DYSPEPSIA AND GASTRIC ULCER by P. JOUSSET, M.D.
DYSPEPSIA
It is an affection characterised by the slowness and the difficulty of digestion. The principal symptoms of this affection are a more or less painful weight in the region of the stomach, eructations regurgitations, and sometimes vomiting, constipation, or diarrhoea. Also there are other symptoms not referred to the stomach and which will find their place in the following description.
The history of intestinal dyspepsia is based upon the manifestations of disturbances several hours after meals and the coincidence of intestinal colic. The affection is never found alone, and it is but a sequelae of gastric dyspepsia, the only one which we admit.
Dyspepsia is usually a symptomatic affection. It is noticed in the following diseases: tetter, gout, haemorrhoids, hypochondriasis, hysteria, chlorosis, chronic gastritis simple ulcer of stomach and cancer of this viscus. Dyspepsia is also present, either as a precursory phenomenon, a transient symptom, or as part of the cachectic state, in several chronic diseases: phthisis, scrofula, syphilis albuminuria, diabetes etc. Affection of those organs which are in the vicinity of the stomach also produces dyspepsia: affection of the liver and of the gall bladder, intestinal affection etc. It is also met with in most cases of poisoning. Besides dyspepsia manifests itself in those who do not present any symptom of another disease, and thus constitutes idiopathic dyspepsia.
We shall now describe the most frequent varieties of this affection, in order to reach at least a precise indication of the most appropriate remedies. Dyspepsia exhibits five principal varieties:
Bradyspepsia (slow from), pituitary dyspepsia, flatulent dyspepsia, acid and masked dyspepsia. Under this last name we shall describe that variety of dyspepsia in which the gastric symptoms are masked, so to speak. by the symptoms referred to the heart, lung and brain.
1. Bradyspepsia.
This variety of dyspepsia is the most common of all .It is characterized by the slowness and the difficulty of digestion. One or several hours after meals the patient feels a painful weight at the pit of the stomach. This pain, which in violent cases lasts to the next meal, is accompanied by a sensation of swelling.
Patients are obliged to loosen the clothing entirely. They have regurgitations. first with the taste of the food, soon after acidity, still later they vomit, which relieves them much. From time to time, when patients insist upon overeating, vomiting of food occurs, and true indigestion sets in Appetite is compatible with this variety of dyspepsia; the mouth, however, is usually foul, the tongue white, and covered with a frothy saliva . In some rare cases the liquids especially are not digested.
This peculiar variety is recognized by the aggravation on taking liquids, by the splashing sound of the liquids produced in the stomach, by succussion, and by the scant urine. This variety is chiefly noticed in those suffering from gout and haemorrhoids.
2. Pituitary Dyspepsia: This variety of dyspepsia is characterized by the slowness of digestion, and principally by the vomiting of a transparent and more or less thick mucus. Patients affected with this variety of dyspepsia exhibit most of the symptoms of the preceding variety; furthermore, they vomit every morning with extremely violent efforts, sometimes with cough and suffocation. Once they vomit, with great difficulty, a few mouthfuls of a stringy and slimy, sometimes bloody, liquid, they feel relieved. This attack, which almost always occurs in the morning on an empty stomach, may be repeated several times during the day.
This variety of dyspepsia is symptomatic or chronic alcoholism. It chiefly develops itself by the use of strong alcoholic liquors, taken on empty stomach. Beer drinkers are also subject to this trouble. This dyspepsia is the usual symptom of chronic gastritis.
3. Flatulent Dyspepsia:
The variety is characterized by considerable formation of gas in the stomach and intestines. As soon as the digestion commences the mucous membrane of the stomach and intestines secrete, with an extreme rapidity, a great quantity of gas. Patients almost choke, and are obliged to loosen their clothing, the abdomen is greatly distended. Tympanites, borborygmi, and eructations annoy them at the height of the disease, and they commence then to belch an enormous quantity of gas. These eructations, usually tasteless, odorless, and extremely noisy, last for a long time , and end the attack of dyspepsia.
This variety is peculiarly met with in hysteria and hypochondriasis.
