The acute intermittent type of this neurosis known as Rossbach's Gasiroxynsis should be treated promptly at the commencement of the attack by an emetic such as a very large draught of lukewarm water, which should contain a full dose of Sodium Bicarbonate to neutralise the excess of acid, as this may cause severe irritation of the epiglottis as it comes up the gullet.
The rubber stomach-tube may be passed as soon as the attack declares itself, but even then an alkaline solution should first be introduced into the organ before siphoning off the contents, as vomiting often comes on during the process. It will be well to thoroughly wash out with weak Permanganate of Potash or Creosote solution, and Nitrate of Silver (It) grs. to the pint) has been used to finally wash out any remaining secretion, care being taken that the whole of the liquid is siphoned off.
After the relief of the distress caused by the excess of scalding acid secretion Alkalies should be steadily persevered with and Bismuth given along with them in full doses.
Hypochlorhydria—the opposite condition to hyperacidity—is best met by free Hydrochloric Acid and full doses of Pepsin combined with Strych nine, given along with or soon after meals, vegetable bitters being prescribed before food.
R. Acid. or.
Liq. Strychnina Ilytt. 3j.
Glycerin. Pepsina ad Misce.
Fiat Mistura. C fft. 3j. ex 3ij. aqua cum cilium.
When the sUbacidity is accompanied by fermentative changes which cause excess of the organic acids—a common eondition—then the Papain and Alkali combination should be resorted to, as under these circum stances free IIC1 often aggravates matters, and Creosote is very valuable.
The diet must be light and as easily digested as possible; in severe cases bordering upon the next-mentioned type, the dietary must consist of peptonised foods.
Achlorhydria.—In this neurosis, which is a degree further added to subacidity, and in Ackylia Gastrica—a condition in which there is neither lin nor pepsin secreted—the treatment is the same, only the dosage of the acid and pepsin combination must be greater, and all foods must also be peptonised till the normal secretion begins to return, after which gradually increasing quantities of simple food, as milk and strong soups, may be administered. This type of neurosis in all its degrees of severity, from simple hypochlorhydria to achylia, supplies many of the cases which were formerly labelled Atonic Dyspepsia. When in addition to the diminution or absence of the normal secretion, and as the direct result of this deficiency, fermentations are set up, the clinical picture changes to Irritative Dyspepsia, where pyrosis, vomiting, heartburn, &c., are prominent from organic acidity (see under Dyspepsia). In this latter condition the vegetable bitters should be withheld till Papain and Alkalies with a minute dose of Morphia (2, gr.) have soothed the gastric irritability, after which pepsin and acid may be administered and an occasional lavage is beneficial. Sometimes Pancreatic preparations are more suitable than pepsin, and their action is not weakened by the administration of Creosote.