NERVOUS ANOREXIA.—In this neuro sis both appetite and the sensation of hunger is completely and permanently absent and an absolute aversion for all food may exist. The patient becomes greatly emaciated; so that her appearance suggests a wasting disease, such as tuber culosis pulmonum.
The treatment consists in searching for and removing the underlying cause; veg etable bitters should be given, such as nux vomica or strychnine, eondurango, etc. Hydrochloric acid is of service in combination with these. Orexin (basic) or the tannate, commonly recommended, is not of much value in promoting appe tite in these cases. Forced feeding may be required, as may the so-called Weir Mitchell rest-cure.
Secretory Neuroses. — HYPERCHLOR IIYDRIA (HYPERCFIYLIA; SUPERACIDITY).
—Hyperchlorhydria is a condition char acterized by an increase in the percent age of the secreted IIC1 and of the fer ments in the gastric juice. It may be associated with a much-increased flow of gastric juice, the percentage of HC1 and of the ferments remaining normal. It occurs (a) as a pure neurosis without ana tomical alterations in the gastric tubules; (b) as a result of a decided increase in number of the acid- and ferment- secre tory cells,—a proliferation of the glandu lar elements and especially of the acid secreting cells; (c) as a form of gastritis (gastritis acida). As a pure neurosis its occurrence is not constant, and periods are not infrequent in which subacidity or inacidity alternate with it. In class b the hyperchlorhydria is more constant. In class c the total acidity of the gastric filtrate, though heightened by an in creased percentage of HC1, is also aug mented by the presence of a fair or con siderable amount of the acids of fer mentation.
In hyperchlorhydria free HCl appears earlier than normal in the process of di gestion and exists in an increased per centage throughout the digestive phase. The acidity of the gastric filtrate at the height of digestion of various trial meals is upward of 0.4 to 0.7 per cent., instead of the usual 0.15 to 0.2 per cent. The digestion of proteids is very active, and that of carbohydrates greatly interfered with. Hyperchlorhydria is a very com mon affection, forming a high percentage of the cases of the various forms of indi gestion that one is called upon to treat. It is common in neurotic subjects, and its development can often be traced to nerv ous strain, worry, or fatigue.
Symptoms.—Briefly, there is more or less gastric distress, uneasiness, or diffuse pain occurring at a variable time after meals (one to three or four hours), at a period when saturation of the albumi noids and salts of the ingesta has occurred and a considerable excess of HCl over that necessary for this purpose becomes evident. There is often an accompany ing sensation of burning in the epigas trium (heart-burn), and pyrosis is com mon. These symptoms are quickly dis sipated by the ingestion of food or by a full dose of antacid.
The appetite is well preserved; the bowels may be constipated, especially if intestinal indigestion is present. This last often occurs in consequence of the ill effect of the high percentage of lICl on the pancreatic secretion. Both gas tric and intestinal arnylolysis are inter fered with.
There may be diffuse tenderness in the epigastrium, largely through the gastric hyperwsthesia accompanying. The gas tric motility may be normal, increased, or diminished. Itypermotility (too rapid passage of the ingests into the bowel) is more common than stony; the latter, though, is not unusual.
Diagnosis. — This affection is differ entiated from ulcer chiefly by the fact that the disagreeable sensations, or pain, in the former are almost invariably dis sipated by the taking of food or a full dose of an antacid. Other differential points are the absence of all, save occa sional, vomiting, of hfernatemesis, of lo calized pain, and of chloramemia.
Treatment.—The medical treatment is largely that of gastric ulcer: the free use of antacids three to four hours after a meal (the dose graded by the percentage of HCl excess, ascertained by several ex aminations of the stomach-contents), and the local use of silver, alumnol, and of moderate doses of bismuth. Most impor tant is removal of any apparent underly ing cause, improvement of the general health, and an out-of-door life. The amount of carbohydrates in the food must be restricted, as must the in-take of table-salt. When carbohydrates are eaten, diastase should be coincidently taken. Then, too, chewing gum for a half-hour after a meal is often of value. Xervines—such as arsenic, asaftetida, valerian, and sumbul, in neurotic cases —and nerve-sedatives—such as the bro mides, and especially strontium bromide —are often indicated.