[Reprint from The Alienist and Neurologist, Jan., 1886.] 
On the Relations Existing Between the 
Digestive System and the Brainv^SGf! 
By Edward C. Mann, M. D., New York, 
Superintendent Sunnyside Home for Nervous Invalids, 204 Leffert’s Place, 
Brooklyn, N. Y. 
/"TAHERE is a very intimate connection existing between 
a man’s stomach and bowels and his brain. Neu- 
rologists are rather apt to attribute all nervous symptoms 
directly to disease of the brain or spinal cord, and to 
apply remedies with this in view. There is a very com- 
mon condition of depression consisting of a peculiar form 
of melancholia, the patient’s thoughts being only of his 
bodily ailments. The patient is constantly feeling his 
stomach and pulse. He broods over his own ailments, 
but this condition I generally find will disappear on the 
cure of a gastric catarrh that is present with these symp- 
toms. When we find a patient suffering in this manner, 
it is safe to suspect that there is something wrong in his 
abdominal viscera. We shall observe, if the disease has 
lasted for some time, that the nutrition of the patient has 
suffered. The fat has disappeared, the muscles have 
* become relaxed, the skin is dry, there is burning in the 
palm of the hands and the nervous system is, as we have 
seen, markedly involved. We find simple congestion or 
chronic congestion of the stomach, with secretion becom- 
ing less active and digestion becoming defective. Slowness 
of the blood current, in any organ of the body, always 
lessens the nutritive processes. It lessens the supply of 
oxygen, and we have passive hyperaemia of the organ so 
affected. It is decidedly rare to find any acute idiopathic 
inflammation of the stomach or idiopathic gastritis, so we 
can leave this out of the question in our patients, unless 
we have reason to think that they have been taking some 
corrosive poison. We shall find, rather frequently, how- 2 
Edward C. Mann. 
ever, that our patient’s nervous condition depends upon 
a subacute inflammatory process or gastric catarrh, or 
inflammatory dyspepsia. We might confound gastralgia 
with gastritis, but there are marked points of distinction. 
The pain in gastralgia comes in paroxysms generally, 
there is no vomiting, or very rarely, and there is absence 
of pain on pressure. The condition of subacute inflam- 
mation of the stomach, chronic gastritis or gastric 
catarrh, which gives rise to the nervous symptoms of 
depression and melancholia before referred to, differs 
entirely from the functional varieties of dyspepsia. 
Gastric catarrh or inflammatory dyspepsia is an 
organic, not a functional disease of the stomach. The 
pathology of this condition is as follows: The mucous 
membrane becomes more or less opaque and thicker than 
natural, and it is changed in its color. It is brown, black 
or gray, due to pigmentary changes which take place in 
the coats of the stomach. The surface of the mucous 
membrane may present a mamillated appearance. The 
tubes become changed; they are less straight and less 
parallel than in the normal mucous membrane ; under the 
microscope they look mixed up. The stomach often 
appears fatty and granular owing to the structural trouble. 
The mouths of the tubes become glued up, as it were, 
and little cysts form at the bottom of them. 
Sometimes solitary glands become enlarged and waste 
away. Associated with this chronic structural change of 
the mucous membrane of the stomach, of our nervous 
invalid, we may find granular kidney. In simple nervous 
dyspepsia we find no distinct structural change, as in 
gastric catarrh. We have a loss of power in the mus- 
cular coats of the stomach in gastric catarrh. The con- 
dition of gastric catarrh consists of engorgement of the 
mucous membrane, with a copious generation of young 
cells, abnormal selections and increased detachment of 
epithelium. The cause of gastric catarrh, or inflammatory 
dyspepsia, is a diminution of the gastric juice which favors 
decomposition of the food taken into the stomach. If Relations of the Digestive System and Brain. 
3 
there is more food taken into the stomach than there is 
gastric juice to dissolve it, there will be decomposition 
and fermentation set up. This induces hyperaemia and 
an abundant flow of mucus, which neutralizes what little 
gastic juice there is present. There is no use in feeding 
any patient beyond his power of assimilation. The secre- 
tion of gastric juice is very much under the influence of 
the nervous system and depressing emotions caused by 
business reverses, or domestic trouble and grief, often is the 
starting point of a diminution of the gastric juice which 
eventuates in gastric catarrh, and the secondary state of 
depression and melancholia, referred to in the beginning of 
this paper. Causes also exist in the stomach itself. 
Large quantities of easily digested food may cause trouble, 
if there is not sufficient gastic juice to digest it, and small 
quantities of food, which from its nature is not easily di- 
gested, may produce irritation and hyperaemia. Anything 
that has commenced to decompose before taken into 
the stomach may produce a like result. There is a phys- 
iological hyperaemia produced by food in the stomach, 
but I refer only to morbid hyperaemia. One of the most 
common causes of morbid hyperaemia of the stomach is 
the habitual use of alcohol, especially on an empty stom- 
ach or in the morning. It should be a rule to discover 
whether patient had any liver, heart or circulatory trouble. 
An obstruction in the portal vein may keep the stomach 
in a constant state of hyperaemia. 
The symptoms of gastric catarrh, or inflammatory dyspep- 
sia, causing melancholia, are very similar to those of 
ordinary indigestion. There is loss of appetite, sense of 
weight and fullness in the region of the stomach, perhaps 
vomiting, and a generally perverted condition of the gastric 
secretion. It now becomes necessary to make a diagno- 
sis between gastric catarrh or inflammatory dyspepsia, and 
ordinary nervous dyspepsia. The patient suffering from 
gastric catarrh has probably had the disease a long time. 
