fc *P9 -*£ttfMV ,, DYSPEPSIA: ITS CAUSES, .i- SYMPTOMS AND CURE. y J. H. KELLOGG, M. D., MKMgER*AMERICAN PUBLIC HEALTH ASSOCIATION, AMERICAN SOCIETY •FOR THE ADVANCEMENT OF SCIENCE. AMERICAN' SOCIETY OF MICROSCOPY. MICHIGAN STATE MEDICAL SOCIETY, MEDICAL SUPERINTENDENT OF BATTLE CREEK SANITARIUM, * * AUTHOR OF NUMEROUS WORKS ON HEALTH^ ETC. OZ-£*y lyert y PUBLISHED BY THE v GOOD HEALTH PUBLISHING COMPANY, jg}„ BATTLE CREEK, MICH. 1879. S-flOfe** A WI 100 K29d 1879 39420470R NLM051957097 y 3 v .^ ^ >A DUE TWO WEEKS FROM LAST DATE Ff* a rass % \ .^ ] v{j /V* S DYSPEPSIA: ITS CAUSES, SYMPTOMS AND CURE. J. H. KELLOGG, M. D., MKMBEH AMERICAN PUBLIC HEALTH ASSOCIATION, AMERICAN SOCIETY FOR THE ADVANCEMENT OF SCIENCE, AMERICAN SOCIETY OF MICROSCOPY, MICHIGAN STATE MEDICAL SOCIETY, MEDICAL SUPERINTENDENT OF BATTLE CREEK SANITARIUM, AUTHOR OF NUMEROUS WORKS ON HEALTH, ETC. PUBLISHED BY THE GOOD HEALTH PUBLISHING COMPANY, BATTLE CREEK, MICH. 1879. Ar\ui\ Entered according to Act of Congress, in the year 1879, By J. H. KELLOGG, M. D., In the Office of the Librarian of Congress, at Washington. PREFACE. Having been so situated for several years as to have the medical care of a large number of dyspeptics, many of whom were cases of the most chronic sort, who had tried in vain all remedies which had been presented to them by numerous medical advisers, but without relief, we have found it neces- sary to give to this disease much careful study and a some- what larger degree of attention than would have been re- quired in a different field of practice. The result of our ob- servations has been the conclusion that not only the com- mon people but medical practitioners also are in general very deficient in knowledge on this subject. This is evidenced in the one case by the persistent continuance of habits which have in many instances been the sole cause of the produc- tion and perpetuation of the malady ; and in the other by the fact that patients are rarely informed of the real cause of their disease, but are treated with remedies which can at most but palliate the symptoms, doing nothing toward re- moving the cause of the disease, and too frequently aggrava- ting the patient's sufferings in the end. We have had, also, abundant reason for being convinced that there is on the part of all classes, not excepting a large share of the average medical practitioners, a sad deficiency of information on the subject of dietetics. The relation of food to health, and especially the relations of different dieta- (iii) iv PREFACE. ries to different morbid conditions of the digestive organs, are subjects concerning which there is the most, lamentable ignorance. We have met numerous cases in which the dis- orders of digestion required nothing more than a change of diet, an adaptation of the food to the state of the digestive organs, to effect a cure. The object of this little work is to point out as concisely as possible the symptoms of dyspepsia and to indicate the general principles upon which any mode of treatment, to be successful, must be based. The causes of dyspepsia are sim- ply enumerated, without any explanation of the manner in which their adverse influence is exerted. The consideration of this subject, together with that of digestion in health, was precluded by the narrow limits of the work, much to the re- gret of the author, as these subjects are of first importance to a correct understanding of the disorders of digestion. They are, however, considered at length in the larger, bound edi- tion of the work, to which we must refer those who are de- sirous of further information. J. H. K. Battle Creek, Mich.. 7uly, i87o. CONTENTS. Page. DYSPEPSIA,............................................ 7 CAUSES OF DYSPEPSIA,............................ 9 Errors in Diet, ............................................... 10 Errors in Manner of Eating,.................................. 11 Errors in Regard to the Quality of Food,....................... 12 Causes not Directly Related to Food........................... 12 SYMPTOMS OF DYSPEPSIA,...... ............... 13 Classification of Indigestions, .............................. 13 Uneasiness at the Stomach,................................... 15 Flatulence,.................................................. 16 Fermentation,................................................. 17 Acidity,................................................... 19 Heart-Burn,.................................................. 19 Water-Brash—Pyrosis,....................................... 20 Nausea,..................................................... 20 Vomiting,.................................................... 21 Regurgitation,............................................... 22 Gripes—Colic, ............................................... 23 Weight,..................................................... 23 Pain,........................................................ 24 Biliousness,.................................................. 26 Appearance of the Tongue,................................... 27 Aphthae, .................................................... 29 Throat-Ail,.................................................... 29 Sour Taste in the Mouth, ..................................... 29 Constipation,................................................ 30 Diarrhoea,..................................................... 30 The Feces,................................................... 31 The Urine,................................................... 32 Dryness of the Skin,.......................................... 32 Nervous Symptoms,.......................................... 33 Headache, ................................................... 34 Sick-Headache, .............................................. 35 Disturbance of the Circulation,................................ 35 Stomach Cough,.............................................. 36 Nervousness,................................................. 37 Vertigo,.................................................... 38 Disturbance of Sight, Hearing, etc., ........................... 38 Vi CONTENTS. Page. Nervous Diseases,............................................ 39 Unusual Drowsiness,......................................... 39 Sleeplessness,................................................. 40 Mental Disorders, ............................................ 40 TREATMENT OF DYSPEPSIA,.................... 42 The Road to Health,.......................................... 43 Slow Digestion,.............................................. 45 Acid Dyspepsia,.............................................. 46 Bilious " .............................................. 47 Painful " .............................................. 49 Nervous " .............................................. 50 Diet and Regimen,............................................ 53 Articles Easy of Digestion,.................................... 55 Articles Not Easy of Digestion,.............................. . 56 Indigestible Articles,.......................................... :>-, Practical Hints,.............................................. ,-,,s Specific Restrictions for Dyspeptics,........................... 58 Diet for Slow Digestion,....................................... ,>s " " Acid Dyspepsia, ..................................... ",cj " " Bilious Dyspepsia,................................... 5 Measures to Improve the Secretions,........................... ;••> " " Increase Muscular Action,......................... 74 Flatulence,............................................... -, Acidity,............................................. ~- Vomiting,.............................................. -- Constipation,............................................ ~g Cold Feet, etc.,........................................... -y Sleeplessness,............................................ ^y F all diseases or derangements of the human system, disorders of digestion are by far the most common. Indeed, it may be safely said that very few escape some personal knowledge of the tortures of indigestion—either acute or chronic—at least in this country, in which these maladies are so nearly universal that Americans have gained the reputation of being " a nation of dyspeptics." No other term in the English language expresses so much of misery and suffering as are comprehended in the one word, "dyspepsia." Indigestion is, in fact, a synonym for every word expressing pain, physical or mental suffering, misery, despondency, despair, and every degree of wretchedness possible to humanity. Dyspepsia is a disease which deprives its victims of all the pleasures of living, and yet allows them to drag out year after year of misery until, worn out by incessant, unremittent suffering, death comes to their release. The very fact that it is not a speedily fatal disease, makes it to some all the more terrible; since, having tried in vain almost innumerable "sure cures "for the disease, they have (7) 8 DYSPEPSIA. given up in hopeless despair, and long for death to end their sufferings. Cholera is a fearful scourge; yellow fever is a ter- rible destroyer; scarlet fever and small-pox may well be dreaded as most calamitous imports into any com- munity; but dyspepsia is a more stupendous evil than any or all of these, notwithstanding the fact that it rarely figures largely, if at all, in the mort- uary tables. These reports are on this point very misleading, since they usually name only the imme- diate cause of death, not making apparent the fact that a large share of all chronic diseases have their beginning in disturbances of nutrition arising from impaired digestion. If the whole truth were shown respecting the influence of remote causes on the death rate, no doubt it would appear that the causes of indigestion are responsible for more deaths than all other causes combined. It is evident that this is a malady that demands the most serious attention. This is especially seen when we recognize the fact that of all chronic ail- ments this is pre-eminent as being preventable by the employment of proper means. No disease is more dependent upon conditions which the indi- vidual can himself control than is this ; neither is there any disease which more readily yields to the application of appropriate remedies when the nec- essary conditions are supplied. We have no hes- itancy in asserting that every case of purely func- tional disease of the stomach can be cured, provided CAUSES. 9 the requisite conditions can be secured. This is not always easy to accomplish, however, since one of the obstacles to recovery may exist in the mind of the patient, and may be so thoroughly settled there as to make its removal impossible. CAUSES OF DYSPEPSIA, Two things are necessary to the healthy per- formance of the digestive function; viz., prop- er food, and a healthy condition of the organs directly and indirectly concerned in the process of digestion. Where these two requisites exist, the organs of digestion perform their work with- out in any way disturbing the other organs or functions. Indeed, normal digestion is performed unconsciously. An individual who is conscious of the working of his stomach, is suffering with a disordered state of that organ. The disorder may be of any degree, from that indicated by a slight feeling of weight or uneasiness occasioned by tak- ing a small excess of food, to the most chronic case of indigestion, exhibiting all the most an- noying symptoms of this formidable disease. We say formidable disease, not because it is often a fatal malady, but because of its obstinacy, which too often baffles for years the best efforts of those suffering from its debilitating effects. In most instances, unfortunately, the efforts of the patient and of his advisers, though earnest and perse- vering, are unavailing, because not well directed. 10 DYSPEPSIA. With this, as with all other diseases, the first step toward recovery lies in the discovery and removal of the causes of the disease. Fortunately for the sufferers from this disease, this can usually be done. It is very rare indeed that the causes of functional disorders are of such a character as to make their discovery impossible, though it is often a much more difficult task to effect their removal when they have been detected. Sometimes, it is true, the first stages of organic disease of the stom- ach exhibit symptoms identical with those of purely functional disease ; but these rare cases are exceptions. Before mentioning in detail the various causes which may be considered most active in occasion- ing disorders of digestion, it is important that we call attention to a general principle which applies to all cases of functional disease of the organs of digestion. In the study of digestion in health it is found that the two essential things are secretion and muscular action. So we find, correspondingly, that the two primary morbid conditions are de- fective secretion and disordered muscular action. The defect in the digestive secretions may be either in quantity or in quality, or may be both combined. The disordered muscular action may be either in- creased or diminished muscular activity; in the great majority of cases it is the latter condition. The special causes which will be mentioned are more or less active as agents productive of dyspep- CAUSES. 11 sia, just in proportion as they disturb these two essential functions of digestion, secretion and mus- cular action. Errors in Diet.—There is no room to doubt that errors in diet, in manner of eating, or in quantity and quality of food, are by far the most active causes of indigestion in^this country, as well as in most others. By asking a dyspeptic how he eats, what he eats, and when he eats, it is usually easy to discover the cause of his suffering; and by inducing him to form correct habits in these three particulars, a cure will be effected in nine cases out of ten. Errors in the Manner of Eating.—Hasty eating; drinking at meals; hot drinks; cold drinks, ices, etc.; use of cold food ; eating too frequently ; eating be- tween meals; irregularity of meals; eating when weary; violent exercise just after eating; sleeping soon after eating; late suppers ; hot or cold bath- ing shortly before or soon after eating; overeating; eating too little; unseasonable diet, as the use of highly carbonaceous and heating foods in summer, as fat meats, lard, butter, and excessive quantities of sugar and other sweets. Errors in Regard to the Quality of Food.