A common cause is that of bolting the food hurriedly. This, contrary to what is usually stated, is more frequently found amongst those who have good teeth than those who have imperfect or absent molars, because though in the latter mastication must be imperfect, the individual is usually conscious of his defect and takes his food more slowly. This form of dyspepsia can be at once recognised by a peculiar sparse furring of the tongue with prominence and redness of the papillte, and one often meets with such patients who have gone the rounds of various physicians and used numerous drugs and elaborate diet lists without relief for months or even years; the correction of the bolting rapidly removes all dyspeptic distress.
Wind-sucking is sometimes the sole cause of an inveterate dyspepsia. After some temporary interference with the digestive process, as rapid eating or badly cooked food, the patient tries to belch up flatus in order to obtain relief; with each yob/Wary belching effort a larger amount of air is always swallowed or drawn into the stomach each time than the volume of expelled flatus, and the result is that a chronic habit is induced which is too often labelled as a form of gastric neurosis, especially as the flatulent distension may remain from the exercise of the habit long after the original cause of the dyspepsia has disappeared. Once the physician can convince an intelligent patient that he swallows more air than he expels, this symptom of chronic dyspepsia speedily disappears upon the discon tinuance of the habit.
Another cause of simple chronic dyspepsia must be mentioned, as its correction is the main or only treatment necessary for the cure of the resulting failure in digestion. This is caries of the which, however, is a totally different question from imperfect mastication, though much misconception exists on this apparently trivial distinction. The hollow cavities of the necrosing molars harbour myriads of micro-organisms, which flourish in this rich culture-ground and are swallowed with each meal along with their soluble toxins. These undoubtedly interfere with the digestive process in the stomach, leading to a retardation of the normal time, and probably also by inhibiting the pepsin secretion fermentative changes are started. That the dyspepsia under these conditions is the direct result of microbic action, and not of imperfect mastication, is easily proven by placing the patient upon a purely: liquid dietary, when no im provement will follow. The treatment is obvious: the patient's symptoms should not be prescribed for; he should be handed over to a dentist, who is to make a complete and clean sweep out of every diseased tooth, and it is astonishing to witness the change which often follows; the dyspeptic symptoms speedily disappear, appetite returns, and the weight increases.
It is obvious from the above examples of simple dyspepsia which do not fall under the modern classification of stomach ailments, but which perhaps are more common than the whole of the gastric neuroses group, how important it is to investigate every case when disturbed digestion is the prominent feature so as to find out the cause in each, instead of prescribing fancy diets and feeding the patient on drugs. A remark may
be made about the most common of all varieties of dyspepsia, though it seldom conies under the physician's care. This shows itself in perfectly healthy individuals with an apparently normal condition of stomach, but where an attack of acute dyspepsia always follows the ingestion of a particular article of diet which other healthy and even dyspeptic patients may eat with impunity—the condition is akin to the idiosyncrasy which the physician meets with occasionally in prescribing certain drugs. As the patient of average intelligence discovers his peculiarity for himself he soon learns to avoid the disturbing element in his dietary.
Though the removal of the cause will speedily effect a cure in the great majority of cases of simple dyspepsia, nevertheless a few remarks may be made about the general regulation of the dietary and the use of routine medicinal aids which tend to expedite recovery.
The fashion of giving the patient a printed or written cut-and-dry list of the different meals of the clay should be avoided when possible. Flint's statement may be accepted as a truism applicable in most instances: " I have never known a dyspeptic recover vigorous health who undertook to live after a strictly regulated diet. and I have never known of an instance of a healthy person living according to a strict dietetic system who did not become a dyspeptic, and that in a great number of cases in which persons have been sufferers for years on a regulated diet, health has been speedily regained by simply eating in accordance with appetite." The explana tion of this lies probably in the fact that the original error hal. ing been long since corrected, the stomach is weakened by the prolonged restriction imposed by the artificially framed diet, just as a joint becomes useless by the long-continued rest which is insisted upon by the timid surgeon who refrains from prescribing exercise. One rule should never he departed from in any case: the patient should be prohibited from taking baked animal food in every form and from eating meats which have been re cooked. The meal hours and the intervals between these must be well regulated and never departed from unless the causes are quite unavoidable ; an average of 4 or 5 hours between each is desirable, and in subjects liable to attacks of acute dyspepsia from whatever cause the late dinner hour with its necessary heavy meal had better be avoided. The mastica tory apparatus must be put into proper order, bolting in haste must be warned against, tea and coffee between meals, and large quantities especially of cold fluids at meal-times must be forbidden. Rest of mind and body for a short time after food is essential, and breakfast should not be swallowed immediately after getting out of bed. Predigested or peptonised foods are as a rule not indicated in simple dyspepsia. and no case can be considered as cured till a fair amount of fresh vegetables can be introduced into the dietary.