Measures which improve the tone and vigour of the general system are indicated, as suitable clothing (Brunton reccmmended an abdominal flannel binder); a healthy residence upon an elevated, dry situation; open air exercise; sea bathing; change of scene and, if convenient, of employ ment, with early hours; and freedom from occupations causing high pressure or mental worry. Agreeable society, especially at meal-times, is of much use, and it is a good rule which prevents the dyspeptic from dining alone or reading while he sits at meals.
Drugs are not to be prescribed till the cause of the indigestion has been discovered and removed. After a long-continued abuse of the organ following any of the causes already mentioned the condition of gastric catarrh or a genuine gastric neurosis may have become established which will not yield immediately upon the withdrawal of the exciting cause, in which case the condition will require the exhibition of the remedies mentioned under Gastric Neuroses and long and patient administration of gastric sedatives, digestive agents and probably lavage.
Valuable indications will he obtained on recognising two types of stomach condition following prolonged errors in dietary, irregularity in meals, improper methods of eating, dental caries, wind-sucking, &c. These are the conditions which were formerly described as atonic and irritltive dyspepsia when dyspepsia was erroneously regarded as a disease and not as a symptom of many diseased processes in the stomach. Thus in the atonic state of the stomach before dilatation has set in much benefit will be obtainable by the administration of Vegetable Bitters before meals and the use of Pepsin after food, as in the following combinations: B. Tr. Nucis Vomica Ac. Nitro-hydrochlor. Dil. 3iij. Tinct. Aurantii ass.
Infus. Calninbcc ad 5viij. Misce.
Ft. mistura. Capt. ass. ex 3j. aqua ante cibuin.
When symptoms of gastric acidity predominate the above sometimes checks the trouble, hut should they continue the acid must be omitted.
Ii . Glycerini Pepsina aiiiss.
Acid. Hydrochlor. Dil. 3j. Tr. Chiratce ass. Misce.
F1. mistura. Capt. 3j. ex pauluto aqua Nora post cib.
When, however, the feebleness of the gastric function permits the food to remain so long in the stomach that secondary fermentative changes occur with the production of large quantities of lactic, butyric and other organic acids, the administration of hydrochloric acid is a mistake. This drug can never exert any real local antiseptic action on the ferments in the diluted strength in which it is only permissible to prescribe it. Creosote or Carbolic Acid may be substituted for it in 2 min. doses, or one large dose of Sodium Bicarbonate may be administered.
Papain is clearly indicated in such cases, as it will act as a digestive in the presence of a marked alkaline reaction; this enables the physician.to correct the organic acidity and at the same time to hasten the retarded digestive process. The following combination is the most valuable routine remedy under such circumstances, and indeed under most of the conditions met with in chronic gastric ailments even when organic lesions are present: Papain. Puri f. gr. iij.
Sodii Bicarb. gr. xxx.
Mag. Carb. Pond. gr. xx. Afisce.
Ft. pulvis. lllitte tales xxiv. St. i. ex paid. tacos ter die p. cib.
A more convenient plan is to prescribe the papain and alkali in bulk Papain 3ij., Mag. Carb. Pond. Sodii Bicarb. :3"iij. Menthol 5ss., of which a level teaspoonful may he given in a wineglassful or more of milk.
As soon as the atonic state of the stomach has yielded to dilatation the question of lavage, massage, &c., must be considered; the condition then may be regarded as having passed out of the category of a simple dyspepsia or chronic gastritis into that of a gastric neurosis (which see).
In the irritative type of dyspepsia as shown by the small, red, clean tongue, with a tendency to nausea and loss of appetite, vegetable bitters do more harm than good, probably because more or less catarrhal inflam mation is present. The treatment should consist in the employment of gastric sedatives, amongst which Bismuth stands high, though its virtues are greatly overrated. Other gastric sedatives should always be com bined with it, as in the following: 13, Bismuthi Carb. 3iv.
Acid. Hydrocyan. Dil. ass. Liq. Morphia Hyd. 3iss. Mucilaginis Recentis Aqua Chloroformi ad 5viij.
Fiat mistura. Cpt. cockleare mag. p.p.a. ter die ante cib.
Bismuth may also be given with advantage as a cachet in 3o-gr. doses, with gr. Morphia, or the above papain powders may be prescribed, with the addition of the same quantity of morphia to be taken within an hour after meals.
In either variety of simple dyspepsia the tendency towards acidity should be checked by diminished supply of carbohydrates and by giving freely undercooked red minced meat. C. McNeill treats successfully the Dyspepsia of Children (due to various causes) by 3o min. doses of Liquid Paraffin or 15 min. doses of Castor Oil thrice daily.
Constipation will usually require treatment, as the sparely fed dyspeptic patient is nearly always constipated; Aloes or Cascara, as described in the article on Constipation, will afford the best' results. The occasional use of a natural purgative mineral water is also beneficial. Anemia should be corrected by Iron, but this drug must be cautiously used in the irrita tive type of the condition, as it is liable to increase gastric distress, in which case it may be prescribed as Reduced Iron in a keratin-coated pill.
The dyspepsia caused by chronic valvular lesions and cirrhosis of the liver, which lead to passive congestion of the gastric mucosa, must be met by remedies directed against the primary disease combined judiciously with the administration of gastric sedatives and digestive ferments. The same remark applies to the dyspeptic condition so often caused by chronic renal affections and other toxxmic states, which must he relieved by eliminatory treatment.
Sec also under Gastric Inflammation, Gastric Neuroses, Acidity and Gastric I filata lion.