—Man, like other animals, is made of what he eats; hence the German proverb is literally true, that "as a man eateth, so is he," and we may well credit the assertion of an eminent author that the general tendency of thought in any nation may be deter- 12 DYSPEPSIA. mined by the character of the national diet. True as this principle is when applied to the body in gen- eral, it is especially true as referring to the stom- ach. No organ is so directly and so profoundly affected by the quality of the food as the stom- ach. Hence we may well consider with care the various ways in which the digestive organs may become impaired through defects in the quality of the food, which may be enumerated as follows:— Bad cookery; fried food; pastry; poor bread; fat meats; "rich food"; too free use of sugar and sweet foods; soft food; too many varieties at a meal; condiments, as mustard, pepper, pepper- sauce, cinnamon, vinegar, excess of salt, etc.; pickles; preserves; tea and coffee ; alcohol; to- bacco ; hard water; alkalies, as in the use of baking powders, soda, saleratus, ammonia, etc.; decayed food; adulterations exposing the stomach, as well as the whole system, to the deleterious action of lead, zinc, arsenic, copper, sulphuric acid, etc., etc.; use of indigestible substances, as of clay, chalk, slate, and sundry other substances equally innutritious and indigestible in character. Causes not Directly Related to Food. — Pressure upon the stomach; mental worry, care, and anx- iety ; mental impressions; drugs; sexual abuses ; disease of other organs ; worms; inherited dyspep- sia; electrical and other meteorological changes, and numerous other influences which are as yet but imperfectly understood. SYMPTOMS. 13 SYMPTOMS OF DYSPEPSIA, As nearly every disease may include among its symptoms some disorder of digestion, so dyspep- sia may include in its symptoms many of those of nearly every disease that' could be named. This is readily understood when we consider the fact that impairment of the digestion interferes with the nutrition of every organ of the body. Every part suffers, and of course the suffering organs express themselves in the various symptoms by which they manifest diseased or disordered functions. The particular prominent features in any given case will differ with individual peculiarities of constitution or temperament, which give prominence to some particular set of symptoms which may or may not refer to the stomach; it is usual, however, that there are certain symptoms which refer directly to the stomach, and which are generally understood as indicating stomach disease. The intensity of the symptoms manifested, varies from the slight uneasiness and sense of weight or fullness occa- sioned by a small excess in eating, to the most dis- tressing and painful condition of the more aggra- vated forms of the disorder. Classification of Indigestions.—Dyspepsia may be classified, first, as acute and chronic. One of the most important differences between an acute and a chronic case of indigestion is that acute dyspepsia 14 DYSPEPSIA. will cure itself in time, usually in a very short period, by the unaided efforts of nature; while a chronic case of the disease continues from bad to worse, or without material improvement, indefi- nitely. It is true of most chronic diseases that they show little tendency to come to a resolution by limitation. This is especially true of chronic dyspepsia. Most cases of acute dyspepsia are the result of excess in eating, taking food at an unseasonable hour, or partaking of very unwholesome and indi- gestible substances, or the accidental ingestion of some highly irritating substance, as poisoned or de- cayed food, or some similar irritant. The majority of these cases recover spontaneously, and so quickly that they scarcely need further attention in this connection. Chronic dyspepsia is generally much less active in its symptoms than is the acute form of the dis- ease. It usually begins slowly, insidiously making its advances, and thus for a long time eluding ob- servation, in many instances until well established. This is one reason why the diagnosis of the disease is often very obscure. Very frequently, it is over- looked for years, being mistaken for some other disease through the special prominence of certain symptoms, which, as before intimated, may simu- late almost any disease. Basing the classification of chronic dyspepsia upon the most prominent symptoms observed in SYMPTOMS. 15 different cases of the disease, by far the greater part of the number may be included in the follow- ing five classes; viz., simple, acid, foul, painful, and nervous dyspepsia. Each of the classes named has its characteristic symptoms, though any given case may combine the symptoms of one or of each of the different classes. After a brief consideration of the most important of the several symptoms relating to the stomach which appear in different phases of the disease, we will consider the special symptoms or groups of symptoms which characterize the different classes of dyspepsia mentioned. Uneasiness at the Stomach.—One of the most common symptoms, and one which is frequently the first noticed by patients, is an uneasy sensation referred to the stomach, which is variously de- scribed as fullness, weight, tightness, oppression, heaviness, "a load on the stomach," drawing, "working," etc. There may or may not be ten- derness on pressure at this stage. The uneasiness complained of is greatly increased by any excess in food—though occasioned by the usual amount— by eating too rapidly, by drinking at or soon after meals, and by eating articles of food which are dif- ficult of digestion, as warm bread or biscuit and butter, pastry, fried food of any sort, pickles, etc. The essential difference between this condition and that resulting from eating to excess in health is that the symptoms described are produced by an 16 DYSPEPSIA. ordinary and proper amount of food, being only in- creased in severity by excess in quantity. FMtulence.—This symptom indicates the presence of gas in the stomach or bowels, the character of which varies greatly, sometimes consisting of air which has been swallowed with the food in hasty eating. Sometimes, also, persons acquire the habit of swallowing air, as do horses, in which the habit is known as " cribbing." The act requires quite a strong effort, yet is sometimes practiced constantly by hysterical patients, and also by some persons to relieve unpleasant sensations at the stomach. A small quantity of air is swallowed in the act of gulping, which usually occurs just before vomiting, and can be accomplished at will by most persons. The usual cause of gaseous distention of the bow- els, however, is the formation of gas within the bowels themselves, by decomposition of some ele- ments of the food. Sometimes this occurs to an enormous extent, giving rise to belching and eruc- tations, well compared to roaring in some extreme cases. In some cases, accompanied by hysterical manifestations, the accumulation of gas will be al- most instantaneous. When caused by fermentation, the gas usually consists chiefly of carbonic acid, from the destruc- tion of starch and sugar, being both tasteless and odorless. At other times, it contains sulphureted hydrogen and other foul gases, from the decompo- sition of the albuminous and fatty elements of the food. SYMPTOMS. 17 Intestinal flatulence, giving rise to rumbling in the bowels, or borborygm, has the same causes as flatulence of the stomach. The form of flatulence which affects chiefly the small intestine seems also to be in a great degree due to deficient secretion of bile. It affects chiefly weakly persons, those greatly debilitated by chronic rheumatism, especially, and more often women than men. It is frequently a cause of sleeplessness, and of unpleasant and erotic dreams, giving rise to nocturnal losses in persons whose sexual organs are in a weakened condition. Flatulency of the colon, or large intestine, occa- sioning offensive gaseous discharges, arises from the decomposition of the retained contents of the bowel. It occurs most frequently as an accompaniment of constipation, and is due to deficient bile. Fermentation. — Septic and even putrefactive changes may take place within the body as well as outside of it. According to the conclusions arr rived at by careful scientific investigation, the pro- cess of fermentation consists of changes in organ- ized substances induced by germs received from the air. There are various kinds of germs which in- duce different forms of fermentation. That known as the torula, or the yeast plant, excites the fer- mentation by means of which bread is raised, beer and wine fermented, etc. Through the action of yeast, sugar and starch are first converted into car- bonic acid, alcohol, and water. It is this kind of fermentation which produces that form of flatulence B 18 DYSPEPSIA. in which the stomach is distended with a tasteless and odorless gas. In the stomach, the process is precisely the same as in the baker's dough trough or the beer vats of the brewer. When digestion is promptly performed, the food is digested and ab- sorbed before it has time to ferment; but when it is slow, either on account of deficient muscular ac- tion on the part of the stomach, or because of de- ficient or defective secretion of gastric juice, fer- mentation takes place before digestion is completed. The conditions of the food are peculiarly favorable for the occurrence of fermentation. The decrees of warmth and moisture are exactly those required. Fermentation is also favored by the presence of the saliva and of the mucus of the stomach. A solu- tion of sugar in pure water will keep sweet for many hours; but if a small quantity of saliva be added to the solution, fermentation very quickly begins, as is shown by the rising of bubbles of gas to the surface. This change would always occur in the stomach were it not for the preservative in- fluence of the gastric juice, which neutralizes the saliva, and to a considerable degree prevents fer- mentation. As before remarked, however, if diges- tion is delayed for any reason, then the germs taken in from the air with the food, quickly excite fer- mentative changes, and gases are developed, to- gether with the other usual results. Acidity.—A slight degree of fermentation pro- duces only carbonic acid and a small quantity of SYMPTOMS. 19 alcohol; but when the process continues, the alco- hol is decomposed, acetic acid being formed. Every housewife is familiar with this fact from observing that bread allowed to ferment, or " rise," too long, becomes sour, an accident which bakers remedy by the addition of saleratus, an alkali, which neutral- izes the acid. By the same process, wine, milk, and other fermentable substances, become sour. The juice of apples or other fruit, allowed to remain in a warm place, is thus converted into vinegar, which in this way becomes a simple solution of acetic acid in water, which is known as vinegar. In a man- ner precisely similar, the contents of the stomach may sour, the acetic acid being formed from the fermentation of the starch and sugar of the food. Patients suffering with acidity often complain of having " too much gastric juice," or state that " the stomach is in a gastric condition," from the fact that by a reversed action of the muscles of the oesophagus some portions of the sour contents of the stomach are brought up into the mouth, the acid taste causing the patient to suppose that he has more gastric juice than is needed. Heart-burn.—A burning or smarting sensation felt at the pit of the stomach or the lower end of the oesophagus, sometimes extending upward, and often accompanied by the rising into the mouth of a small quantity of a very acrid, irritating, pungent, foul-smelling liquid. The latest investigations on the subject seem to show that this symptom is due 20 DYSPEPSIA. to the formation in the stomach of butyric acid from the fermentation of some of the elements of food. The formation of this irritating substance is particularly favored by the presence in the stom- ach of fatty substances. It is this acid which gives to old cheese and very rancid butter their peculiar pungency. It is also to its presence that the nau- seating odor of vomited matters is due. Water-brash—Pyrosis.—This is a symptom which commonly occurs when the stomach is empty of food, or nearly so; often before breakfast. A quantity of clear fluid, either slightly acid, alka- line, or neutral in taste, is thrown into the mouth from the stomach, varying in amount from less than a mouthful to half a pint or more. It is sup- posed to be caused by the accumulation of saliva in the stomach, which fails to absorb its fluid con- tents on account of inactivity^ The expulsion of fluid may be accompanied by pain, or may be quite free from unpleasant sensation of any kind. It is a symptom which is almost universal among the Lapps and New Zealanders, and is also exceedingly prevalent in Scotland, where it seems to be due to the use of insufficiently cooked oatmeal. Nausea.—This symptom is a peculiar sensation referred to the stomach, which is not easily de- scribed, as it is unlike anything else. It usually precedes the act of vomiting, though not always, and frequently exists without vomiting. It is de- rived from the Greek word "<"*, meaning a ship, SYMPTOMS. 21 being always a prominent symptom in seasickness. It commonly occurs, when habitual, in persons whose digestive organs are very weak. Vomiting,—This is an expulsive act, in which the abdominal muscles and the diaphragm are chiefly active. As a symptom of acute dyspepsia, it is very common, but is much less so in chronic disorders of the digestive organs. When present, it usually in- dicates something in the stomach which should be ejected, being an effort of nature to defend the sys- tem from injury. Sometimes the presence of simple mucus, in excessive quantity, as in gastric catarrh, will give rise to vomiting. Vomiting also occurs very frequently in connection with whooping cough, chronic bronchitis, and consumption, being due to violent coughing. It is also sometimes induced, as is coughing, by the tickling sensation produced in the throat by a relaxed or elongated palate. Tick- ling the throat with the finger or a feather will in many persons excite vomiting, especially if there is the slightest degree of nausea. Some persons can produce the act of vomiting at will. When violent vomiting continues for some con- siderable length of time, the vomited matter con- sists wholly of bile and mucus. The presence of bile leads many persons to suppose that bile is the cause of the vomiting, being evidence of " bilious- ness," and having produced nausea by its presence in the stomach. This is an error. Bile is rarely present in the stomach, and then only from some 22 DYSPEPSIA. disturbance of the usual relations of the digestive functions. The violent efforts in vomiting finally extend to the duodenum, where the bile exists nat- urally, and causes it to be thrown upward into the stomach, whence it is expelled by vomiting. The first portions of bile vomited usually have a yel- lowish color, due to the fact that the alkaline bile is neutralized by the acid contents of the stomach. Afterward, when the bile becomes more than suffi- cient to neutralize the acid contents and secretions of the stomach, its natural greenish color appears. Severe, protracted, and painful vomiting is a common symptom of organic disease of the stom- ach, as in cancer, ulcer, dilatation, contraction, or some other structural change. Regurgitation.