We connect this form of dyspepsia with deficiency of hydrochloric acid, and a certain percentage of dilatation of stomach. As to the deficiency of acid, it is marked by considerable decrease of hydrochloric acid of the stomach, when it is found to be associated with a certain degree of gastric dilatation. There is stasis of undigested alimentary substances, which ferment, and a great quantity of organic acids is formed, so that the acidity of the liquids contained in the stomach in cases of deficiency of hydrochloric acid is more common than in cases of hyperacidity; and, as these organic acids lack the aseptic properties of hydrochloric acid, the alimentary substances become decomposed, and the formation of ptomaines starts auto-intoxication. In such cases eructations may have a putrid taste and odor.
4. Acid Dyspepsia: This variety is characterized by sour eructations, acid evacuations, and vomiting. is due to an excess in the secretion of gastric juice. Patients, soon after eating, having a sour stomach, sometimes pyrosis. The saliva is acid, and sets the teeth on edge; and after gastric digestion there sometimes occurs vomiting, largely composed of gastric juice.
Hyperacidity should be connected with this form of dyspepsia; acid vomiting, acid eructations, pyrosis, and the pains, often violent, which occur four or five hours after meals, are due to this excess of hydrochloric acid. This variety is frequently connected with chronic gastritis, or it is a prodromal symptom of cancer of the stomach; it accompanies organic affections of the liver, or it may manifest itself as a symptom of gout.
5. Masked Dyspepsia:
In this variety the gastric symptoms are slightly developed while the symptoms so-called sympathetic are the more marked.
There is palpitation and irregular pulsation of the heart, lipothymia, syncope, symptoms of angina pectoris. There is arthritic dyspnoea, dyspnoea by choking sensation, dry and teasing cough. Habitual headaches, weight on the vertex, vertigo, megrim, hypochondriasis. This variety of dyspepsia is especially met with in hysteria hypochondriasis, and in haemorrhoidal affections.
To this form we connect a great number of cases of dilatation of stomach, and we are going to mention the signs that will enable us to determine this dilatation. These signs are chiefly two: increase of the resonance and the splashing sound.
Percussion should be made on the bare skin. First the lung is located, then the resonance over the stomach.
The splashing sound is the sign par excellence. It may be obtained either by succussion or by an abrupt pressure with the closing fingers brought together on a same line, and exercised upon the regions which extend from the umbilicus to the false ribs. Should the patient's stomach be empty, it is best to make him drink half a glass of water in order to hear this sound.
It is an affection characterised by the slowness and the difficulty of digestion. The principal symptoms of this affection are a more or less painful weight in the region of the stomach, eructations regurgitations, and sometimes vomiting, constipation, or diarrhoea. Also there are other symptoms not referred to the stomach and which will find their place in the following description.
The history of intestinal dyspepsia is based upon the manifestations of disturbances several hours after meals and the coincidence of intestinal colic. The affection is never found alone, and it is but a sequelae of gastric dyspepsia, the only one which we admit.
Dyspepsia is usually a symptomatic affection. It is noticed in the following diseases: tetter, gout, haemorrhoids, hypochondriasis, hysteria, chlorosis, chronic gastritis simple ulcer of stomach and cancer of this viscus. Dyspepsia is also present, either as a precursory phenomenon, a transient symptom, or as part of the cachectic state, in several chronic diseases: phthisis, scrofula, syphilis albuminuria, diabetes etc. Affection of those organs which are in the vicinity of the stomach also produces dyspepsia: affection of the liver and of the gall bladder, intestinal affection etc. It is also met with in most cases of poisoning. Besides dyspepsia manifests itself in those who do not present any symptom of another disease, and thus constitutes idiopathic dyspepsia.
We shall now describe the most frequent varieties of this affection, in order to reach at least a precise indication of the most appropriate remedies. Dyspepsia exhibits five principal varieties:
Bradyspepsia (slow from), pituitary dyspepsia, flatulent dyspepsia, acid and masked dyspepsia. Under this last name we shall describe that variety of dyspepsia in which the gastric symptoms are masked, so to speak. by the symptoms referred to the heart, lung and brain.
1. Bradyspepsia.
This variety of dyspepsia is the most common of all .It is characterized by the slowness and the difficulty of digestion. One or several hours after meals the patient feels a painful weight at the pit of the stomach. This pain, which in violent cases lasts to the next meal, is accompanied by a sensation of swelling.
