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be rejected, then the quantity must be diminished, and only a very small portion given, as a few tea-spoonfuls of milk, with soda water or with lime water every quarter or half hour, and if the pulse be failing a small quantity of brandy may be added. If the regurgitation still continue, then it is well to allow the stomach to rest entirely, and to administer by enemata, nutrient fluids three or four times a day, as a cup-full of strong meat soup, thickened with flour, and with the addition of five to ten drops of laudanum, and a table-spoonful of brandy. We have known many obstinate cases entirely cured in this way. In one patient the injections were continued for a fortnight, and only a few tea-spoonfuls of cold water were given to relieve the thirst. The bowels should be gently acted upon by aloetic pill, alone or with steel, with henbane, or with the extract of nux vomica.
I have often found the nitrate of bismuth, with carbonate of soda and chloric ether in mucilage mixture, very useful ; so also the black oxide of manganese in dose of gr. x. to xx., as recommended by Dr. Leared. The salts of cerium are praised by some, but I have found other remedies more efficacious.
When the extreme irritability has lessened, there must be a gradual return to more strengthening diet, and the milder preparations of iron are very serviceable, as the ammonio-citrate of iron with carbonate of ammonia, the phosphate and hypophosphite of iron with dilute phosphoric or hydrochloric acids; sometimes also the sulphate of iron, in half-grain doses, with sulphate of quinine and extract of henbane is useful.
Other remedies, with uncertain effect, are tried, as hydrocyanic acid, alkalies, magnesia or its carbonate creasote, chloroform and chloric ether, opium. Opium does not act so well in these cases, as in ulcer of the stomach. If the pain be severe, a small quantity of morphia may be used hypodermically. Belladonna is better than opium. Small blisters applied to the scrobiculus cordis, or to the spine sometimes alleviate the symptoms.
Calomel has been used as a sedative to the mucous membrane of the stomach in some of these cases of extreme sympathetic irritability. This condition is, however, so frequently associated with an anæmic, chlorotic, or hysterical state, that the administration of mercurials, except as occasional aperients, is better avoided. Still we have witnessed instances, where one grain of calomel, given several times during the day, has been followed by cessation of the symptoms.
There are several other conditions of dyspepsia which are atonic in their character, but appear at the same time to be sympathetic, and connected with the state of the cerebro-spinal system. In some men we observe a state closely resembling hysteria, as shewn by flatulence, loss of appetite, sensibility of the surface of the abdomen, sensations almost amounting to globus hystericus, disturbed cerebral function, depression,
anæsthesia, incapacity for exertion, &c. In this condition, which is often combined with distended colon, I have found marked benefit result from the use of aloes combined with steel; fresh air and vigorous exercise are important remedial agents, when they can be obtained
In other cases, the head is badly formed, and the forehead narrow, shewing that the brain is likely to be easily disturbed, or there is hereditary tendency to mental disease, mania, and melancholia. The body is well nourished, but the patient complains of pain at the scrobiculus cordis and in the back, or in various parts of the body; the mind is depressed, and the appetite irregular. Although muscular, a man may be quite incapacitated for exertion; the tongue may be clean, the bowels regular, the evacuations normal or pale, the pulse tolerably full or depressed and irregular. It would seem that dyspepsia has arisen from ordinary causes, but the sympathetic nerve reacts upon the cerebro-spinal centres, and these being easily disturbed from their healthy balance, again react upon the sympathetic nerve, perpetuating and aggravating the original and slighter malady.
In young children the susceptibility of the nervous system during first dentition is universally acknowledged, although frequently too much is attributed to this cause; and every disturbance of the brain or of the digestive system is attributed to this circumstance; but the same susceptibility, though less energetic, is manifested at a later period. We have often found young persons, between the ages of eighteen and twenty-five, affected with vague nervous and dyspeptic symptoms during the passage of the wisdom teeth through the gums; the mind is oppressed, so that there is an incapacity for directing fixed attention to any subject, and slight disorder of the gastric function is associated, irregular appetite, occasional nausea, &c.; and in some instances we have known severe epileptiform attacks come on.
These states of sympathetic dyspepsia, with nervous irritation, require attention. The 'bowels should be freely acted upon, so as to unload the colon; and the diet should be sustaining without being of a stimulant character. If there be any direct pressure upon the gum, free incision should be made ; but what is of still greater importance is the general treatment of the patient: the mind must have rest from close application ; exercise in the open air is desirable, especially horse exercise; hot rooms and exciting pleasures should be avoided ; and when it can be attained, several months of travel and change of scene is greatly conducive to complete restoration of health.
Less severe, but more distressing, is the dyspepsia in hypochondriasis. Wė might have spoken of it in connection with atonic dyspepsia, for there is great feebleness in the vaso-motor nerve, leading, it may be, to a
leficient secretion of gastric juice; or we might have lescribed a very similar state as being produced by gouty dyspepsia; or, lastly, as arising from an overworked mind and body. In these instances the whole attention is occupied with the diet; the mind is depressed and its energies enfeebled; one change after another is tried, but pain and discomfort equally follow; the stomach is sometimes exceedingly irritable, the bowels are over-anxiously watched, the sleep is unrefreshing, and life rendered miserable. To tell the patient nothing is the matter, would be to drive him to some one who would give an opinion more in unison with his feelings.
By carefully regulating the diet and the bowels, by cold sponging, by taking frequent exercise, either walking or on horseback, or a pedestrian tour when it is possible; by keeping the mind free from anxiety, and by cheerful society and occupation, all the symptoms may be greatly relieved. Such patients often take too spare a diet, leaving off one thing after another as unsuitable; and considerable improvement follows a more generous diet, especially when the mind is encouraged and cheered by the prospect of restored health.