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pepsia is a common symptom. The face, and especially the forehead, often become irregularly bronzed in patches, the headache is severe, either at the vertex or at the temple; ringing noises in the ears are experienced; the eyes are intolerant of strong light, the pulse is compressible, the stomach and bowels are irritable, causing either diarrhoea or vomiting, or both; the appetite is poor, and faintness is often felt, or there is a sensation of abdominal exhaustion and emptiness. The same condition is observed in the exhaustion from other causes; from severe haemorrhages, from excessive menstruation and leucorrhoea, and in the convalescence from acute diseases. Mercurial medicines, if continued so as to affect the system, cause general depression, exhaust the nervous energy, and relax the mucous membrane, and thus induce dyspepsia of this form. Tobacco is "a powerful depressant, and although, after its moderate use, it has a soothing effect on the nervous system, and it renders the intellectual power more vigorous, we often witness that in habitual smokers, the heart is enfeebled, the mucous membrane relaxed, the appetite is lessened, and a form of atonic dyspepsia results. This is still more apparent in great snuff-takers, especially if smoking be combined. The state of the nervous supply to the mucous membrane of the stomach and its glands, is the probable cause of these symptoms. Large branches are sent from the semi-lunar ganglia upon the coronary arteries to every part of the stomach, and it is by their influence that the gastric juice is poured out at its proper time, and in its proper quantity. The mere presence of food in the stomach will not induce further gastric secretion, if nervous energy be wanting. The enfeebled state of the nerve power is not, however, limited to the stomach, but the heart and its cardiac plexus are in a like state, and the supply of blood to the stomach is thus rendered insufficient. The attacks :pf faintness may be explained in the same way, namely, that a larger supply of blood being sent to the stomach, less is conveyed to the brain, causing a temporary failure of power. I have observed actual syncope, as the result of the slight disturbance to the circulation from urging exhausted patients to take solid food. In persons who are inordinately stout, we find feebleness of digestion, and this is in part due to the state of the vaso-motor nerve. The symptoms arise from the feeble condition of the heart and circulation, and are increased by an inactive state of the liver. A greater amount of food may be taken than can either be digested, or is needed for the system, and it consequently induces a sense of weight and exhaustion. Although the appetite is often small in stout persons, it is not always so, it may be both fastidious and one that has been pampered with highly-seasoned and indigestible diet; the hydrocarbons are stored up, instead of being removed in the ordinary changes of respiration, &c.; but the mischief is still further increased when the heart is irregular
from an excess of fat about it, or when the feeble circulation of the brain manifests itself in vertigo and disordered sensations. Much relief is afforded by occasional alteratives, by aloes, rhubarb, and taraxacuni, or by nitro-hydrochloric acid with bitter infusions; stimulants should be cautiously given, and outdoor exercise gradually increased. To such patients horse-exercise is often most serviceable. Although in some of these cases of atonic dyspepsia superficial ulceration may take place, and from the want of power the other coats of the stomach be perforated, as we shall afterwards have to describe, it will generally be found that, with proper treatment and care, the symptoms slowly subside.
The object of the treatment is to rouse vital energy, at the same time that a diet, as sustaining as possible, is administered. The following are some of the medicinal agents at our disposal: the carbonates of ammonia induce a direct stimulant effect, and aromatics, with mild vegetable infusions, act in a similar manner. If the tongue be large and flaccid, and the food remains, as a weight at the stomach, mineral acids are of great service, and assist digestion.
^At a later period steel and quinine may be used, but care is required both as to the form of administration, and the mode of combination. It is well always to give ferruginous preparations directly after a meal; the medicine thus becomes incorporated and absorbed, without any excitement or pain being produced. The milder preparations of iron should be tried, the ammonio-citrate, potash-tartrate, the phosphate, or the reduced iron.
• Quinine often disagrees, and if the tongue be injected, the medicine is likely to cause sickness, headache, and increased distress; the liquor cinchonae is a more elegant and less bulky preparation than the decoction, and it is often borne better than quinine itself.
There is a remedy, which I have found of great service, namely, nux vomica and its alkaloid strychnia; as a tonic, it proves beneficial, especially in promoting the contraction of involuntary muscular fibre, thus relieving flatulent distension and constipation; but it requires a careful administration, as it will sometimes produce a sense of most distressing faintness and exhaustion, even when given in small doses.
Pepsin is an artificial substitute for the normal solvent of the food; it was proposed by M. Corvisart, and introduced into English practice by Dr. Ballard. It has been employed dried, and mixed with starch constitutes the "Poudre Nutrimentive," and about gr. xv. have been given as a dose, alone, or mixed with hydrochlorate of morphia or with strychnia. The fluid pepsin is, however, more efficacious; still, as an agent in promoting digestion, it is very unsatisfactory in its action; and, it is better to remove the cause of the natural defect, than to supplement the deficiency in a very imperfect manner.
Stimulants are of great value in this form of dyspepsia, but should only be used with nourishment, or to enable the stomach to perform its normal function; strong alcoholic liquors taken in excess during digestion, retard the solution of food; and most injurious results may follow, if the transient stimulant of wine or ardent spirits be made to supply the place of nutriment, and be habitually resorted to, as a remedy for the sensation of weakness and exhaustion.
Ipecacuanha, perhaps, increases the secretion of the gastric juice, thus it is often given with capsicum and rhubarb, as a dinner pill, and proves of great service.
The judicious use of stimulants and tonics should only be subservient to the restoration of healthy function, and in proportion as health is restored, these should be discontinued.