—Rumination is ah act by which the food is returned to the mouth from the stom- ach by a reversal of the act by which food is swal- lowed, and without the violent efforts attending vomiting. In some animals, as the ox, sheep, goat, and others of the same species, all the food is re- turned to the mouth in this way, being re-chewed. In man, regurgitation does not occur in health, being caused by an irritable state of the mucous membrane of the stomach, which excites contrac- tion in the organ and forces the food upward. Sometimes the act becomes more or less voluntary; but more often it is occasioned by a morbid condi- tion of the stomach, and cannot be controlled by any effort of the will. Patients suffering in this way frequently complain of " spitting up their food." SYMPTOMS. 23 Gripes—Colic.—This symptom, sometimes called also " belly-ache," is caused by irregular muscular contraction, or spasm, of the small intestine. The exciting cause may be distention with gas, or the presence of irritating matter in the bowels. Very common in patients subject to constipation. Weight.—A symptom very often complained of by patients who may or may not have acidity, heart-burn, water-brash, and other local symptoms. It is sometimes referred to as " a constriction," " a tightness," or " oppression," and is generally lo- cated at a point a little to the left of the median line, just beneath the lower border of the ribs. It indicates a catarrhal condition of the membrane of the stomach. The sense of fullness which it often occasions after leafing is deceptive, being fully as great in many cases when the stomach is empty, or when only a small quantity of solid food or liquid has been taken. Persons suffering thus are usually very despondent, and it may be this fact that has given rise to the term hypochondria, which literally has reference to the region in which the sensation described is felt. It often accompanies sperma- torrhoea and other forms of sexual weakness. The "sinking sensation" at the stomach, of which many patients complain, though not iden- tical with, is allied to, the sensation of weight de- scribed. It is probably due to a relaxed condition of the walls of the stomach. Pain.—As a symptom of dyspepsia, pain may ap- 24 DYSPEPSIA. pear in the region of the stomach, or it may be re- ferred to the spine, the chest, beneath the shoulder- blade or between the shoulders, or, in fact, to any part of the body. The most usual pain is a dull aching after meals at the pit of the stomach, which is increased on pressure either with the palm of the hand or with the tip of the finger. In some cases pain, though not severe, is constant, being no greater after a meal than when the stomach is empty, and often being apparently relieved by bland food, but coming on again as soon as the stomach is empty. This sort of pain is usually ac- companied by a pain beneath the shoulder. It in- dicates congestion of the mucous membrane of the stomach, and being usually preceded by the sense of weight already described, is doujbtless indicative of gastric catarrh, in many instances at least. Sometimes pain felt in the stomach is wholly from increased sensibility of the mucous membrane. This condition is accompanied by abnormal sensi- bility elsewhere, in most cases, and commonly occurs in persons of hysterical tendencies, chiefly in young ladies. It not infrequently accompanies the condition rather vaguely known as " spinal ir- ritation." We have nearly always found tenderness at the epigastrium present in cases in which there was marked tenderness of the dorsal spine. A constant, wearing pain, though not severe, often becomes unbearable from its long continu- ance. It gives to a patient a haggard, despairing SYMPTOMS. 25 look, which is also in part due to deprivation of sleep, another ill consequence of this variety of pain. The local pain is often aggravated by shoot- ing pains emanating from the pit of the stomach and running into the limbs and other parts of the body. Patients' frequently complain of a pain felt " clear through the body," starting from the pit of the stomach and terminating in a tender spot in the spine nearly opposite. Pain accompanied by vomiting of blood is in- dicative of gastric ulcer or of some other severe structural trouble. Flatulence produces a pain peculiar to itself. Neuralgia of the stomach is one of the most severe pains an individual can experi- ence, often coming on suddenly, and in many cases soon after eating, and by its intensity not infre- quently causing fainting. Soreness on pressure, with neuralgiac and other pains, also exists in the small intestines in some cases of dyspepsia, the conditions being essentially the same as those present in stomach pain. We should not omit to remark in this connection that the various pains referred to are often mis- taken for other diseases. The pain in the chest leads the patient and his friends to believe that he has consumption; and the emaciation occasioned by the defective nutrition seems to confirm this opinion. If the patient has a slight cough, the diagnosis is considered certain, and the patient is hurried off to Florida, to California, Colorado, or 26 DYSPEPSIA. some other locality supposed to be favorable for consumptives. By change of air, scenery, diet, in- crease of exercise, etc., the patient recovers, and the locality visited gets the credit of having cured a case of consumption, when the lungs have been sound from the first. If the patient stays at home, some quack or a worthless nostrum gets the credit, and every real consumptive who bears of the won- derful cure forthwith tries the same remedy, but of course without benefit. Such cases occur con- stantly, yet it must not be supposed that all pains in the chest come from the stomach. The same mistake is made in respect to other pains. In the region of the heart, it is supposed to be heart dis- ease, especially if there is sympathetic palpitation of that organ. Pain between the shoulders is spinal disease. Occurring lower in the spine, it is thought to be kidney trouble, especially if there happens to be a sediment in the urine. Pain in the duodenum, occurring just beneath the lower border of the ribs on the right side, is " liver complaint," and must be treated by a plaster or a " liver pad " ! Biliousness.—What is termed biliousness, or "a bilious attack," is really acute gastric catarrh- From the long retention of undigested articles of food, the stomach becomes irritated to such a de- gree that nausea and vomiting are produced. At first, the matters vomited consist of undigested food in an advanced stage of decomposition, as indicated by the foul odor and nauseous taste. After vomit- SYMPTOMS. 27 ing has continued for some time, bile and mucus are the principal matters expelled. The patient feels better soon, and in a few days is as well as ever. In these cases the difficulty is really in the stomach, and not in the liver, as many suppose, though such attacks may be accompanied by dis- turbance of the functions of the liver. The irrita- tion extending down to the duodenum, its mucous membrane becomes so swollen that the opening of the duct from the liver is obstructed. This occa- sions retention of the bile, and absorption takes place, when the individual notices a jaundiced color of the skin, a dingy appearance of the white of the eye, etc. This is what gives to this symptom, or group of symptoms, the term of biliousness, when it is really gastric catarrh. One of the most com- mon causes of acute gastric catarrh is " taking cold " after overeating or eating food difficult of digestion. Appearance of the Tongue.—While the impor- tance of the condition of the tongue as a symptom of dyspepsia is such as to make its mention neces- sary, it should be borne in mind that its indications have more distinct reference to the system in gen- eral than to the stomach in particular. A clean tongue, of natural color, appearance, and moisture, is a pretty sure indication of health. A feverish condition is readily shown by the tongue. Unnatural redness of the tongue, most com- monly at the tip and edges, sometimes with a strawberry appearance, indicates an irritable state 28 DYSPEPSIA. of the stomach. It is usually accompanied by sore- ness at the pit of the stomach, little appetite, and great thirst. A yellowish or creamy coating on the tongue in- dicates an inactive state of the stomach and intes- tines, giving rise to a foul condition of the organs. A white coat on the tongue indicates a feverish condition. This often appears in connection with unnatural redness at the edges and tip. A broad, pale, flabby tongue indicates a weak- ened, debilitated condition of the digestion and of the whole system. A tongue of this sort usually exhibits indentations on its margin, formed by the teeth, owing to its flabby state. A brown coat upon the tongue is very common in acute dyspepsia. It is often accompanied by a bad taste in the mouth, with unnatural dryness. Sometimes this is due to sleeping with the mouth open, by which the secretions and epithelium be- come dried to an unnatural extent. Sometimes the tongue is coated in the middle, the edges being smooth and clean. This is due to the fact that the epithelium has become softened on the smooth portions, and has been rubbed off by the friction of the teeth. Clean spots are also due to lost epithelium, in many cases. Transverse fissures of the tongue indicate a dis- eased state of the mucous membrane of the stomach. Aphtha.—In cases of acidity of the stomach, oc- casioning irritability of the organ, little pimples SYMPTOMS. 29 often appear on the sides and under part of the tongue, and just within the corners of the mouth. After a short time, small white patches of lymph appear, which frequently leave very troublesome little ulcers when they disappear. These very annoying ulcers are positive evidence of stom- ach disorder, though the patient will often assert that he has no difficulty with his food, and never has any pain or inconvenience connected with the stomach. Throat-Ail.—Congestion of the pharynx, with a granular condition of the mucous membrane, re- laxation and elongation of the uvula, accompanied by a sense of constriction, tightness, dryness, tick- ling, and other symptoms, are not infrequent indi- cations of stomach disorder. The patient is often much troubled with a tenacious mucus which he finds difficulty in dislodging. Sometimes the throat trouble amounts to real difficulty in swallowing. What is known as " clergyman's sore throat" is usually associated with disorders of digestion. Sour Taste in the Mouth.—This symptom, not a very infrequent one, is due to an acid condition of the saliva, which not only renders it of little use as a digestive fluid, but ruins the teeth in addition, by destroying the enamel. In anomalous cases the saliva has a sweetish taste. In inactive conditions of the liver, it is likely to be bitter, so that the patient complains constantly of a bitter taste in the mouth. Viscid- 30 DYSPEPSIA. ity of the saliva, accompanied by an unpleasant sense of heat in the mouth in the tnorning, is a common indication of derangement of digestion. Constipation.—Though often an accompaniment of dyspepsia, this condition is not a constant one in that disease. There seems to be a quite general error on this point, since many patients confound the use of the term indigestion with constipa- tion. We have often been told by patients, in answer to an inquiry respecting the state of the bowels, that their " digestion " was very regular, or very irregular, as the state of the bowels happened to be. A person may have very poor stomach di- gestion without any marked disturbance of the bowels; yet constipation or costiveness — some make a distinction between the two—is rarely present without disorder of some sort in the digest- ive apparatus. DiarrhoBa.—This also is as marked a symptom of dyspeptic conditions as the preceding, though less frequent. Whether constipation or looseness is pres- ent, depends on the particular form of indigestion. When the most prominent difficulty is slow diges- tion, constipation is usually present. In foul dyspep- sia, the decomposition of the food gives rise to such a degree of irritation that diarrhoea is induced. Di- arrhoea is also present in cases in which there is so great irritability of the mucous membrane that the food is hastened along without complete digestion. Not infrequently, the two conditions alternate, each SYMPTOMS. 31 being occasioned by the other, the vital forces being too weak to maintain a healthy medium of activity. The Feces.—Quite too little attention is paid to the character of the bowel discharges by physicians as well as by patients. In all cases of dyspepsia, they should be carefully and frequently examined. The feces should be well formed, and of moderate consistency. Ragged, unformed feces indicate some degree of irritability of the digestive track. Watery stools show deficient absorption, or too profuse se- cretion from the mucous membrane. Slimy dis- charges indicate a catarrhal condition. Small, pellet-like masses are indicative of constipation due to deranged function of the colon. If the dis- charges are unnaturally light in color, too little bile is present. An unnaturally dark color, with very offensive odor, often accompanies foul dyspepsia. The appearance of portions of undigested food, in- dicates great inactivity of the digestive organs. Microscopic examination is often extremely useful, as by this means it can be ascertained, in many cases, what particular element of the food may not be well digested. For example, if starch granules are found, the indigestion of starchy or farinaceous substances is indicated; if portions of undigested meat are discovered, difficulty in digesting animal food will be understood. The examination of the fecal discharges also af- fords the only reliable evidence of worms, as by this means either the worms themselves or their 32 DYSPEPSIA. eggs may certainly be found if they are present in such numbers as to occasion mischief. The Urine.—Examinations of the urine are also important; but little need be said oil this point, as a reliable examination can be made only by a com- petent physician. A reddish or brick-dust sedi- ment is very common in dyspepsia, together with other deposits. These are most often found after an unusually severe attack of indigestion. We mention the fact that deposits in the urine are frequent in this disease more particularly because those who are ignorant on the subject are often led, by the advice of quacks or otherwise, to take them as evidence of disease of the kidneys, of which they are not positive indications. Dryness of the Skin.