Neuroses of the Stomach.

Synonyms.—Nervous Dyspepsia; Gastric Neurasthenia.

Definition.—A functional disturbance of the stomach, in which there is no organic lesion sufficient to account for the gastric derangement. There is more or less distress after eating, which may, or may not, affect digestion.

Etiology.—There are quite a variety of causes giving rise to this condition. It occurs more frequently in the more "well-to-do" classes, and may follow sexual or social excesses. Great mental excitement, worry over business or family affairs, grief not easily assuaged, and prolonged melancholy, should be considered as causal factors.

Many times it is reflex, and the cause must be sought in the irritation of the sympathetic at some point distant from the stomach. Thus ovarian irritation, laceration of the cervix uteri, and endometritis, or hemorrhoids, fissures, rectal pockets, fistulae, and papillae. Sometimes the urethra is the seat of the disturbance, and a stricture or a caruncle is teasing the terminal fibers. Hysterical and neurasthenic patients are frequently troubled with nervous dyspepsia.

There may be hypersecretion of the gastric juice, or undue acidity, and at times we find a defect in the quantity, any one of which will give rise to the disorder. Underlying all of the causes, however, is undoubtedly a nervous temperament.

Pathology.—After repeated examinations of the stomach, there will be failure to find structural lesions, and many times the pathological wrongs will be found at a distant part, as the uterus, rectum, or urethra.

Symptoms.—The symptoms of nervous dyspepsia are legion, and a nervous subject complains of nearly every symptom to which flesh is heir. We see patients that are very much emaciated, while others are full-fleshed, and appear the picture of health, and between these, there is every grade of diseased condition.

The most common symptoms are, a sense of fullness and weight, accompanied by pain of a burning, gnawing character, shortly after taking food. At times there is great distention of the stomach, and the patient is compelled to hurry to her room and loosen dress, corset, and everything which presses upon the stomach; finally, loud and frequent eructations of gas afford relief, leaving the stomach, however, quite painful on pressure. Or the gas may pass into the bowels, followed by borborygmus, a condition embarrassing, though not painful.

Where there is hyperacidity and hypersecretion, the patient experiences a burning sensation in from one to three hours after a meal, attended by eructations of sour fluid, and finally vomiting ensues, giving entire relief to all distress. Spasm of the cardiac orifice is attended by severe pain, at times simulating angina, and frightening both patient and friends, who fear a fatal termination to the attack.

Constipation is usually present, with more or less flatulent distention of the intestines, and frequently there is abdominal pain. Headache, malaise, sleeplessness, and melancholy are commonly present.

Diagnosis.—In the diagnosis of this disease many difficulties present themselves, and many times the symptoms are so similar to those of organic disease of the stomach that great care is required to differentiate between them. If we bear in mind the etiology of this condition, it will aid materially in recognizing the lesion.

The nervous temperament, the history of the case, the normal time in digesting the food, notwithstanding the pain and discomfort, and, finally, examining the contents of the stomach after a test meal, are sufficient to make the case clear. If the local symptoms are insufficient for a diagnosis, do not fail to examine the rectum and genito-urinary apparatus.

Prognosis.—In a large percentage of cases a cure should be effected. It is important to impress a nervous patient that a cure will ensue, if complete instructions are followed; then persevere till the cause of the disease is located, and a cure will soon follow.

Treatment.—A very careful examination should be made to determine the producing or continuing cause. Is it due to errors in digestion, to mental worry or overwork, to sexual excesses, to late hours and dissipation in general; if so, they must be corrected. Above all, do not fail to determine if the terminal fibers of the sympathetic are being teased by wrongs of the genito-urinary system. By correcting these wrongs as they appear, a cure is soon effected.

One of the worst cases of nervous dyspepsia it has ever been my lot to treat, was due to endometritis and rectal troubles. She had suffered for two years, and had been treated by a number of reputable physicians, who, strange to say, had overlooked the reproductive apparatus. She had been placed upon a rigid diet, had heroic medication, and also infinitesimal doses, but all to no purpose.

An examination revealed a uterine leucorrhea, due to endometritis and a bad rectum. A thorough curetting, and some rectal work, gave the patient the first genuine relief she had experienced, and the case made an uneventful recovery.

Some patients need to be restricted in their diet, while others may be allowed a generous but nutritious bill of fare. As a rule, fried .and greasy articles should be prohibited; also sweets and starchy foods. Tea, coffee, milk, and water should be restricted, the patient living on a dry diet.

To encourage digestion, and add tone to the stomach, give nux and hydrastin. To overcome constipation, have the patient massage the abdomen before rising in the morning, drink a glass of cold water, and go to stool at a regular hour. To encourage the bowels, a half dram of cascara evacuant may be given for a few days, till the bowels assume their normal condition. Spasm of the cardia or pylorus will be benefited by the following prescription :

Colocynth 8 drops
Compound Spirits of Lavender. 2 drams.
Water 4 ounces. M.
Sig. Teaspoonful every ten, twenty, thirty, or sixty minutes.

For the burning, bismuth subnitrate in mint-water answers an excellent purpose.

Some very stubborn cases, where melancholy is a prominent symptom, will improve rapidly by a change of air, scenery, and surroundings, thus getting the patient away from self and interested in what is going on in the world. A sea-voyage, a mountain journey, or a visit to the country, will thus accomplish what drugs fail to do.
