MOTOR NEUROSES.
These include Peristaltic Unrest or Ilyffermotility, Nervous Vomiting, Rumination or .1.1erycism„ Belching, Gastric Spasm, Gastric Atony and Pyloric Insufficiency. All these common conditions may be but the symptoms of organic stomach disease or of a simple dyspepsia caused by the continual violation of the health laws which should govern the selection and proper cooking of food, mastication, regularity of meals, oral asepsis, &c., and treatment of each varied condition on the lines of a true gastric neurosis should not be commenced till all these primary causes have been eliminated. Upon the other hand the difficulty is not lessened by the fact that theoretically any one or more of these neuroses may be the only visible sign of an underlying general neurosis, though often hysterical or neurasthenic manifestations are also present. It must never be forgotten that the imperfectly performed gastric function (due to local conditions) will of itself produce nervous symptoms liable to be accepted by the theorist as proof of the presence of a general neurosis which does not exist. But, as insisted upon before, the mere presence of hysteria must not determine the diagnosis. Take, for example, the case of belching. This generally is a mere habit first started by sonic temporary flatulent distension produced by an accidental error in diet. The individual by voluntary effort eructates or belches up the gaseous contents of the stomach, more air is swallowed in the act during the descent of the diaphragm, and the stomach becomes more and more distended. The same results follow constant attempts at swallowing saliva. As the air passes into the bowel, borborygmi are produced and some relief obtained, but if there he any irritable condition of the stomach present spasm of the pylorus prevents this, and the stomach becomes blown up like a balloon, a condition known as gastric spasm or pnennia tosis being produced. This " wind-sucking " is possibly never the result of a neurosis, and is cured readily in its early stages by explaining the dangerous results following the purely volitional act of belching. It is more liable to become a habit in neurotic patients, and Rumination is a similar habit only removable by educational methods.
Nervous Vomiting is, however, a true neurotic phenomenon, and can only be removed by a rigid treatment directed against the underlying neurosis. Regular lavage by its moral effect often speedily effects a cure.
Peristaltic unrest (Kussmaul) and the borborygmi which often are produced by emotional excitement may be remedied by rest after eating. The diet should be restricted to small quantities of solid food; a very limited amount of fluid should be ingested, and constipation must be guarded against. The condition is more frequently the result of motor weakness than of motor excess, in which case the stomach contents are delayed instead of being hastened in their passage through the pylorus, as is frequently stated to be the case. Occasional lavage is beneficial, only a limited amount of fluid being poured into the stomach each time before siphoning off. Small doses of Strychnine, if they do not intensify the symptom, are often highly valuable.
Pyloric insufficiency always yields to Strychnine, as it depends upon a paralytic or weakened state of the sphincter caused by over-stimulation.
The drug should be administered as soon as the diagnosis is made clear by passing the rubber tube 3o or 4o minutes after a test breakfast, when the organ will be found empty. This premature emptiness is rarely, if ever, due to hypermotility, which would be increased by strychnine, and it is doubtful if this latter condition really ever exists alone. Local massage and electricity are useful adjuvants to the strychnine treatment.
Atony of the stcnnach is a common if not a constant condition after all severe exhausting illnesses, and in its established form—ilyasthenia Gastrica—it is the best-marked type of a true gastric motor neurosis, and as such supplies the most typical example of the Atonic Dyspepsia of old writers (see Dyspepsia). The underlying neurasthenia must be met by a prolonged rest from all mental labour, and, when possible, by a complete change of environment, with moderate open-air exercise and the benefits of cheerful companionship with changes afforded by varied travelling and sight-seeing. This is a line of treatment essential when the affection is the result of over-study, prolonged anxiety or grief, or too close application to business occupations.
When travelling is impossible, hydropathy, golf, gymnastic exercises, massage, and electrical treatment may be tried. Owing to the feebleness of the gastric muscle and the tendency towards dilatation of the organ, Weir Mitchell treatment should not be resorted to at once, though this is an ideal method later on.
The diet must be carefully regulated, as in cases of dilatation; only small amounts of easily digested solid foods should be given at intervals of two or three hours, and liquids should be confined to the intervals between meals. At first a short rest after each meal should be insisted upon; gradually, as the meals become more voluminous, less precaution is necessary.
Lavage will be indicated where, owing to the long delay of the food in the stomach, secondary fermentative processes set up organic acidity, but the amount of fluid poured into the stomach before siphoning must be limited. The passage of the stomach contents may be facilitated by gentle abdominal massage, vibratory or electrical stimulation.
Drug treatment can achieve much. In the absence of irritability a vegetable bitter before meals may he given. Strychnine is, however, the main remedy upon which reliance is to be placed. It should be adminis tered shortly after meals in combination with Pepsin and HCI. The pepsin can be omitted often with advantage in the early stages of treat ment, when it is necessary to peptonise the food. Papain and Alkalies are invaluable when organic acidity is present. By administering Pay creatic preparations or Taka-Diastase starchy and farinaceous foods :may be safely permitted. Pepsin should never he added to the food previous to swallowing, though pancreatic ferments can be so utilised with advan tage both in rectal and mouth feeding.
The treatment of aton• of the stomach, when this has ended in inducing a permanent dilatation of the organ, is more fully detailed in the article on Gastric I )ilatation on a previous page.