—A peculiar dry, rough con- dition of the skin is very common in dyspepsia, though not peculiar to the disease. In these cases, the natural secretion of the skin is greatly dimin- ished. The patient will frequently complain that he never sweats. In some forms of dyspepsia, the opposite condi- tion is present, the skin being tawny and having a greasy feel. Occasionally it is unusually clear, pliable, and sensitive, sometimes being almost trans- parent. These cases usually occur in the class of nervous dyspeptics. Dyspepsia must be recognized as the primary cause in many cases of eczema, urticaria, or nettle rash, and other skin affections. The use of partic- SYMPTOMS. 33 ular articles of food will in certain individuals give rise to skin eruptions of various sorts, very soon after eating, the eruption being accompanied by marked evidences of indigestion. Nervous Symptoms.—Most of the symptoms thus far mentioned have related directly to the digestive organs; still other symptoms of importance remain to be noticed, which may be termed nervous symp- toms, as they are indirectly occasioned by abnormal conditions of the stomach and bowels. These symp- toms, notwithstanding that they arise wholly from disturbances of digestion, are often mistaken for distinct and serious diseases of the nervous system. There is no doubt that faulty digestion is one great cause of nervous disorders of many sorts, owing doubtless to the fact mentioned, symptoms at first temporary becoming chronic, and functional dis- turbances giving rise to organic diseases. The nervous disorders which accompany dys- pepsia are due to four causes: 1. To sympathetic disturbance of function, through the nervous con- nections of the stomach; 2. To impaired nutrition of the nervous system, defective digestion occasion- ing a poor quality of blood; 3. To the presence in the blood of the products of indigestion, imper- fectly elaborated food, acetic and butyric acids, etc.; 4. To retention of the excretions, owing to the inactive condition of the liver, skin, and bowels, resulting from impaired nutrition. The various injurious elements mentioned, com- C 34 DYSPEPSIA. ing in contact with delicate nerves already weak- ened by impaired nutrition, increase their irritabil- ity, and occasion disordered actions of almost every conceivable variety; from the slightest degree of mental disturbance, as shown in the little confusion of thought observed by the student, or the forget- fulness of engagements by the business man, to complete loss of mental control, even actual insan- ity ; and from the slight nervousness familiarly known as fidgets, to the most alarming convulsive action. One of the most common of all nervous symp- toms is, Headache.—Various forms of headache are among the most common symptoms of dyspepsia. In dif- ferent cases, different parts of the head are affected, and in the same person at different times. The whole head may be affected, the temples throbbing, and feeling, as the patient sometimes says, " as though it would burst." Again, the pain will be confined to the back or front of the head, to the top of the head, to the region of the ears, to the eyeballs, to the upper part of the neck, or will ex- tend down between the shoulders. In many cases there is also tenderness of the part affected, it feel- ing sore on pressure. When headache occurs during digestion, or soon after eating, it is usually of a dull, heavy character, often located in the front part of the head, accom- panied by more or less confusion of thought, cold SYMPTOMS. 35 feet, and sometimes dimness of vision. This form of headache often accompanies a sense of weight at the pit of the stomach. The kind of headache which comes on the next day or several hours after taking an indigestible meal, is of a more severe character. It is commonly accompanied by pain and tenderness just below the ribs of the right side, in the region of the duo- denum, which is probably the part chiefly affected. Sick-Headache.—Another form of headache, quite distinct from that which accompanies a "bilious attack," with which it is sometimes confounded, is usually confined to one side of the head, and is really of a neuialgiac character. This, together with numerous other forms of neuralgia, is due to disease of the digestive organs. Disturbance of the Circulation.—Various disturb- ances of the circulation are very common in dys- pepsia. Coldness of the hands and feet, or the op- posite condition, especially at night, accompanied by an aggravating, burning sensation; unnatural heat in the head, often accompanied by fullness of the veins of the forehead and neck, showing intense congestion; palpitation of the heart, especially oc- casioned by excitement of any kind, and sometimes coming on suddenly in the night without apparent cause of that sort; intermittent action of the heart, with sudden sensations as of stopping, causing the patient to apprehend impending death; throbbing of the arteries in various parts of the body, this 36 DYSPEPSIA. being especially noticeable in irritable conditions of the stomach which are often accompanied by strong pulsation of the aorta, felt at the pit of the stomach, or lower in the abdomen; sudden flushing of the face, with or without any slight mental ex- citement,—these are some of the more common symptoms of this class, some of which often occa- sion no little uneasiness on the part of the patient Hoy exciting fears of organic disease of the heart, or some other serious malady, which he thinks may end his life at any moment. " Stomach Cough."—This popular term has really more significance than many physicians are accus- tomed to allow. It is a very common observation that the stomach and lungs sympathetically affect each other. Most cases of consumption and of chronic bronchitis are accompanied by stomach dif- ficulty; and, on the other hand, there are many cases in which dyspeptic conditions are accom- panied by a troublesome cough, usually of a dry, hacking character, without expectoration. In not a few of these cases the cough is due to an elon- gated palate, or to congestion of the pharynx. Most of the remarkable consumptive cures are cases of this sort. It must not be supposed, how- ever, that every hacking cough is due to disease of the stomach. Many real consumptives make the mistake of supposing that their cough is wholly due to disease of the stomach, and by procras- tination lose their only chance for recovery. A SYMPTOMS. 37 cough accompanied by copious expectoration, or by a rapid pulse and night sweats, is never a " stomach cough." Difficulty of breathing and a sense of suffocation are among the symptoms of dyspepsia in which the lungs are involved. The difficulty may arise from pressure against the diaphragm by a distended stomach, or through nervous influence. Nervousness.—Many dyspeptics suffer more or less with an indescribable uneasiness, sometimes termed "fidgets." The limbs are chiefly affected. The patient finds it impossible to sit still. The lower limbs, especially, are kept in almost constant mo- tion. Such persons find the confinement of sitting in church almost unendurable. This difficulty is especially troublesome in the afternoon and at night. It is often accompanied by peculiar sensa- tions in the limbs, especially when sitting or ly- ing, as "crawling," "prickling," "numbness," etc., which " traveling doctors" call attention to as in- dications of " a tendency to paralysis," but which merely indicate a weakened circulation and badly nourished nerves. An allied, and very singluar sensation is that of motion. The patient, if very nervous—and this is especially the case with young women—will often complain of feeling as though he were being carried, involuntarily, to different parts of the room, as from one corner to another, to the ceiling, to the window, or even into another room. Patients some- 38 DYSPEPSIA. times complain, also, of feeling as though some por- tion of the body were larger than natural; as, when lying down, the sensation will be that a limb, or a hand, or the head is immensely large. The delu- sion vanishes, however, upon the patient's attempt- ing to move the particular part affected. Vertigo.—Giddiness, light-headedness, sensations of falling, are common symptoms of stomach dis- orders, being due to ansemia of the brain, or defi- ciency of blood, as is the case in syncope, or to pres- sure of gas in the stomach. Persons so troubled often live in constant fear of apoplexy; but there is much less danger of such an accident than is generally apprehended. The great danger is from impaired nutrition from the defects in digestion. Disturbance of Sight, Hearing, etc.—Nothing is more common in this disease than disturbances of vision and of the various other special senses. Dimness of vision, sensitiveness to light, deafness, ringing in the ears, unusual sensitiveness to noise, etc., occur in many cases. Not infrequently the patient sees imaginary forms of various sorts. Sometimes the intolerance of light is so very great that the patient is confined in a dark room. This is more common in women than in men. Often the extreme degree of apparent sensitiveness is more imaginary than real. The appearance of black or bright spots of vari- ous shapes and sizes, especially noted when stoop- ing over, is another common symptom, SYMPTOMS. 39 Unnatural thirst, perversions of taste, peculiar sensitiveness of various parts of the body, are also symptoms worthy of being noted. Nervous Diseases.—Functional nervous disorders, as hysteria, epilepsy, and even temporary paralysis, often originate in dyspepsia. Dr. Chambers, an eminent English physician, asserts that nine cases out of ten of hysteria are due to indigestion. This statement we have found abundantly confirmed by our own observation. In the treatment of a good many cases of epilepsy, we have observed, in near- ly every case, tenderness at the pit of the stom- ach and a foul tongue. In some cases, no doubt, the stomach disease is secondary; but in many, at least, we believe that the latter difficulty is the primary affection; and the failure to recognize this fact is one reason that causes this malady to be looked upon as so difficult of cure. In many instan- ces the remedy given to cure the disease is of a char- acter to defeat the end desired, by deranging the stomach. Unusual Drowsiness.—This symptom occurs most often after eating, though it sometimes continues much of the time. An hour or two after eating, the patient feels an almost irresistible disposition to sleep. The sense of weariness and lassitude is sometimes so great that it is with difficulty that the patient can be induced to make an attempt to exercise. If he will do so, however, he feels much better than if he yields to his feelings and sleeps. 40 DYSPEPSIA. Exercise dispels the exhausted feeling, which is not fatigue ; while if the patient allows himself to sleep, he awakes unrefreshed, and really worse than when he lay down. Sleeplessness.—This condition, quite the opposite of the preceding, is equally common, and often ex- ists in the same individual, the person being very sleepy soon after eating, but wakeful at night. The patient is not kept awake by pain, but by simple nervousness, or by a sense of weight at the stomach, by morbid anxiety or fears, or by burning of the feet and hands, or some similar cause. If sleep comes, it is not sound, but with troubled dreams, from which he awakes in the morning un- rested and unrefreshed. These patients usually feel best in the afternoon and early evening. Mental Disorders.—Until of late years it was not known that dyspepsia could be recognized by the mental and nervous symptoms alone; and even yet the fact is not as well understood as it should be. It is thoroughly established, however, at the pres- ent time, that this is the case, and also that in cases in which the mental and nervous symptoms are most prominent, those which point directly to the digestive organs are the fewest and most obscure. Hypochondria has long been associated with indi- gestion, though often attributed to the liver. Cases of so-called softening of the brain in students, cler- gymen, and other mental workers, with " cerebral hyperemia," or chronic congestion of the brain, are SYMPTOMS. 41 nearly always cases of indigestion, resulting in de- fective nutrition of the nervous system. Gloomy ap- prehensions, forebodings, peevishness, perversity of disposition, religious despair, confusion of thought, loss of memory, absent-mindedness, and many other forms of mental disturbance, are justly attributable to this cause, and disappear upon its removal. The failure to recognize this class of cases, has consigned many men of ability and influence to the walls of an insane asylum with no hope of re- covery, who might have been saved to the world, their families, and themselves, by a judicious course of treatment aimed in the right direction. Hun- dreds of nervous females have had their spines blistered, and burned, and cauterized, for some sup- posed obscure nervous trouble, in vain, enduring years of torture, all without benefit, who might be made well by a few months of intelligent treat- ment for impaired digestion. A good many of both classes of invalids having come under our care, some of whom had been inmates of insane asylums for years without getting better, while others had baffled the skill of eminent neurologists, we are convinced that much more attention ought to be paid to this class of dyspeptic cases, and hence we have dwelt at considerable length upon it. 42 DYSPEPSIA. TREATMENT OF DYSPEPSIA, As dyspepsia is not usually a fatal disease, thou- sands of people allow themselves to suffer from its pains and inconveniences for years without making serious efforts to recover. If anything is done, it is most likely to be a trial of some quack nostrum advertised on the fence or heralded in the daily newspaper as a " sure cure " for indigestion, its merits certified by a long list of fictitious or pur- chased testimonials. Every effort of this sort, of course, makes the disease worse in the end, even though there may be apparent temporary relief. Failing in several attempts, perhaps, the sufferer settles down in despair to the melancholy conclu- sion that he must remain as he is, that his malady is incurable; and so he lives along in a wretched way until consumption, that dread disease which often follows close on the heels of the hydra-headed malady we are considering, claims him as a victim and ends his misery. The importance of giving to the treatment of this disease most serious attention is further seen by the fact that many organic affections which when once well established are impossible to cure, have their or- igin, in many cases, in indigestion. This is undoubt- edly true of tuberculous degeneration of the lungs and other parts, together with other degenerative changes. The same may also be said of various nervous affec- tions. This accounts, in part at least, for the almost TREATMENT. 43 constant association of impaired digestion with con- sumption, and with various organic affections of the liver, kidneys, and other organs. In most of these cases, the best, and often the only hope for a cure, lies in the treatment and cure of the digestive disor- der ; and, without doubt, if this could be accomplished sufficiently early, many cases of hopeless organic dis- ease of the lungs and other organs might be prevented altogether. The Road to Health.