncumatosis; nervous vom iting.
Sensory Neuroses. — GASTRIC HYPER tTSTRESIA is an increased irritability of the sensory gastric nerves. In presence of normal gastric secretion and motility, or these deranged in minor degree, there occur attacks lasting days or months, in which distress is experienced after all food and often after water, if taken save in the smallest quantity. Gastralgia, allied to gastric hypercesthesia, as is cutaneous hypermsthesia allied to actual neuralgic pain, may co-exist. This af fection occurs in neurotics often without assignable cause, or it may exist as a con sequence of constitutional states, such as chlorosis. Excesses in venery or alcohol predispose.
Treatment. — The underlying cause must be especially aimed at and the general bodily nutrition, if below par, raised. Any article of diet that seems at fault must be forbidden. Silver, alumnol, and bismuth, locally, as sug gested in the treatment of ulcer, are of value. The bismuth should be employed in a smaller dose, and combined with codeine and perhaps cocaine and dilute hydrocyanic acid, as in the treatment of the pain of gastric ulcer. If gastric mo tility is good and hypersecretion does not exist, the silver may be administered by the mouth in solution in a dose of grain, diluted with water, fifteen minutes before meals. Courses of strontium bro mide and arsenic are of special service in the highly neurotic, as are asafoetida and valerian. Local applications, such as a Preissnitz bandage, constantly worn by day, is most useful, as are general hydro pathic measures. The rest-cure may be demanded with the local and general treatment.
The reverse condition to the above, more or less ANA:STHESIA of the gastric mucosa, may exist as a neurosis; so that there is little appreciation of satiety after meals, or no sensations of discomfort after the ingestion of substances that or dinarily would excite gastric uneasiness, such as those of extremes of temperature, and overseasoned food. The most nause
ous drug can be taken by certain of these cases without the usual effect.
GASTRALGIA.—In this affection attacks of severe paroxysmal epigastric pain oc cur which radiate over the abdomen and through into the back. Attacks occur either by day or by night, and often show a curious periodicity. In the simple variety (not dependent upon ulcer, gas trosuccorrhcea, or pylorospasm) it is either independent of food or the pain may be relieved by eating or by drinking a hot liquid. Vomiting is not usual un less the gastralgia accompanies ulcer or is associated with and caused by pyloro spasm and gastrosuccorrhcea. Gastralgia may occur solely as the local manifesta tion of a neurosis; or as an accompani ment of gastric ulcer, cancer, or a motor or secretory neurosis, such as pyloro spasm, cardiospasm, gastrosuccorrhcea; or it may have a central cause in early or advanced tabes.
treatment of this af fection is on lines laid down under the management of gastric hypermsthesia, the paroxysm being treated similarly as are the pains occurring in ulcer: Sina pisms, or turpentine stupe externally, and morphine hypodermically (guardedly re sorted to in attacks occurring frequently) in the more severe paroxysms. In the intervals, or in mild seizures, hydro cyanic acid, cocaine, and codeine, with bismuth or with cerium oxalate, should be given on the empty stomach.
The following combination is useful in mild attacks:— Ii Oil of cajuput, 1 to 4 minims. Spirit of chloroform, 10 to 20 ims.
Aromatic spirit of ammonia, 10 to 20 minims.
Tincture of valerian, 10 to 20 min ims.
Compound spirit of lavender, to 2 drachms.—M.
This represents one dose, to be taken in water at intervals of a half-hour.
The use of silver nitrate as directed in ulcer and in hyperchlorhydria should be tried. If the last-named affection co exists, antacids are necessary.