SECRETORY NEUROSES.
Hyperchlorhydria is the most important of these, but the mistake of confusing this affection with the more common condition universally recognised by the simple term " acidity " should never be made. The disease under consideration is characterised by the presence of excess of free hydrochloric acid in the gastric secretion, and cannot he recognised without a careful examination of the gastric contents. In health the percentage of free I ICI varies from •i to •2 per cent., and the total acidity to under 7o per cent. (As hyperehlorhydria is commonly present in gastric ulcer cases, this latter affection must be eliminated before the treatment of a gastric neurosis is entered upon.) In the article on Acidity the fact is made clear that in many if not in the majority of patients suffering from acid dyspepsia the acidity is due to the presence of organic acids--butyric, lactic or acetic. These are derived from the food ingested or are formed during imperfect, delayed or interrupted digestion, their presence being commonly due to eating over-baked fatty foods, to imperfect mastication or bolting, or to pyloric obstruction, or to a motor neurosis which keeps the food too long in the stomach. It is an important fact which must not be lost sight of in the treatment of all stomach affections in which acid sensa tions arc prominent that these may be really duo to the absence of EICI or diminution in the secretion of healthy acid gastric juice.
The lines of treatment of hyperchlorhydria when this is due to a pure secretory neurosis are clear. The underlying hysterical or neurasthenic condition must receive careful attention, and menstrual irregularities and chlorosis will require correction. The diet is of great importance; farinaceous and fatty foods of all kinds should be given in small amount; undercooked red meat or Salisbury diet answers most indications. A line of treatment directly opposite to this is recommended by Walks and Fischal, who administer a diet in which Cream and Olive Oil figure conspicuously on the theory that vegetable oils or animal fats lessen the production of FICI, and at the same time hasten the digestion of albumins. This method of dietetic treatment is more satisfactory in cases of hyper secretion than in pure cases of hyperchlorhydria where the gastric juice may he normal in amount, though hyper-acid. It may, however, be
tried in the latter condition, and if found satisfactory it may be safely continued. Where the excess of acid has already induced irritability of the stomach and vomiting, a pure milk diet may be tried. Peptonised foods usually aggravate matters.
As the hyperchlorhydria is usually intermittent, and acute attacks often cause much distress, relief should be sought in the administration of large doses of _11kalies; Bicarbonate of Soda may be freely given even for considerable periods, and there is no remedy of such constant value as the Papain, Soda and Magnesia combination mentioned upon p. r r in the article on Acidity. When a large dose of alkali is administered during digestion the sudden neutralisation of the HO arrests the diges tive process, as pepsin only acts in an acid medium, but with papain the function is hastened, as this vegetable ferment acts in an alkaline, neutral, or even acid medium. The magnesia, in addition to its alkaline reaction, corrects the constipation which is usually present.
An occasional lavage of the stomach is highly beneficial in all severe cases. Gastro-enterostomy has been recommended for hyperchlorhydria„ hut the operation should be restricted to those cases which are not examples of a pure gastric neurosis.
flypersecrelicm or Gastrosuccorrhcea.—When this condition is continuous it is known as Disease or Pyloric Spasm, where large quan tities of acid gastric secretion are constantly manufactured independent of the presence of food. Whilst the underlying neurosis is being attended to by appropriate agents the diet should be restricted to albuminoids, undercooked lean meat, fish or poultry, with a limited amount of fluids at meal-times. Alkalies may be freely given as in the combination just mentioned, and when this is administered farinaceous foods may be safely permitted. Copious draughts of lukewarm water should be taken with the view of washing out the stomach, and it is a good practice to carry out stomach lavage every second or third day, using a weak alkaline solution for the purpose. When the condition resists this treatment a diet consisting of large amounts of cream and olive oil with fresh saltless butter and dry toast or biscuit may be tried.