—The dyspeptic, of all in- valids, needs especially to enter upon the work of getting well with a determination to succeed, and resolved to do all in his power to accomplish that end. Though an intelligent physician can do much, the patient himself can do vastly more for himself than any one can do for him. It belongs to him very largely to make his conditions favorable for recovery. Indeed, he alone can control many of the conditions essential for the happy termina- tion of his sufferings. If the dyspeptic would re- cover, he must seek carefully for each one of the causes of his disease, and carefully remove them. It is of no use to hope for recovery without doing this. If the cause is in the manner of eating, let him take care to eat properly. If he has erred in eating too much, or in eating improper articles of food, let him make a thorough reform in this re- gard. If the difficulty has been in overwork, too much anxiety, too little time to digest, or too sed- entary habits, he must get away from his care, 44 DYSPEPSIA. his business, his writing-desk, and seek health in out-of-door exercise, coupled with happy, cheerful associations. The careworn, burdened mother must have relief from the tedium of her routine life. A journey, a visit to a friend, or some other means of diversion, must be adopted. Whatever the cause has been, it must be removed. No medicine known, no matter how potent, nor how skillful its adminis- tration, can antidote the effects of the transgression of physical laws. Nature is inexorable. She de- mands obedience, and will not be put off with any sort of subterfuge. To the great army of dyspeptics, to which al- most the whole American nation belong, and a large proportion of other nationalities, we would say, You can get well if you wish to, if you care enough about health to make the effort, and we are about to point out the way; but the man who has been a dyspeptic for years must not expect to get well in a week, nor in a month. He must be willing to persevere in his efforts after he has started in the right direction, never relaxing for a moment his determination to get well. He must also make up his mind to deny his appetite of all things harm- ful, to wage a constant warfare against the things which have made him ill. It must not be supposed that any one plan will accomplish the result desired in all cases. There are various forms of dyspepsia, each of which re- quires special management, though the general TREATMENT. 45 principles laid down apply to all classes of the dis- ease. We will now point out with greater definite- ness than heretofore the distinguishing features of the several forms of the disease, and the general line of regimen and treatment necessary to effect a cure. The suggestions made, if thoroughly understood and efficiently applied, cannot fail to do much good. Slow Digestion.—This, the simplest and most com- mon form of the malady, is sometimes called sim- ple dyspepsia. It is more common in men than in women, and especially affects sedentary persons, and those nervous individuals who eat rapidly, swallowing their food without proper mastication. It is also common in persons whose teeth are de- fective. Its immediate cause is deficient activity of the muscular walls of the stomach and intestines, and also deficient quantity or quality of gastric juice. The symptoms are much the same as those which follow the taking of an excess of food, but are felt when only a moderate amount has been taken. An hour or two after eating, a sensation of weight and oppression is felt. The discomfort con- tinues for some hours, gradually wearing off before the next meal. The appetite is usually pretty good, but often will not be prepared for the reception of food at meal-time, as the work of digesting the pre- vious meal has not yet been accomplished. Some- times there is considerable flatulence of the stom- ach, the eructations being tasteless, however, never offensive; often pain between the shoulders, or 46 DYSPEPSIA. beneath one shoulder-blade, and not infrequently in the region of the heart. Palpitation of the heart often occurs in the night, causing great alarm on the part of the patient and his friends, who enter- tain fears of sudden death. Sleep is disturbed and unrefreshing. The tongue is often foul in the morn- ing, with a bad taste in the mouth. All the symp- toms mentioned are greatly exaggerated by a late supper, or by any unusual excess in quantity or quality of food. The bowels are usually constipa- ted, but may be regular. When the difficulty has been long continued, there will be observed a marked disposition to sleep after meals, or unnatu- ral sleepiness at other times, and a decided loss of natural vivacity and energy. Acid Dyspepsia.—This form of indigestion is that in which the slowness of digestion is such that the food undergoes fermentation, forming acids which irritate the stomach and give rise to the same symp- toms, much exaggerated, which have been men- tioned as attending slowness of digestion, with sev- eral others, the principal of which are heart-burn, regurgitation of intensely sour liquid from the stom- ach, acid eructations, a white tongue, frequently with transverse fissures, often flabby and indented at the edges, acid saliva, causing decay of the teeth, bowels likely to be either constipated or unnatu- rally loose, grinding of the teeth at night, and a reddish sediment in the urine. No one patient pre- sents all of these symptoms, but more or less of TREATMENT. 47 them. There is quite likely also to be pain at the pit of the stomach, with soreness on pressure. On account of the extreme slowness of digestion, farinaceous foods always aggravate this form of dyspepsia. Starchy food, sugar, fruits, and espe- cially vegetables of all kinds, cause great increase of acidity and heart-burn. In some cases, even bread and all sorts of preparations from grains will disagree. Sugar, or any food containing it, will give rise to great distress. A meal consisting of animal food almost entirely, may be digested with- out difficulty, though milk frequently sours. The digestion being very slow, portions of fer- menting food remain in the stomach from one meal to another, so that acidity becomes habitual. Patients suffering with this form of dyspepsia are usually very thin, and bloodless. Occasionally, however, we meet a case of the opposite kind, in which there is an abundance of tissue, though of a loose, flabby texture. Women suffer from acidity more than men. Bilious Dyspepsia.—The term "bilious" is used to distinguish this form of indigestion, not because either the liver or the bile is the immediate cause of it, but because of the bilious vomiting and jaundiced appearance of the skin which usually occur in this class of cases. This is what is generally known as "biliousness." Acute dyspepsia of the same sort is termed " a bilious attack." Women, tailors, shoe- makers, and sedentary persons generally, are partic- ularly subject to this form. 48 DYSPEPSIA. As in acid dyspepsia, this form of indigestion dif- fers from slow digestion chiefly in the exaggera- tion of the morbid conditions present in that dis- ease. Digestion being still slower than in acid dyspepsia, the characteristic symptoms occur more remote from the time of eating. The usual time for the appearance of the' most marked symptoms is the morning, before breakfast. Headache, great flatulence, a very foul tongue, a bitter taste in the mouth, with nausea and finally vomiting of undi- gested and partially decayed food in a very foul state, indicate the inactivity of the digestive organs present in this form of dyspepsia. When vomiting is con- tinued, bile is generally expelled, the duodenum be- coming affected and taking part in the expulsive action. Diarrhoea often accompanies, and in some cases replaces, the vomiting. Owing to this thorough clearing out of the stom- ach and bowels, these attacks do not occur at very brief intervals. They are often periodical, how- ever, recurring sometimes as often as once or twice a week, and again not more often than once in two to four weeks. In addition to the more important symptoms mentioned may be noted headache, often of a " split- ting" or "throbbing" character, fetid eructations, and usually severe pain in the eyes. This is not real sick headache, however, as it is often termed, that difficulty being of a neuralgiac character and affecting only one side of the head at a time. TREATMENT. 49 Farinaceous foods give much less trouble than meats, especially fat meats. Vegetables eaten with fat, pastry, oily nuts, meat which has been kept too long, sometimes eggs, especially those not perfectly fresh, with albuminous and fatty foods generally, increase the symptoms peculiar to bilious dyspepsia, and bring on the attacks. Sufferers from this dif- ficulty often make themselves vastly worse by the use of purgative medicines. Painful Dyspepsia.—The chief characteristic of this disease is tenderness at the pit of the stomach, just at the lower end of the sternum, usually, but some- times affecting other portions of the stomach and also the duodenum, the pain in the latter region being usually mistaken for some affection of the liver. We have met a few cases in which the sensi- bility extended to other parts of the small intestine. The tenderness described is almost always accom- panied by a very unpleasant sensation at the epi- gastrium or extending up beneath the sternum, which the patient describes as a " tearing," " burn- ing," " rasping," " gnawing" pain, which comes on soon after taking food. This pain may be due to a morbid sensibility of the mucous membrane, or to a congested state usually called chronic inflammation of the stomach, or chronic gastritis, accompanied by a catarrhal secretion resembling that from any other mucous membrane in a catarrhal condition. When the pain is due to morbid sensibility of the stom- ach, it usually ceases when digestion is completed. d N ,oa v/a Ufa - - . „ ■< *> '' 50 DYSPEPSIA. When due to congestion, it is continuous, perhaps be- ing in some degree relieved by taking a moderate amount of bland food, and of a character which the patient describes as a " sinking," " all-gone " feeling, when the stomach is empty. The pain is often accompanied by throbbing of the aorta, felt at the pit of the stomach or below. Not infrequently the congestion to which this pain is sometimes due is caused by compression of the abdominal organs, obstructing free circulation. Hence, women who wear corsets are very liable to be affected by it, though they will rarely admit the cause, and still more rarely can be induced to re- move it. As a pithy writer once said, women have a strong "won't," which they sometimes oppose very strongly to all arguments, no matter how irre- sistible may be the logic. Nervous Dyspepsia.—The mutual sympathy be- tween the stomach and the brain is very marked. Disease of the stomach may be produced by men- tal disorders, and various mental and nervous af- fections may arise from disease of the stomach. As before remarked, cases sometimes occur in which the most prominent symptoms of dyspepsia mani- fest themselves through the nervous system, by which alone the disease may be made out. Such cases are included under this head. All of the symptoms previously enumerated un- der the head of mental and nervous disturbances, are observed in these cases. The stomach symp- TREATMENT. 51 toms of indigestion are sometimes so very slight that they can hardly be distinguished; yet there is undoubtedly a serious fault in these cases in the elaboration of the food. The process of digestion is left incomplete, and the blood becomes full of crude, unelaborated material, which not only does not impart to the tissues new life and vigor, but is a direct source of irritation. The brain, being the most sensitive part of the nervous system, of course suffers most, and hence we have abundant cause for the mental depression, unbalanced mental ac- tion, confusion of ideas, vacillation of judgment, perversity of disposition, and other kindred disturb- ances from which the nervous dyspeptic suffers. Many persons, finding themselves in this wretched state, and not realizing the influence of physical conditions upon the mind, fall into hopeless despair, even when no outbreaking sin or intentionally wrong act has been committed. At first, there will be observed simply an exaggeration of real difficul- ties or misfortunes; but after a time the individ- ual settles into a state of gloom, despondency, and mental depression in which he will suffer with troubles that are purely imaginary. Of these hypochondriacal persons, Dr. Cullen gave a very graphic description, which we quote as follows :— " In certain persons there is a state of mind dis- tinguished by the following circumstances: a lan- guor, a listlessness or want of resolution with refer- ence to all undertakings; a disposition to serious- 52 DYSPEPSIA. ness, sadness, and timidity as to all future events ; an apprehension of the worst or most unhappy state of them; and therefore, often upon slight grounds, an apprehension of great evil. Such persons are particularly attentive to the state of their own health, to every smallest change of feeling in their bodies; and from any unusual feeling, perhaps of the slightest kind, they apprehend great danger, and even death itself. In respect to all these feel- ings and apprehensions, there is commonly the most obstinate belief and persuasion." Nervous dyspeptics often suffer much in mind from a morbid sensitiveness. They imagine them- selves the subject of criticism or ridicule, become morose and irritable, and exceedingly unhappy. Occasionally they find themselves haunted with evil thoughts, with almost irresistible impulses to commit improper or criminal acts, as blasphemy, suicide, etc. They are almost always certain to imagine themselves the subjects of many different diseases, usually of some incurable malady. It is observed that mental disorders of the char- acter described are often the result of intestinal dyspepsia, a form of the disease in which the local symptoms are less prominent than are those which relate to the stomach, but equally grave. TREATMENT. 