LIBRARY OF CONGRESS. Chap. Copyright No. ShelfJRUL 3 S .-3*4 £ — the treat- ment will have to be adapted to the constitution, and not directed to the stomach alone or chiefly, as when that organ is primarily at fault. The remedies most useful in dyspepsia of gout are, Sulphur, Carbo vegetabilis, and Lycopodium. Patients who have loss of appetite every spring and autumn, and find they cannot digest eggs as they can at other times, who suffer from ii4 Treatment of Indigestion, drowsiness, heaviness on waking, unpleasant taste in the mouth, and possibly constipation, will be greatly benefited by a few doses of Sulphur. Others who have flatu- lence with pains in the chest, are chilly, and yet desire air ; bowels open or loose, require Car bo veg. Lycopodium is suited for those who have flatulence in the bowels, with constipation, and urine giving a red deposit. I will now relate two cases in point. Cask XIX.— A Chronic Constitution- al Cask with Dilatkd Stomach ; Rkcurrknt Fistula, Curkd with Sulphur. A >ear or two back an officer in the army, who had seen a good deal of service abroad, came to consult me about his digestion. He was 45 years of age, and with Illustrative Cases. 115 though a man of large frame, was wasted to a degree. He brought with him a photograph taken before the illness commenced, and it was difficult to recog- nize any resemblance between it and the patient in his then condition. His history in brief was as follows : — For ten years he had had indigestion with constipation and piles. He had lost much flesh, especially in the last year. In India he had had fever and had taken much quinine. Lately he had taken much quack medicine, principally for opening the bowels. Seventeen years before I saw him he had had a ( ■ boil ' ' form near the anus, and ever since then after great exertion he had had a recurrence of anal abscess and fis- tula. The last time w T as eight months be- fore. It bled much, but had never formed again, and since that time his indigestion had been worse. He had been a great smoker, but for ten months had not smoked at all. n6 Treatment of Indigestion, When he came to me he was having attacks every week of violent vomiting. In two minutes he would vomit as much as a gallon of fluid, sour or sweet. The least exertion caused him to vomit. There was pain and great thirst in the stomach, but not severe. The stomach I found to be considerably dilated, the spleen some- what enlarged, and there were some en- larged glands in the groin. The tongue was dirty ; often there was a bad taste, and the mouth was clammy and sticky in the morning. Up till ten years before, the bowels had been regular, but since then has had constipation, which he has taken purgatives to relieve. The piles were not painful, but bled, and at times came down. He had cramp in the calves, and cold, dry feet. Sleep was rest- less. He took long to go off, and waked early in the morning. He was very irritable and wished to be left alone. I gave him Sulphur 30 three times a with Illustrative Cases. 117 day, and told him to take no purgatives, but to use eneinata if necessary. In a month he reported himself very much better, and it was plain to see that he was quite a different man . He had had much fewer attacks, and those that came were less severe. He had been able to eat meat again without discomfort, though he had been subsisting on porridge and gruel chiefly before. The excessive thirst had gone, and though the constipa- tion remained, the piles were very much better. The urine, which had been thick and offensive, was now normal. Sleeps bet- ter, though he still wakes at 4 a.m. Sul- phur 30 twice a day, and Nux v. at bed- time. In another month still further improve- ment was apparent. He had filled out to such an extent that he did not at all belie his photograph. He complained chiefly of his appetite being too good, being most hungry in the afternoons. At times the thirst returned, and he had 1 1 8 Treatment of Indigestion , flatulence sometimes. There was still a tendency to early waking. Lycopodium was now given, and that completed the cure. Now this was a decidedly constitutional case. The indigestion was only one mani- festation of his ailment, and this became worse when the fistula healed. The fistula and the indigestion were not two com- plaints — but one; and only deeply acting constitutional remedies, homoeopathically related to all affected parts of the organ- ism could have cured the patient. Severe measures, such as surgical treatment of the piles, or acids or alkalies to correct the state of the stomach, though sanctified by the approval of the highest scientific authority in the old school, is the merest cobbling work, and no true cure at all. with Illustrative Cases. 