DYSPEPSIA.
In displacing the term " Dyspepsia " by that of " Gastric Neuroses " confusion has risen. Dyspepsia may in its varied phases be accepted as the predominant symptom of these affections, as it also is of many truly organic diseases of the stomach, but the treatment of functional affections of this organ has been plunged into hopeless confusion by re garding all cases where acute or chronic indigestion is the main symptom as falling under either organic disease of the organ or a gastric neurosis, or as the result of gastritis.
Similar confusion has arisen in the treatment of diarrhoea owing to the craze for classifying this symptom under the various headings of " Enteritis," and the student is advised to read the article on Diarrhoea in association with the remarks which here follow on the treatment of dyspepsia.
To simplify the subject we may define dyspepsia as purely a symptom of gastric indigestion or of some perverted or retarded action in the normal digestive process. Accepting this definition, we may safely affirm that numerous cases in which disordered digestion is the prominent feature are constantly presenting themselves for treatment in which there is no gross structural lesion or any active inflammatory condition present, and in which the function of the nervous mechanism is working normally. For convenience such cases may be considered as examples of simple dtspepsia, regarding the condition solely as a symptom-complex and not as a disease.
The first step in treatment is to determine the causal agent and effect its removal. In acute attacks this may he: (I) some irritating substance introduced into the healthy stomach generally in the form of improperly cooked food, as baked fat meat or pork, food which has alreadycommenced to undergo putrefactive change, warm freshly baked bread or cakes, improperly made pastry, unripe fruit, acid beer, wine or cider, or even large draughts of iced water; (2) the food may be normal in every respect, hut taken in such amount as is beyond the power of the gastric juice to cope with; (3) the quantity and quality being normal, it may be bolted hastily in such unmasticated lumps as will only permit the digestive juices to operate upon the outer laver of each mass, the normal process being thus prolonged and secondary fermentative changes set up; (4) the same results will follow when the intervals between the meals are so short as to prevent the stomach being emptied before another supply of food is introduced; or (5) an acute attack of dyspepsia may result from indulgence in an ordinary meal of solid food after a very prolonged fast.
Should these errors be persisted in a true catarrhal inflammation of the mucosa will become established, but such gastritis should be regarded as the result and not the cause of the dyspepsia, a condition of affairs exactly corresponding to the diarrhcea which results from the irritation of the intestines by cathartics, which is usually described Nc rongly as being of inflammatory origin.
An attack of Simple Acute Dyspepsia is best treated, if severe, by the administration of an emetic if nature does not effect relief by vomiting, after which all symptoms of pain, nausea, and distension rapidly disappear. The best emetic in these cases is a copious draught of lukewarm water or a pint of warm infusion of Chamomile Flowers, assisted if necessary by tickling the fauces; the large quantity of water will also often afford considerable relief by diluting the irritating contents of the stomach. Where intense acidity is the predominating feature of the distress a large dose (I to 2 drs.) of Soda Bicarb. in a tumblerful of cold water will often give immediate relief by neutralising the organic acids produced by fermentation. The after-treatment will consist in a short period of judicious starvation and the administration of a purgative if diarrhcea has not already followed.
Simple Chronic Dyspepsia may be the result of similar errors in feeding, and the correction of these will effectually cure the condition and prevent recurrences. In many instances the physician by careful and conscien tious investigation may find that the error in diet arises from a too restricted dietary, the patient having eliminated one article of food after another under some fanciful theory that each is injurious, whilst the cause of the condition may be due to irregularity in the meal hours or other unsuspected error. Of all the articles of diet, perhaps no single one is so frequently responsible for simple indigestion as the pernicious custom chiefly prevailing amongst women of indulging in tea between meals and sometimes at all hours of the day. This is seen constantly amongst the female operatives in mills and factories, whose chief meals consist largely of tea often infused or even boiled for long periods. Though this type of chronic indigestion is classified amongst the gastric neuroses or as a form of gastritis, it nevertheless usually disappears promptly and permanently when the cause is removed if no inflammatory or nerve disturbance has been set up.