Chapter 9 - Diseases of the Abdominal Cavity
Introduction to Diseases of the Abdominal Cavity
Acute Inflammation of the Liver
Chronic Inflammation of the Liver
Congestion of the Liver
Passive Congestion of the Liver
Cirrhosis of the Liver
Acute Inflammation of the Spleen
Chronic Inflammation of the Spleen
Gall Stones
Acute Inflammation of the Stomach
Chronic Inflammation of the Stomach
Heart Burn
Cramps in the stomach
Water Brash
Milk Sickness
Acute Inflammation of the Peritoneum
Chronic Inflammation of the Peritoneum
Acute Inflammation of the Bowels
Chronic Inflammation of the Bowels
Cancer of the Intestine
Intestinal Obstruction
Air Swellings
Bilious Colic
Painters' Colic
Chronic Diarrhea
Cholera Morbus
Asiatic Cholera
Chronic Dysentery
Acute Inflamation of the Kidneys
Chronic Inflamation of the Kidneys
Acute Inflammation of the Bladder
Chronic Inflammation of the Bladder
Disease of the Supra Renal Capsules
Bright's Disease
Simple Home Tests for Urine - Diagram
Bleeding from the Kidneys
Suppresion of Urine
Retention of Urine
Inability to Hold Urine
Uric Acid Gravel
Phosphatic Deposits
Oxalic Deposits
Urate of Ammonia Deposits
Hippuric Acid Deposits
Cystine Deposits
Bladder Stones
Dropsy of the Belly
General Dropsy

9.13 Indigestion/Dyspepsia

Indigestion. Dyspepsia.

DYSPEPSIA is a disease of civilization. Savages know nothing of it. It is the costly price we pay for luxuries. All civilized nations suffer from it, more or less, but none so much as the people of the United States. It is here, in the new world, that the disease has become domesticated, and we, as a people, who have threatened to monopolize its miseries.
Few disorders inflict upon their victims greater suffering; yet it is not particularly dangerous, and it is even doubtful whether it tends very much to shorten life, unless the length of life be judged to consist in the sum of happiness enjoyed, in which case few complaints shorten it more.

Symptoms. These vary very much in different stages of the disease, and in different persons. In general the complaint begins with a sense of fullness, tightness, and weight in the stomacl4 sooner or later, after meals, and a changeable, diminished, or lost appetite. Occasionally, the appetite is craving, and when, in obedience to its promptings, a large meal is taken, there is pain in the stomach, with general distress and nervousness, and sometimes vomiting. Flatulency and acidity are common, with sour and offensive belching of wind; and very often there is a water brash, or vomiting of a clear, glairy fluid when the stomach is empty. Dizziness is a prominent symptom. There is a great deal of what patients call an , all gone " feeling at the pit of the stomach, a weakness so great at that particular spot, that it is very hard to sit up straight. There is a bad taste in the mouth; the tongue is covered with a whitish fur; there is headache, heartburn, palpitation at times, high colored urine, and tenderness, now and then, at the pit of the stomach. The bowels are generally irregular, sometimes very costive, at other times loose, when portions of food are passed off undigested.

Nervous Complication. Such are the symptoms in a case of simple disorder of the stomach, when no other part of the system is materially involved. This is indigestion, well marked, and distressing enough; but it is only a part of what is understood by a case of modern dyspepsia. In this, either the indigestion, in its course, disturbs and involves the nervous system, or the nerves become themselves disordered, and produce the indigestion. Sometimes one happens, sometimes the other, it matters not which; both are present the affection of the stomach and of the nerves in a case of thorough dyspepsia. To make out a full case, in its tormenting completeness, we must add to the above symptoms, great depression of spirits, amounting at times to complete hopelessness and despondency; a dread and fear of some impending evil; a lack of interest in passing events; unwillingness to see company or to move about; an irritable and fretful temper; a desire to talk of one's troubles, and nothing else, a sallow, haggard, sunken, and sometimes wild expression of countenance; a dry, wrinkled, and harsh skin, with unrefreshing sleep, disturbed by all sorts of annoyances and difficulties, such as shipwrecks, falls down precipices, and nightmare.
The man who has all these symptoms, or any considerable portion of them, has dyspepsia, and is about as miserable as if all the sorrows of life were electrical currents, and were running through him continually.