53 DIET AND BEGIMEN. In the treatment of this disease, proper diet and regimen are of first importance. Drugs hold a very subordinate place, in many cases being en- tirely unnecessary, provided proper hygienic condi- tions are secured, these being far more important than all other measures combined. The diet is of special importance. It is necessary, however, that it should be most carefully adapted to the wants of each individual case, as nothing could be more true than the adage that " what is one man's meat is another's poison " when referring to cases of dys- pepsia. The common plan of recommending some special dietary to all dyspeptics indiscriminately is a most pernicious one. We hear much of the grape cure, the beef cure, the fat cure, the cod-liver-oil cure, the milk and sundry other special diet cures, of dyspepsia, as well as the vegetarian cure. Each of these diets may be of special service to some special case, but all are totally unfitted for all cases alike. We have seen many persons become dys- peptics by the adoption of a vegetarian diet; but we have seen many more cured by exchanging a diet of fat meats, sweets, etc., for a plain diet of fruits, grains, and vegetables. It is not an easy matter to induce individuals suffering with dyspepsia to deny the demands of appetite. In many cases, the will is weakened by long-continued disease, and the appetite is perverted, 54 DYSPEPSIA. so that the patient loses self-control, and thus him- 'self stands as the most difficult obstacle in the way of his recovery. It must be insisted, however, that the directions to be given shall be followed implic- itly. In no other way can a bad dyspeptic hope for recovery. All but one or two requirements may be conformed to, but the failure in one particular may be sufficient to make all other efforts useless. Although, as before remarked, there is no such thing as a universal diet for dyspeptics, there are certain articles of diet that must be discarded by all persons who have a weak digestion, and certain dietetic rules which must be conformed to by all. To the most important of these we will now call attention. 1. Eat slowly, masticating the food very thor- oughly, even more so, if possible, than is required in health. The more time the food spends in the mouth, the less it will spend in the stomach. 2. Avoid drinking at meals; at most, take a few sips of warm drink at the close of the meal, if the food is very dry in character. 3. In general, dyspeptic stomachs manage dry food better than that containing much fluid. 4. Eat neither very hot nor cold food. The best temperature is about that of the body. Avoid ex- posure to cold after eating. 5. Be careful to avoid excess in eating. Eat no more than the wants of the system require. Some- times less than is really needed must be taken when TREATMENT. 55 digestion is very weak. Strength depends not on what is eaten, but on what is digested. 6. Never take violent exercise of any sort, either mental or physical, either just before or just after a meal. It is not good to sleep immediately after eating, nor within four hours of a meal. 7. Never eat more than three times a day, and make the last meal very light. For many dyspep- tics, two meals are better than more. 8. Never eat a morsel of any sort between meals. 9. Never eat when very tired, whether exhausted from mental or physical labor. 10. Never eat when the mind is worried or the temper ruffled, if possible to avoid doing so. 11. Eat only food that is easy of digestion, avoid- ing complicated and indigestible dishes, and taking but one to three kinds at a meal. 12. Most persons will be benefited by the use of oatmeal, wheat meal, or graham flour, cracked wheat, and other whole-grain preparations, though many will find it necessary to avoid vegetables, es- pecially when fruits are taken. As an aid in the selection of articles of diet we present tables of foods classified according to their digestibility, giving first a table of Articles Easy of Digestion.—The following arti- cles are readily digested by a healthy stomach, and can be digested with comparative ease by most dys- peptics :— 56 DYSPEPSIA. ANIMAL FOODS. Raw white of egg, beaten to a froth. Beef tea, free from fat. Raw whole egg, beaten. Milk, fresh and warm. Fresh eggs, soft boiled. Mutton, broiled. Venison steak, broiled. Chicken, especially the white Rabbit. [parts. Fresh trout, and most fresh fish which are not oily. VEGETABLE FOODS. Stale bread. Graham rolls, made without yeast or soda. Rice, well boiled or steamed. Tapioca, sago, corn-starch. Oatmeal porridge, eaten with dry toast. Graham mush or crushed wheat. Cauliflower. Asparagus, if very tender. French beans. Baked sweet or subacid apples. Strawberries and whortleberries. Grapes, without skins or seeds. Oranges and bananas. The following list Articles not Easy of Digestion includes the common articles of food which require a considerable degree of vigor on the part of the digestive organs, and must be avoided by all bad dyspeptics:— ANIMAL FOODS. Animal soups of all sorts. Codfish. Beef. Oysters, raw. Lamb. Butter. Turkey, duck, pigeon. All sorts of roast meats. VEGETAB] LiE FOODS. Potatoes. Raisins and most dried fruits Turnips. Apples. Cabbage. Peaches. Tomatoes. Plums. Peas. Cherries. Beans. Pineapple. TREATMENT. 57 Beets. Carrots. Spinach. Parsnips. Vegetable soups. Corn-meal preparations. Salads of all sorts. VEGETABLE FOODS. (Continued.) Currants. Gooseberries. Raspberries. Blackberries. Rhubarb. Jelly. Indigestible Articles.—The following articles, while they may be digested by a vigorous stomach, impair the digestive powers and induce indigestion, and are more of the character of poisons than foods to the dyspeptic:— Pork. Veal. Goose. Liver. Kidney. Heart. Sausage. Hard-boiled eggs. Scrambled eggs. Cheese. Hashed and stewed meats ANIMAL FOODS. Salt and smoked meats. Melted butter, and all animal fats. Mackerel, and all oily fish. Salt fish. Dried and smoked fish. Sardines, and other fish preserved in oil. Lobster, crabs, etc. Cooked oysters and clams. Fried meats of all sorts. Warm bread, especially when taken with butter. Muffins. Buttered toast. Pies, cakes, and all sorts of pas- Pancakes, [try. Fried bread and vegetables. Nuts of all kinds. VEGETABLE FOODS. Onions. Mushrooms. Pickles. Tea, colt'ee, cocoa, chocolate. Mustard, pepper, spices, and other condiments. Sugar, preserves, and all saccha- rine foods. 58 DYSPEPSIA. Practical Hints.—In addition to the above tables, which are based upon the observation of the effects of different articles of food on a large number of dyspeptics, the following practical suggestions may be made:— 1. The flesh of wild game is usually more easy of digestion than that of domestic animals, and is less likely to be diseased. 2. Fats are injurious to dyspeptics almost without exception. If eaten at all, butter is the only form admissible, and this should never be eaten cooked, but cold, on bread. 3. Broiling is the best mode of cooking meat. 4. " High " meat should never be eaten, as it has begun to decay. 5. Meat and vegetables do not agree well to- gether. 6. Fruit and vegetables often disagree. Some cases must be required to discard vegetables alto- gether. 7. Milk does not agree well with either vege- tables or fruits. Specific Restrictions for Dyspeptics.—The differ- ent forms of dyspepsia require the observance' of specific restrictions for each variety of the disorder, in addition to the general restrictions already made. Slow Digestion is benefited by the two-meal plan of eating, as by this means the stomach is given more time for its work. Six or seven hours should intervene between the meals. The more nearly the TREATMENT. 59 patient confines himself to articles included in the first table, the better progress he will make. Acid Dyspepsia is aggravated by the use of starchy foods and those containing sugar. Vegetables must be discarded for a time. Sugar and all articles con- taining it must be wholly discarded. The idea many people have that sugar neutralizes acids, is quite a mistake. The grains can be taken better than other farinaceous foods. Often, fermented bread cannot be eaten without distress. Aerated bread, or light unleavened bread in the form of rolls, crisps, or crackers,* is much preferable. Toasting until crisp and slightly brown renders bread much less likely to sour. Fermented bread should never be eaten until it is a day or two old. Diet for Bilious Dyspepsia.—In this form of in- digestion, the greatest simplicity in diet is neces- sary. Complicated dishes, stews, etc., must be wholly interdicted. Pastry is practically synony- mous with poison, for these patients. Fats, as but- ter, lard, etc., and fat meats, together with nuts and fruits containing oils, must be entirely discarded. Sweets of all sorts are about equally injurious. Many persons suffering with this form of dyspep- sia can trace the cause of the attack to eating freely of sugar or sweetmeats. Vegetables, being difficult of digestion, are very * Recipes for this kind of bread and many other wholesome foods for dyspeptics will be found in a work by the author, entitled, "Healthful Cookery:" Good Health Pub. Co., Battle Creek, Mich. 60 DYSPEPSIA. productive of gas, and hence should be avoided by persons subject to bilious dyspepsia. Farinaceous foods, as oatmeal, wheat meal, rice, and ripe fruits, are adapted to this class of cases. Meat should be taken sparingly, and in many cases can be advan- tageously discarded altogether for a time. Diet for Painful Dyspepsia.—Meat and all coarse vegetables must be carefully avoided in this affec- tion. Preparations from the grains, as farina, corn- starch, well-boiled oatmeal porridge, and other far- inaceous substances, as sago, tapioca, etc., agree best. It should be borne in mind, however, that in this class of cases such articles as cracked and crushed wheat, samp, graham bread, and other foods con- taining the coarser parts of the grain, are likely to do harm, the outside woody parts of the grain act- ing as a mechanical irritant to the sensitive mucous membrane of the stomach. It is this fact which has given seeming occasion for a class of ignorant individuals who have mercenary ends to serve, to declaim so loudly against the use of whole-wheat flour. The fact that the coarser parts of the grain can be removed with advantage for this class of cases, is no evidence against its utility in most other cases of indigestion. In extremely bad cases, it is often necessary to put the patient on extremely simple diet. In cases of this sort, nothing generally answers the indica- tions so well as milk. It should be taken fresh as possible, and should be given to the patient about TREATMENT. 61 as warm as can be taken with comfort, unless there is considerable fever, when it may be taken in small quantities iced. In extreme cases, the irri- tability may be so great that the food will be re- jected if taken in any considerable quantities. In these cases, it becomes necessary to take the food, milk by preference, in very small quantities, often repeated. If necessary, so small a quantity as one or two spoonfuls may be given once an hour at first, gradually increasing the quantity and the in- tervals, until the necessary quantity is taken at the usual intervals for meals. Then a little well- boiled and strained oatmeal or graham gruel may be added, the quantity being increased until the pa- tient can bear semi-solid food. Many lives have been saved by this plan when death seemed immi- nent from inability to digest sufficient nourishment. In some cases, we have found even milk intolerable, and have then secured the most successful results by the use of the white of egg beaten to a froth, and made palatable by the addition of a few drops of lemon juice or wine. In many cases of this form of dyspepsia, the pa- tient feels a terrible faintness as soon as the stom- ach is empty of food, which is in some degree re- lieved by taking proper food. This often leads the patient to resort to frequent eating when there is no requirement for so doing, and with great detri- ment. The difficulty referred to occurs particular- ly before breakfast; and the unpleasant sensations 62 DYSPEPSIA. sometimes become so great that the appetite is de- stroyed. While the faintness described is not real hunger, it is best to relieve it sometimes by the taking of some simple food, or a little warm drink. When troublesome at night, the patient may take a few sips of warm milk; or if incon- venience is experienced from this, a little very weak hot lemonade may be taken. It should be made by pouring boiling water on a slice of lemon or a little lemon peel. Add very little sugar, better none at all. Drink after allowing it to stand a few minutes. A few sips of cold water will also relieve the difficulty in many cases. In the morn- ing, a cup of warm drink may sometimes be taken an hour before breakfast. Diet in Nervous Dyspepsia.—Nervous dyspeptics rarely complain of much difficulty with digestion, yet the most careful observance of strict dietetic rules is of great importance in this class of cases. The diet must be plain, unstimulating, but very nu- tritious. It is of special importance that the pa- tient make a free use of the whole-grain prepara- tions. Oatmeal is a specially good article of food, as are also graham and cracked wheat. Pepper, spice, mustard, and all other irritating condiments, must be scrupulously avoided. There is usually a slow digestion in these cases, and hence the sug- gestions made respecting that form of stomach dis- ease also apply to this. Mixed Cases.—It not infrequently happens that TREATMENT. 63 cases of dyspepsia exhibit the symptoms which be- long to two or more classes of the disease. In cases of this sort it is of course necessary to conform to the special indications so far as can be done. The most frequent combination is acid and painful dys- pepsia. These cases are often very troublesome to manage. None but a careful, discerning physician is competent to successfully pilot safely out of his doubly perplexing difficulties such a sufferer as this; but sufficient care, patience, perseverance, and well-directed effort will secure certain success. An Important Caution.—It is of great importance to recollect that the special directions for the diet in different forms of dyspepsia which we have giv- en are not intended as rules to be followed for any great period of time. In many cases it is necessary to adhere strictly to the special dietary only for a few days, when the diet may by degrees be made to in- clude a larger variety of foods. We would, how- ever, impress upon the mind of the dyspeptic this fact; that when he finds himself well again, he must not make the error to suppose that the prin- ciple " once in grace always in grace " in any sense or in the smallest degree applies to the improved state of his digestion. Although the stomach may be restored to a sufficient degree of health and vig- or to enable it to do its duty well under favorable circumstances, it will be certain to fail and relapse into a diseased state again as soon as those condi- tions are no longer supplied. The dyspeptic must 64 DYSPEPSIA. make up his mind to study carefully the laws of good digestion and apply them to his own case, not only as a means of recovering his health, but as an essential for keeping well when he has once recov- ered. When the stomach has once lost its natural healthy tone, it will never again bear the degree of abuse which it may have once endured for a con- siderable time before breaking down. MEASURES OF TREATMENT, In the treatment of this disease, attention to hy- giene and the application of what are by some termed " hygienic remedies," are of first importance. Indeed, it is by these agents that nature is aided in her restorative work more than by any others, and upon these the most skillful and successful of those who have given great attention to the treatment of the functional diseases of the stomach find it safest to rely. Undoubtedly there are cases and circum- stances which may be benefited, and the work of cure hastened, by the employment of medicinal agents ; nevertheless we feel quite confident that the abuse of drugs is so very great, and has been the direct cause of so many bad cases of confirmed dyspepsia, that it would be far better to do without them altogether than to use them as they are not infrequently employed. An eminent writer on this subject, in referring to the treatment of dyspepsia says, " My main object in the treatment is to pre- vent the sufferers from resorting to drugs, which, TREATMENT. 