Patients are obliged to loosen the clothing entirely. They have regurgitations. first with the taste of the food, soon after acidity, still later they vomit, which relieves them much. From time to time, when patients insist upon overeating, vomiting of food occurs, and true indigestion sets in Appetite is compatible with this variety of dyspepsia; the mouth, however, is usually foul, the tongue white, and covered with a frothy saliva . In some rare cases the liquids especially are not digested.
This peculiar variety is recognized by the aggravation on taking liquids, by the splashing sound of the liquids produced in the stomach, by succussion, and by the scant urine. This variety is chiefly noticed in those suffering from gout and haemorrhoids.
2. Pituitary Dyspepsia: This variety of dyspepsia is characterized by the slowness of digestion, and principally by the vomiting of a transparent and more or less thick mucus. Patients affected with this variety of dyspepsia exhibit most of the symptoms of the preceding variety; furthermore, they vomit every morning with extremely violent efforts, sometimes with cough and suffocation. Once they vomit, with great difficulty, a few mouthfuls of a stringy and slimy, sometimes bloody, liquid, they feel relieved. This attack, which almost always occurs in the morning on an empty stomach, may be repeated several times during the day.
This variety of dyspepsia is symptomatic or chronic alcoholism. It chiefly develops itself by the use of strong alcoholic liquors, taken on empty stomach. Beer drinkers are also subject to this trouble. This dyspepsia is the usual symptom of chronic gastritis.
3. Flatulent Dyspepsia:
The variety is characterized by considerable formation of gas in the stomach and intestines. As soon as the digestion commences the mucous membrane of the stomach and intestines secrete, with an extreme rapidity, a great quantity of gas. Patients almost choke, and are obliged to loosen their clothing, the abdomen is greatly distended. Tympanites, borborygmi, and eructations annoy them at the height of the disease, and they commence then to belch an enormous quantity of gas. These eructations, usually tasteless, odorless, and extremely noisy, last for a long time , and end the attack of dyspepsia.
This variety is peculiarly met with in hysteria and hypochondriasis.
We connect this form of dyspepsia with deficiency of hydrochloric acid, and a certain percentage of dilatation of stomach. As to the deficiency of acid, it is marked by considerable decrease of hydrochloric acid of the stomach, when it is found to be associated with a certain degree of gastric dilatation. There is stasis of undigested alimentary substances, which ferment, and a great quantity of organic acids is formed, so that the acidity of the liquids contained in the stomach in cases of deficiency of hydrochloric acid is more common than in cases of hyperacidity; and, as these organic acids lack the aseptic properties of hydrochloric acid, the alimentary substances become decomposed, and the formation of ptomaines starts auto-intoxication. In such cases eructations may have a putrid taste and odor.
4. Acid Dyspepsia: This variety is characterized by sour eructations, acid evacuations, and vomiting. is due to an excess in the secretion of gastric juice. Patients, soon after eating, having a sour stomach, sometimes pyrosis. The saliva is acid, and sets the teeth on edge; and after gastric digestion there sometimes occurs vomiting, largely composed of gastric juice.
Hyperacidity should be connected with this form of dyspepsia; acid vomiting, acid eructations, pyrosis, and the pains, often violent, which occur four or five hours after meals, are due to this excess of hydrochloric acid. This variety is frequently connected with chronic gastritis, or it is a prodromal symptom of cancer of the stomach; it accompanies organic affections of the liver, or it may manifest itself as a symptom of gout.
5. Masked Dyspepsia:
In this variety the gastric symptoms are slightly developed while the symptoms so-called sympathetic are the more marked.
There is palpitation and irregular pulsation of the heart, lipothymia, syncope, symptoms of angina pectoris. There is arthritic dyspnoea, dyspnoea by choking sensation, dry and teasing cough. Habitual headaches, weight on the vertex, vertigo, megrim, hypochondriasis. This variety of dyspepsia is especially met with in hysteria hypochondriasis, and in haemorrhoidal affections.
To this form we connect a great number of cases of dilatation of stomach, and we are going to mention the signs that will enable us to determine this dilatation. These signs are chiefly two: increase of the resonance and the splashing sound.
Percussion should be made on the bare skin. First the lung is located, then the resonance over the stomach.
The splashing sound is the sign par excellence. It may be obtained either by succussion or by an abrupt pressure with the closing fingers brought together on a same line, and exercised upon the regions which extend from the umbilicus to the false ribs. Should the patient's stomach be empty, it is best to make him drink half a glass of water in order to hear this sound.
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