The symptoms are never absent, but are permanent. Per- 
manence of the symptoms distinguishes chronic indigestion 4 
Edward C. Mann. 
from functional indigestion. In gastric catarrh the pa- 
tient suffers from distress soon after eating. In func- 
tional disorder the patient often feels better after taking 
food. Functional difficulty is often relieved by stimulants, 
while in structural trouble the stimulants burn the stom- 
ach at once. In structural trouble the pain is relieved 
when the stomach is empty; in functional dyspepsia the 
stomach feels worse when it is empty. In gastric catarrh 
the smallest piece of bread will often cause severe pain. 
The tongue in gastric catarrh is broad, flabby, and 
has an unpleasant odor. The condition of catarrh may 
extend to the upper part of the small intestine. 
We may see a gastric duodenitis. This may extend 
up into the bile ducts and produce bilious disorders. The 
inflammation in gastric catarrh may extend to other vis- 
cera, and the liver, kidneys and spleen may become 
involved. Stricture at the pyloric orifice may occur from 
simple hypertrophy of the mucous membrane. Should this 
occur, there will be great distension of the stomach with 
vomiting. Gastric catarrh is very often overlooked and 
treated merely as a functional derangement of the stomach, 
and it is very important not to make any such mistake. 
In the treatment of gastric catarrh we must give the 
stomach rest. The less medicine the better for the 
patient; harsh purgatives should never be given. All 
starchy and farinaceous food must be omitted. Tender 
brown meats, that are thoroughly masticated and taken in 
moderate quantities, will be the most beneficial. Aside 
from a meat diet, an exclusively milk diet is good with 
lime water to drink with a little salt in it. Keep the 
patient on this diet for three weeks, after which stale 
bread, eggs, soft boiled rice, mutton chops, etc., may be 
given. Fresh buttermilk is an admirable drink for these 
patients. If there is tenderness over the epigastrium, heat 
may be applied, and if it continues, counter irritation in 
the form of a few small blisters may be required. Keep 
the bowels open by enemas of warm water and soap 
suds. As to medicines, the alkaline carbonates lessen Relations of the Digestive System and Brain. 
5 
the toughness of the mucous membrane. The bi-carbonate 
of soda or phosphate of soda is excellent. We may give 
io grs. of bi-carbonate of soda in a half tumbler of water, 
putting in a pinch of chloride of sodium. Give this half 
an hour before breakfast and other meals. This increases 
the secretion of the gastric juice. Or we may use the 
natural alkaline water before meals. In patients of full 
habit, I have found it excellent practice to give a tea- 
spoonful of epsom salts in half a tumbler of water with a 
little salt in it every morning, for several days, or a week 
or two. When the bowels are constipated give warm 
enemas and not cathartics. There is one very valuable 
remedy for atony of the mucous membrane of the stom- 
ach, ipecac. Given in small doses it has a very bene- 
ficial effect in this disease. From one to three drops of 
the tincture will often result in rapid pouring out of 
healthy gastric juice. The sub-nitrate of bismuth has an 
excellent local sedative effect, and small doses of morphia 
may be combined with it, if thought desirable. After the 
inflammation has ceased, we may put the patient on an 
improved diet and tonics. A little nux vomica with 
hydrochloric acid is an excellent tonic. One drop of 
Fowler’s solution is often of great benefit in gastric 
catarrh which results from alcohol, where the patient has 
morning sickness. This should be given before meals. 
The great majority of patients with gastric catarrh are 
drugged too much, and no due attention paid to proper 
diet. Mental troubles and distress are very apt to pro- 
duce atonic dyspepsia or functional trouble, but very 
rarely operate in the production of true structural 
troubles as we have seen, except, perhaps, in the first link 
of the chain by arresting the flow of gastric juice. On 
general principles, a cheerful state is decidedly favorable 
to the gastric secretion and vice-versa. If the secretions 
of the liver are perverted, we may also find patients 
mentally despondent, with dull pain over the right hypo- 
chondriac region. In these cases we must regulate the 
food and give saline purgatives in the morning. 6 
Edward C. Mann. 
A large number of cases of hypochondriasis we shall 
find associated with duodenal or intestinal dyspepsia. 
This is manifested by a sense of weight and uneasiness, 
not unfrequently felt, in the right hypochondriac region. 
The disturbance is felt some time after eating food. 
The duodenum and liver are involved. The most common 
cause of this is in the inability of the stomach to bring 
about the requisite changes in the food, so that the food 
pouring into the duodenum is unfit for digestion in the 
duodenum. This produces irritation, and this irritation 
is transmitted to the liver. This form of dyspepsia and 
the resulting hypochondriasis demand a special line of 
treatment. Small doses of hydrargyrum with small doses 
of ipecac in the morning is, I think, the best treatment. 
Horseback riding is good for these patients. Continual 
exercises of the brain in brain-workers brings about indi- 
gestion very frequently, and rest and recreation is what 
this class of nervous invalids need. Finally, in women 
who are nervous invalids, I often find that disorders of 
the sexual system, uterus and ovaries, produces disorders 
of the stomach through the nervous system, which dis- 
appear when the chronic affection of the uterus is cured. 
We should see that our patient has no bad teeth. The 
stomach should never be filled to an uneasy sense of 
repletion. There should be no exercise taken immedi- 
ately after a meal. There should be certain hours 
intervening between meals. If certain food does not 
agree with a patient, he must avoid its use. Patients 
should be kept well nourished, and not kept on a low 
weak diet.