65 in such cases, not only produce their own morbid conditions, but also confirm those already existing." * The extensive and often habitual use of alkalies for acidity, of purgatives for constipation, nervines and opiates for sleeplessness, and after-dinner pills to goad into action the lagging stomach, has been a potent factor in the production of a large class of most inveterate dyspepsias. This kind of treat- ment for dyspepsia cannot be too much deplored, nor too often discouraged. Especially to be dis- countenanced is the wholesale employment of "liver pills," "stomach tonics," " anti-bilious pills," " bit- ters," and the whole genus of quack nostrums and proprietary drugs. Another and still more weighty reason which we would offer for not having in this work recom- mended the use of medicinal agents is that this class of remedies, if beneficial under any circum- stances, can be judiciously used only by one who is wholly conversant with the varied properties and effects of the remedy used, and hence will be likely to be properly employed only by the judicious and skillful physician, for whom this book is not so much intended as for the poor dyspeptic himself who wants to explore the mysteries of his disease, and learn to escape from future suffering by obedi- ence to nature's laws. Exercise.—This is of first importance as a general renovator of vital action. The secretion of gas- * Chambers. E 66 DYSPEPSIA. trie juice is, under ordinary circumstances, propor- tionate to the amount of nourishment which the system is prepared to assimilate. Exercise creates a demand for food, and so stimulates both assimila- tion and secretion. The best forms of exercise are those which will secure the most uniform activity of the several parts of the muscular system. Rid- ing, walking, rowing, and especially horseback rid- ing, are to be recommended as excellent. Gymnas- tic exercises and the judicious use of the " health lift" are also good, and for persons who from lack of time, or other cause, cannot adopt the other methods, these may be considered as almost indis- pensable. Such exercises as running, jumping, baseball playing, " walking matches," and other vi- olent exercises, cannot be recommended. Trapeze exercises must also be discountenanced on the same grounds. Agriculture, especially the raising of small fruits and the cultivation of flowers, cannot be too highly recommended as forms of exercise for dys- peptic patients. For that large class of sallow- skinned, weak-backed, dyspeptic young ladies who have been made dyspeptics by idleness and too much "coddling" by fond mothers who sacrifice themselves to the monotonous drudgery of the cook-stove and the sewing-machine and their daughters to sentimental idleness and fashionable piano-thrumming,—for the indigestion of these poor victims of mistaken maternal care, the varied exercise necessitated by domestic labor is a most TREATMENT. 67 admirable panacea. And for the gaunt, hollow- cheeked, sunken-eyed, slab-sided, cigar-worshiping young man whose chief occupation is cultivating a mustache, smoking cigarettes, and swinging a gold- headed cane, a little wholesome experience in earn- ing a subsistence by the sweat of the brow, instead of leaning upon rich relatives, will prove a specific for " softening," which begins in the brain and ex- tends to every part of the system. Exercise before breakfast, while excellent for some, cannot be too much condemned for others. Persons who suffer with "goneness," "faintness," "sinking," and allied pains when the stomach is empty, and especially in the morning, must avoid exercise to any considerable extent before eating. Disregard of this rule occasions loss of appetite and weakening of digestion. Persons who are very weak must also avoid exercise before eating in the morning. As before remarked, only gentle exercise can be taken soon after eating, or immediately before, without injury. Persons who feel a constant " sinking " or weakness in the stomach and bowels will derive benefit from wearing about the body a broad band of flannel. Sleeping.—It is of great importance that sufficient sleep be obtained, though sometimes this seems im- possible on account of the nervousness occasioned by this disease. It is generally best to retire early, but there is no virtue in getting up in the morning 68 DYSPEPSIA. at an early hour unless the body is recuperated by rest. Sleep must be obtained, and on many ac- counts it is better to take it in the fore part of the night; but if not secured then, it should be taken at other times. Sleeplessness induced by anxiety is often a cause of dyspepsia. It is a great obstacle in the way of successful treatment. Traveling.—Many physicians are in the habit of recommending patients upon whom they have ex- hausted their skill, to seek health by traveling. Thousands annually leave their homes and at great expense visit various watering places, mineral springs, etc., in this country and Europe, in conse- quence of this advice. Some return much benefited; the majority are no better except from rest. This is due to the fact that traveling does not remove the real cause of the difficulty, and may often in- crease it. In general, while traveling it is next to impossible to secure either regularity of diet or other habits, or a proper quality of food. This, of course, in great degree counteracts the benefit to be derived from gentle exercise and freedom from care. The advantage of special climates is undoubtedly overrated in a very great degree, though a cool cli- mate may generally be considered as best, especially for those suffering with " bilious dyspepsia." With nervous dyspeptics, a warm climate seems to agree better, as it occasions less disturbance of the circu- lation. Mental and Moral Treatment.—This is too impor- TREATMENT. 69 tant a part of a successful plan of treatment to be neglected. The gloomy despondency must be stead- ily combated by a determination to be cheerful. The disposition to fret and worry, and to dwell upon the unpleasant or painful features of the dis- ease, must be fought against with firmness and reso- lution. The dyspeptic who allows his mind to con- stantly dwell upon his stomach, and who speculates upon the probabilities respecting the digestion of each morsel of food as he swallows it, will be cer- tain to remain a dyspeptic. This unfortunate ten- dency on the part of dyspeptics is a great impedi- ment to recovery in many cases. The mind must be diverted from self as much as possible at all times, and especially while eating. The habit many dyspeptics have of talking constantly about them- selves, sometimes amounting almost to a monomania, cannot be too strongly condemned. Too great so- licitude about the stomach, diet, etc., is worse than none at all. Dress.—In addition to wearing the clothing loose, so as to give every organ perfect freedom of action, it is of greatest importance that the extremities be kept thoroughly warm. Cold hands and feet are very common with dyspeptics. It will generally be found necessary to wear flannel undergarments throughout the year, graduating the thickness to the temperature. It will sometimes be necessary to change the clothing once or twice a day to ac- complish this in extreme cases of disturbed circula- 70 DYSPEPSIA. tion. Additional suggestions with reference to cold- ness of the extremities will be given under that head presently. General Measures of Treatment.—The general in- dications for treatment are, 1. To increase the gen- eral vigor of the system by tonic remedies; 2. To balance the circulation; 3. To increase the demand for food, and thereby improve the quantity and quality of the digestive juices. This can be best accomplished by the following means:— Baths.—Water baths are of course useful to keep the skin free from impurities and to increase its ac- tivity. Too frequent bathing, however, will be found harmful, as will also, in most cases, bathing in cold water, especially in the morning, before breakfast. The latter practice has been much rec- ommended, and has been employed by many. We have heard people boast of having taken a cold shower-bath every morning, summer and winter, for years. Some even went so far as to claim to find enjoyment in springing out of bed on a winter morning before day-break and after running a few rods, with no protection from the frosty air and snow, taking a plunge in a lake or stream through a hole cut in the ice for the purpose. Hundreds have been greatly injured by such foolish practices. A person in pretty good flesh may take with advan- tage a hand bath with tepid water, every morning upon rising. But the average dyspeptic will not do well to bathe so often. Two or three times a TREATMENT. 71 week are enough in summer, and half as frequently in winter. For those who are quite gross, with inactive skins, sluggish livers and bowels, there is nothing better than the Turkish bath when given with discretion. This is one of the most active stimulants to activity of the skin which can be employed. The vapor and Russian bath, and the wet-sheet pack, rank next in value. These measures must not be em- ployed too frequently, however, as they are power- ful depletents when injudiciously used, though most energetic vital stimulants if properly employed. The tepid or cool spray is also a valuable remedy used prudently. Sea bathing, so much lauded, is often overdone. If the patient is chilled in taking the bath, it is decidedly harmful. The vigorous rubbing and manipulation of the skin and muscles which properly follow the baths referred to, are as beneficial as the baths themselves, and are especially needful to secure a good reaction. Inunction.—To encourage the surface circulation, the oil bath, or inunction, is a most admirable rem- edy. It is especially serviceable in cases in which there is dryness of the skin. Under the influence of inunctions of fine olive-oil, vaseline, or refined cocoa-nut oil, applied one to three times a week, the skin grows moist, supple, and warm, and the pa- tient will usually increase in weight as well as im- prove in color and in general vigor. In weakly patients who are unable to take sufficient exercise, 72 DYSPEPSIA. this remedy is of great value, especially when coupled with massage, a system of rubbing which in some cases secures surprising results. Simple dry-hand rubbing morning and night is useful, and often seems to benefit the patient more than any- thing else that can be done. Water-Drinking.—In cases of obstinate constipa- tion, due to inactivity of the liver, water-drinking is of advantage, when the stomach will bear it. The quantity of water to be taken must vary from a single glassful taken before breakfast to a half- dozen glasses a day in the intervals between the meals. Repeated experiments by the most eminent physiologists have shown that the liberal use of wa- ter as a beverage is a great promoter of vital activ- ity, not only of the liver, but of other vital organs. This must not be carried to excess, and must be discontinued if it disturbs digestion. SPECIAL MEASURES OF TREATMENT. The special indications to be met by treatment in dyspepsia are, 1. To increase the quantity and qual- ity of the gastric juice, and of the other digestive fluids; 2. To increase the muscular activity of the stomach and bowels; 3. To palliate the various other symptoms which grow out of derangements of these two important functions. First, we will call attention to Measures to Improve the Secretions.—Any meas- TREATMENT. 73 ure which will improve the tone of the stomach will accomplish this result. We may mention, as useful for this purpose, 1. Taking a few sips of cold or hot water just before eating. Not more than one or two table- spoonfuls should be taken. The same quantity of very warm water taken an hour after the meal has a similar effect. 2. The application of hot fomentations to the pit of the stomach stimulates the activity of the gas- tric glands. Alternate hot and cold applications made to the portion of the spine just back of the stomach has a similar effect, and often in a remark- able degree. In some of the worst cases a fomen- tation applied a half-hour after each meal will have a most decidedly beneficial effect. The alternate hot and cold spray or douche may be employed in- stead of fomentations and compresses, and with greater benefit in some cases. The application should be at quite extreme temperatures, and alter- nated every few seconds. It should not be contin- ued more than two or three minutes. Care must be taken to avoid chilling the patient. If the douche cannot be employed, an alternate hot and cold rubbing may be substituted, applying the heat and cold with cloths wrung out of hot and cold water alternately.* * Directions for aU kinds of water treatment may be found in a work entitled, "Uses of Water:" Good Health Pub. Co., Battle Creek, Mich. 74 DYSPEPSIA. 3. In slow digestion the application of fomenta- tions night and morning, and wearing a warm ab- dominal compress through the night, or for a few hours after each meal, are measures of very great utility. Moist warmth applied to the surface is a powerful stimulant of secretion in the stomach, as well as in the liver and other secreting organs. Measures to Increase Muscular Action.—The meas- ures just described are equally useful in exciting muscular activity. In addition may be mentioned gentle manipulation of the bowels, or kneading of the abdomen, especially its upper portion. By this means the local circulation is stimulated, and the natural muscular action of the bowels is both imi- tated and encouraged. This is an excellent rem- edy, and can be employed to advantage each night and morning, and for half an hour or more after each meal. If the patient is able, he should himself make a practice of kneading and percussing the abdomen for fifteen or twenty minutes night and morning. This is a powerful stimulus of muscular activity. Many years ago a quack doctor in New York City made a fortune by curing dyspeptics with this mode alone. He put every patient under an oath of secresy, and required certain wholesome restric- tions of diet, which of course aided in the cure. Flatulence,—Stomach flatulence, occasioned by the formation of carbonic acid gas, may usually be re- lieved by swallowing a small quantity of quite hot TREATMENT. 