Causes of Dyspepsia; To healthy digestion, three conditions are especially necessary, that the food should be well chewed and mixed with saliva before it is swallowed; that the stomach should pour out and mix with it the right amount of healthy gastric juice; and that it should be well churned while in the stomach.
It is well known that the first of these conditions, a thorough chewing of food, is rare in this country. We eat too fast; we do not masticate our food; we bolt it whole.
This is the first cause of dyspepsia, and it is the fruitful mother of causes. It furnishes the occasion for eating too much; for when the food is swallowed with such rapidity, the stomach is taken by surprise, as it were; it cannot secrete gastric juice fast enough to be diffused through the fast growing mass; and the appetite does not decline until a great deal too much is taken. The coats of the stomach, being stretched unnaturally, do not pour out the gastric juice at the right time, or as much of it as is wanted, and what there is, is altered in quality.
Moreover, the stomach being overburdened, cannot turn over and churn it contents properly.
To fast eating, we may add, high seasoned dishes, too stimulating for the stomach; eating between meals, and at unseasonable hours, particularly at bedtime; excessive use of strong drinks and tobacco; habitually sitting up late at night; inactive habits of body; and excessive use of the mind.
No causes of dyspepsia are more active than those which disturb and fret the mind. It is surprising how suddenly any mental agitation will put an end to the appetite, and suspend digestion. And when these mental disturbances are protracted, when care becomes a daily and hourly companion, dyspepsia is almost sure to show itself. Considering the numerous causes of unpleasant mental excitement which we have in the politics, the business, the ambition, the family jars, etc., of this country, it is a wonder that dyspepsia is not even more prevalent. It is hard for the sensitive to escape.
These causes may seem too simple to be the frequent origin of so much misery, and yet whole volumes might be written on this one subject. One cannot too forcibly nor too frequently remind the reader of the importance of these simple and brief remarks. No treatment will avail if they are not heeded

Urinary Deposits. Before speaking of the treatment of dyspepsia, it will be proper to take notice of certain deposits in the urine, to which persons suffering, from this complaint are liable, and the discovery of which will, ii~ many cases, indicate the treatment.
Many dyspeptics have acid urine, which is loaded with crystals of oxalate of lime. These persons are much depressed in spirit, and look upon the dark side of everything. They are painfully disturbed by small annoyances, are irritable in temper, incapable of exerting themselves, look with dread upon the future, and generally have the dark and dingy look of the face which indicates functional derangement of the liver.
The most of these crystals are octahedral in form, and in the field of a good microscope are beautiful objects for inspection. (Figs. 100 and 101.) To obtain them, take a portion of urine passed in the morning (urina sanguinis), and let it stand till a deposit takes place. Pour off the upper portion of the urine; put a part of the remainder in a watch glass, and gently heat it over a lamp. The heat will cause a deposit of the crystals.

The oxalate of lime 'is frequently found in urine, the crystal having the form of dumbbells. When examined by polarized light, they appear beautifully colored and striated. (Fig. 102.)
The urate of ammonia, and uric acid gravel, are likewise found in large quantities in the urine of many dyspeptics. Some are exhausted by them, and reduced almost to skeletons, and to a wretched state of health, having boils, eruptions, etc.
To find the urates, put a little of the urine containing the deposit in a test tube, and warm it gently over a lamp. The deposit readily dissolve, it is probably urate of ammonia (Figs. 103 and l04), and may then be examined under the microscope, to make the matter sure.
To find uric or lithic acid, let morning urine stand unffi a solid deposit has sunk to the bottom; then pour off the liquid, and place some of the solid portion upon a glass, and examine it with a microscope, and if this acid be present, its peculiar crystalline forms (Fig. 105) will be covered, either alone, or mixed with urate of ammonia.

In those cases in which there is a great prostration of the nervous system, with a loss of sexual power, bad feelings in the head, perhaps pain and weakness across the loins, and a tendency to consumption, we may suspect the presence of the triple phosphates in the urine. Phosphorus is one of the elements of the brain and nerves, and when there is a constant drain of this element through the kidneys, the nervous system is gradually exhausted. To find the triple phosphates, put some morning urine in a glass vessel, and let it stand till a sediment has gone to the bottom. Put some of the sediment in a test-tube, and warm it gently over a lamp. If the warmth do not dissolve the deposit, add to it a little acetic acid; if the deposit dissolve in the acetic acid, it probably consists of earthy phosphates. This is then to be examined under the microscope to ascertain whether it is the phosphate of lime, the triple phosphate, or a mixture of both.

Fig. 106 shows us the prismatic crystals of the triple phosphate. In a few rare cases, these are penniform (Fig. 107). Fig. 108 gives us another specimen of the crystals of the triple phosphates, as they appear under the microscope, mixed with amorphous particles of phosphate of lime. If an excess of ammonia be added to the urine, the crystals become star like and foliaceous, as in Fig. 109.