75 water and applying hot fomentations to the stomach with gentle kneading. A little camphor, pepper- mint, or winter-green added to the hot water in- creases its efficiency. Sometimes gulping a small quantity of air will liberate the imprisoned gas by causing relaxation of the muscular fibers at the lower end of the oesophagus. Flatulence of the bowels, together with the pain which sometimes accompanies it, is relieved in the same way. Occa- sionally a hot sitz bath for ten or fifteen minutes, at 100° to 110°, is required. A copious warm enema will be required in some cases which are accom- panied by obstinate constipation. Acidity.—One of the best remedies for acidity, and one which is likely to do no harm while it does much good, is pulverized charcoal. It must be very finely pulverized, being sifted through a cloth, must be of the best quality, and fresh. That made of boxwood or cocoa-nut shells is best. It may be taken in powder, in doses of a half teaspoonful, with water; but the dry powder, taken in capsules, is best. Charcoal may be combined with the food in crackers, rolls, biscuit, and other articles ; and when thus used is often very efficient in preventing sour- ness ; but its value is greatly lessened by mixture with other substances. When old it is almost value- less. As large a quantity as two or three ounces has been taken after a meal without injury. Heart-burn may be treated as directed for acidity. Vomiting.—When present, this symptom is some- 76 DYSPEPSIA. times very troublesome. If there is evidence from other symptoms that there is something in the stomach which needs to be expelled, the efforts of nature should be encouraged by copious draughts of tepid or milk-warm water, which will lessen the painful retching, as well as secure thorough emp- tying of the stomach. When the matters vomited give no evidence of sourness or decomposition, and the symptom is evidently due to nervous condi- tions or to an irritable state of the stomach, a few sips of hot water will usually afford relief, especial- ly if coupled with a hot fomentation over the stom- ach. In cases which are not thus relieved, ice pills, or small sips of ice water, with cold to the stomach and warm to the spine, will almost always succeed. In bilious vomiting, when the matters vomited are of a green color, mild acids, as lemon or lime juice, will be found excellent, sometimes giving almost instant relief. The same remedies recommended as palliatives of vomiting are the proper remedies for nausea. Constipation.—Inactivity of the bowels is often one of the most troublesome difficulties with which the dyspeptic has to contend. Two of its most po- tent causes we have not before mentioned, but call attention to them here as they have an important bearing on treatment; viz., the use of purgatives, and carelessness respecting the observance of the calls of nature. The latter cause is especially com- mon with women, particularly those who reside in TREATMENT. 77 the country, where accommodations for the purpose are by no means so convenient as in the larger cities, where sewers and indoor conveniences are almost universal. With most people, the bowels naturally move in the morning, before or just after breakfast. If the duty is neglected when it should be performed, the bowels become in some degree tolerant of their contents, so that the call is less vigorous; and the neglected organs may be- come so dormant that they may cease to demand relief. The most obstinate cases of constipation are produced in this way. When purgatives are resorted to, the difficulty becomes still worse. Goaded to activity for the time being when stimulated by a cathartic, they re- lapse into worse torpidity when the influence of the excitant has been removed. This demands a renewal of the laxative, and so the evil is perpetu- ated. Cases of this sort have come under our care in which there had been no natural movement of the bowels for twenty years, laxatives of some sort having been employed during the whole time. For the relief of this condition we offer the following suggestions:— 1. Drink a glass of cold water upon rising in the morning, unless the condition of the stomach is such as to forbid the taking of much fluid. This one practice has cured some of the worst cases of constipation, which had resisted many other modes of treatment. 78 DYSPEPSIA. 2. Eat food of sufficient coarseness to afford the necessary bulk for the bowels to act upon. Gra- ham bread, oatmeal, and cracked wheat are excel- lent remedies, as well as foods, in such cases. Con- centrated foods must be sedulously avoided, togeth- er with any excess of fat, as the latter article di- minishes the biliary secretion, which is the natural regulator of the bowels. 3. Apply the same remedies as are recommended for deficient muscular activity of the stomach and bowels. The abdominal bandage worn each night, and also in the day-time for a while at first in bad cases, is one of the best measures of treatment. Kneading and percussing the abdomen is a very useful measure, and should be practiced regularly. 4. In cases in which purgatives have been em- ployed for a long time, the enema will be found necessary at first; but if it is used at a regular hour, and an effort is first made to secure a natural movement each time, it will not require very long to secure a natural activity of the organs. One of the most painful consequences of consti- pation is the production of hemorrhoidal tumors or piles at or near the outlet of the rectum. The ob- struction to the circulation in the bowels causes dil- atation of the veins of the rectum, which become greatly distended, with thickened walls, giving rise to a great degree of irritation and often hemorrhage. Palliative measures of various sorts may mitigate the severity of the symptoms, but in most cases a cure can be effected only by a surgical operation. TREATMENT. 79 Cold Feet, etc.—To cure cold feet, do not toast them at the fire, nor parboil them in hot water. This only relaxes and weakens their circulation. A better plan is this: Just before going to bed, place the feet in a cold bath, with the water about one-fourth of an inch deep. In a few minutes, dry and rub warm with a coarse cloth or with the hand. The alternate hot and cold foot bath may be used with still greater effectiveness. At night, if the feet cannot be kept warm without, hot jugs or foot-stones may be employed; but it is far better to become independent altogether of such artificial substitutes for vital heat. When the feet or hands are too hot, they may be cooled by using cold water instead of hot. Ice-wa- ter may be employed when necessary, and will be found a most excellent means of relieving the un- pleasant burning from which many people, espe- cially older persons, often suffer so much. Sleeplessness.—This most annoying and exhaust- ing symptom may be greatly relieved by attention to the following suggestions :— 1. Retire early, having taken, an hour or so be- fore, sufficient muscular exercise to induce slight weariness. 2. Eat nothing within four hours of bed-time. If " faint" at the stomach, drink half a glass of hot lemonade, made as already directed. If this does not suffice, a mellow sweet or subacid apple may be taken an hour before retiring, unless fruit occasions pain or acidity. 80 DYSPEPSIA. 3. If feverish, the skin being hot and dry, take a light hand bath with tepid water upon retiring. 4. If troubled with cold feet and hands, employ the means suggested for the cure of cold feet. 5. Sleep in a cool room, but take care to see that the bedding is well aired and dry, and the room well ventilated. 6. When nervousness causes loss of sleep, there are various methods of inducing slumber, one of the most efficient being slow, deep, and steady breathing. By this means the lungs are filled with blood, and the brain is thus relieved of the congestion which causes wakefulness. Hints for the removal of other bad conditions have been incidentally made in the consideration of oth- er parts of the subject, and so do not need further attention here. To attempt to describe, and pre- scribe for, all of these morbid states would be be- yond the province of this work; and we now leave the subject to the candid consideration of all who may be suffering from this most unpleasant malady. Popular Works on Health. ------*------ Uses of Water in Health and Disease.—A book for ever) physician and every family. Careful explanations and instruction are giver respecting the uses of water as a preventive of disease, and as a valuable remedy in nearly all classes of maladies. In cloth, 166 pp., 60 cents; papei covers, 136 pp., 25 cents. The Household Manual.—A book that everybody wants. It is brim full of information on a hundred useful topics. Tells how to treat mosl common diseases successfully with simple remedies, how to disinfect and ven- tilate, what to do in case of accidents, how to resuscitate the drowned, and gives much other equally important information. 20,000 sold in less than two years. Bound, 17a pp., 75 cents. 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Paper covers, 128 pp., 25 cents. Healthful Cookery.—A Hand-Book of Food and Diet; or, What to Eat, When to Eat, and How to Eat. It contains a large number of recipes for the preparation of wholesome and palatable food without condiments. Every dyspeptic ought to have it. Enamel paper covers, 128 pp., 25 cents. Proper Diet for Man.—A scientific discussion of the question of vegetable versus animal food, together with a consideration of the relation of salt to the human system. Ultra notions are avoided, and the subjects treated are handled with candor. Price, in flexible covers, 50 cents. (In Press.) Dyspepsia.—A concise account of the nature and causes of this almost universal disease, with directions for its cure. Thousands have been cured by attention to the suggestions contained in this little work. I7° PP-> 75 cents. 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Published by Good Health Publishing Co., Battle Creek, Mich. USES OF WATER. Bound in Cloth, 160 pp., 60 cts. Paper Covers, 25 cts. A work for every family and every physician. It is the ONLY BOOK PUBLISHED which gives the latest scientific knowledge respecting the use of water as a remedy for disease. The instruction which it imparts is PLAIN, PRACTICAL, COMPLETE. Every form of bath is described, together with the conditions to which it is adapted. Plain Facts About Sexual Life, (Second Edition.) Elegantly bound. 416 pp., Gilt, $2.00. .a. booies fozr, the it^es, Treating upon all subjects pertaining to the ANATOMY AND PHYSIOLOGY OF REPRODUCTION in a new and interesting manner. Plain, concise, and complete, yet wholly free from indelicacy, and perfectly chaste in expression. The following are a few of the numerous commendations received from the press :— "A book so intelligently written should not lack for readers."—Boston Journal. " The various subjects, though plainly set forth, are handled in a mannei the most fastidious need not object to."—Haverhill Publisher. "A book well calculated to impart useful knowledge upon very important subjects."—Boston Herald. " We can heartily commend it to parents for their own guidance and in- struction, as well as for the teaching of their children."—Boston Transcript SEND FOR CIRCULAR OF REVISED EDITION. Published by Good Health Publishing Co., Battle Creek, Mich. D YS PE PSI A. A POPULAR TREATISE on the subject, giving a very thorough ac- count of the Causes, Symptoms, Prevention, and Treatment, Of this Common Malady. Every Dyspeptic ought to have it. Beautifully bound, with A FINELY COLORED FRONTISPIECE. Muslin, 176 pages. Price, 75 Cents. ALCOHOLIC POISON : Its IvCoral, Social, ecaa.cL ^Ij-srsica-l Effects. Emael Cover, 125 pp., 25 cts. An interesting, straightforward, and most convincing argument for temper- ance. 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For many years this institution has been widely known as THE LEADING HEALTH INSTITUTION IN THE WEST. Within the last two years extensive improvements have been made, in the erection of a large new main building, the laying out of lawns, erection of a large fountain, and the introduction of all the latest improvements in the line of NEW MEDICAL & SANITARY APPLIANCES. The most efficient and scientific methods of heativ^ and ventilation have been adopted at an expense of more than $"5,000 for this item alone, more than ten miles of steam pipe being used in the building. The ingenious combi- nation of direct and indirect radiation secures equable warmth under all circum- stances ; and an improved method of adding moisture to the air in winter, SECURES THE ADVANTAGES OF A MILD CLIMATE, which makes this a place especially desirable for persons of delicate lungs. Another great advantage of this institution is its SALUBRIOUS LOCATION, on an elevated site, above the malaria so prevalent in many Western States. All Valuable Remedial Agents are Employed. The institution is not a "WATER CURE," a " MOVEMENT CURE" a "DIET CURE," a "HOSPITAL," nor a "REST CURE," but all com- bined, with the addition of all remedial agencies known. Chronic Diseases and Surgical Cases A SPECIALTY. Those who find it necessary to go abroad for their health cannot do bettei than to patronize this institution. flS-SEND FOR CIRCULAR.-®» Address. SANITARIUM, BATTLE CREEK, MICHIGAN Medical and Surgical Sanitarium, BATTLE CREEK, MICH. 5 GOOD HEALTH. Monthly, 32 pages, $1.00 a Tear. THE BEST HEALTH JOURNAL IN THE WORLD. ----------» • «---------- This journal, formerly known as the Health Reformer, has long enjoyed the LARGEST CIRCULATION OF AM HEALTH JOURNAL in this or any other country. This eminent popularity is doubtless attributable to the fact that this journal, now (1879) just beginning its fourteenth volume, has always been A PRACTICAL JOURNAL FOR THE PEOPLE. As many persons cannot afford the expense of several periodicals, the pub- lishers have lately increased the scope of the journal so as to make it meet, so far as possible in a single journal, the various wants of the common people in the direction of PHYSICAL, MENTAL, AND MORAL IMPROVEMENT. Health, Home Topics, Choice General Literature, Science, Practical Suggestions for the Household, News and Miscellany, Are the topics considered in its monthly columns. The journal is A Model of Typographical Neatness and Accuracy, and its publishers offer it at a rate so low as barely to cover the expense of pub- lication, so as to enable the journal to do the greatest amount of good by reaching the largest number of people possible. Send stamp for specimen copy, to GOOD HEALTH, BA TTLE CREEK, MICH. The above Diagram exhibits a correct view of the position of the S™« and its relation to the other In™™»i.flKr..v0 nTOM ( * 4 I WI 100 K29d 1879 39420470R NLM D5n57DT 7 NATIONAL LIBRARY OF MEDICINE NLM051957097