Treatment of Dyspepsia. As there are few complaints which distress the patient more than dyspepsia, so there are few which give the physician more trouble. Generally our art has failed upon it because too much has been required of us. We have not merely been asked to cure the disease, but to do it while the patient continues the indulgence of his appetite, or his excessive application to business or study. It has been expected of us, that with medicine we should contravene the laws of nature, and restore health while the causes of the disease are in full activity.

This complaint is often brought on by not keeping the bowels open. To cure it, therefore, one of the first things to be done is to remove costiveness and regulate the bowels.
One of the very best articles I know of to remove constipation is Parrant's Aperient. I have placed it in the department of Pharmacy; it ought to be in the United States Dispensatory. Taken immediately after meals, in doses of a teaspoonful, it corrects acidity of the stomach, it gently opens the bowels, and when its action is over, will be found to have diminished the costiveness, rather than increased it, as most kinds of physic do. It is excellent in the bilious forms of dyspepsia, acting finely upon the liver, particularly if a few drops of aqua regia in water be taken before meals, the aperient being taken after.
If piles exist, this mixture will be objectionable on account of the aloes, and the fluid neutralizing extract may take its place. Sweet tincture of rhubarb and soda (37), is sometimes preferable to the aperient.
Several other preparations (38), (39), will be found useful to remove costiveness and debility of the stomach.
For acidity, besides the remedies already mentioned, prepared charcoal may be used, in teaspoonful doses, or carbonate of magnesia, or fluid magnesia, or trisnitrate of bismuth. A good remedy is pulverized guaiacum, rhubarb, prepared charcoal, and carbonate of magnesia, equal parts; also (28), (37), (38), (42). If crystals of oxalate of lime be found in the urine, give a few drops of aqua regia, in water, three times a day.

Hygienic Treatment. The diet must be managed with great prudence. Food must be taken in such quantities only as the stomach can digest, however small that quantity may be; and it must be taken slowly, and well chewed. No article should be touched, or thought of, which disagrees with the stomach. Costiveness may frequently be entirely removed by eating no bread except that made from unbolted wheat four, commonly called Graham bread (that made from Franklin Mills flour), or by making one of the three daily meals of boiled cracked wheat, with milk or molasses. If the triple phosphates be found in the urine, there is a special reason why the unbolted flour, or the cracked wheat should be used. The wheat grain abounds in phosphorus, the largest portion of which is in the bran, and this is much needed when the kidneys are robbing the brain of its phosphoric element.

Not too much Brainwork. It is important that the brain and nervous system should be relieved of the burden of too much work, and that the thoughts should be turned into the most agreeable channels. If the patient would get well, the disinclination to move about and see company must be resisted. In many cases, dyspeptics are like seasick persons, feeling as though they would rather go overboard than move. In such instances, friends must not be harsh with them, and frown upon their listlessness as if it were a fault; but rather treat them affectionately, and beguile them out by all sorts of pleasing enticements. Exercise must be had, every day, and be connected, if possible, with an object, so that it may be performed cheerfully. It is important to engage the mind in the exercise; and for this purpose, some contested game is very useful, as playing at billiards, rolling ninepins, pitching quoits, or, where the strength NFM permit, playing ball or riding the bicycle.

Cheerfulness. Nothing does more to drive away dyspepsia than a cheerful, lively, and even mirthful state of mind. All the nervous influences sent from the brain to the stomach should be of the most agreeable kind. Some people think it vulgar to laugh. Let such stand with long faces in life's shadows, if they choose. As a general rule, the best men and women laugh the most. Good, round, hearty, side shaking laughter, is health for everybody; for the dyspeptic, it is Life.
Dyspeptics who have a taste for it, and can endure the expense, should travel. A voyage to Europe, and a year spent in seeing the wonders of the old world, will generally cure the most stubborn case of indigestion. This, however, depends upon circumstances. For those having the finer organizations and the higher natures, extensive traveling is sometimes indispensable. The narrow circle of thoughts, associations and things in their own neighborhood, do not fill the compass of their wants; their many sided faculties need to be drawn on by the large variety to be found only in travel. Their large and impressible natures want to be filled full in order to drive out disease, and it takes a world, or a considerable part of it, to fill them. The dyspepsia of such natures is not comprehended by the multitude, and even physicians are often amazed that their narrow prescriptions do not reach it.

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