119 Cask XX. — A Chronic Cask arising FROM AN IMPROPKRI.YTREATKD SKIN Affection. Sulphur \Nux moschata. This patient was a clerk in the city in the early twenties, and he complained of having had indigestion twelve months. It came on suddenly one day after taking tea, and he could not account for it in any way. His principal symptom was that his food lay like a weight at the umbilical region. Sour eructations, and rising into the throat of bits of the last food taken. Bad taste in the mouth at times; good appetite; takes rather much salt. Thirsty after dinner, which he takes in the even- ing, and which is the meal which gives most trouble. Spirits low; headache occa- sionally. Sleepy after meals. Prefers cold weather, but always feels cold and is sensitive to draughts. Is a total abstainer and a non-smoker. Sulph. 30 ter die. A fortnight later he reported himself as 1 20 Treatment of Indigestion, much better, and for several weeks under Puis., Lye, and Sulph. the improvement went on with fluctuations. One day he mentioned, among other symptoms, that his saliva was very thick, like cotton. R Nux mosck. 30 ter die for a week, to be followed with Salph. 30 for the next week. Whilst taking the Nux moschata the symptoms of indigestion vanished; but, to quote his own words, ' 'singularly enough, the same eruption appeared as existed before I had the indigestion. ' ' The Sulph. rather sent matters back this time, so I gave Nux mosck. again. I now for the first time obtained the history of the eruption. It w T as one of acne, which had been 1 ' cured ' ' by local applications. In other words, the complaint had been driven from his skin to his internal organs. He was subject to eruptions w^hen young. Shaving w^as now difficult, the skin being so tender. Carbo an put that with Illustrative Cases. 121 right. The Nux vioschata made him less chilly, and he did not require much medi- cine after these had done their work. Rheumatic dyspepsia will find its specifics in Bryonia, Kalibichromi- cum (especially where rheumatic pains and dyspeptic symptoms alternate), or Sulphur, Thepsoric individual will require very careful treating. The medicine of the widest range in the treatment of these cases is Sulphur, but his symptoms will require close stud}' and accurate comparison with the symptoms of the drugs in order to find the drug that most closely corresponds. For the hydrogenoid or sycotic constitution, in which the patient suffers intermittent^ from indigestion, with other symptoms, 9 122 Treatment of Indigestion, worse on every change of the weather, and especially when the air is damp and cold, Arsen., Nux, Ipec, and Natrum mur. will be found most useful according to the indications given in the Materia Medica. Wzfm- CHAPTER VI. DIET IN DYSPEPSIA. TT is just as easy to give too little food to dyspeptics as too much. When a stomach has once become whimsical, its whims will have to be disregarded in the process of breaking it into more wholesome habits. Of course, this will mean a certain amount of suffering at first, but the good results of it will soon be apparent. When there is ulceration of the stomach present, it will be neces- sary to give only liquid food, and of all liquid foods in these states, koumiss is the best. 124 Diet in Dyspepsia. In acute attacks of indigestion the best of all remedies is to go without any food at all until the stomach has had time to recover itself. In the chronic cases where the vitality is low, and the general tone of health not robust, great care will be required in bringing the patient back to ordinary diet. Cold foods must be particularly avoided. Bread only sparingly used. Bread is not nearly so digestible an article as most people imagine, and dys- peptics should never eat bread and butter, or hot buttered toast. Dry toast is all they should indulge in. When toast is not tolerated, rusks or biscuits may take its place. Plain water-biscuits are the best ; Diet in Dyspepsia. 125 such as Huntly & Palmer's "Break- fast biscuits," and "Captain's bis- cuits;" Cracknell's; and Spiking's (Dover Street, Piccadilly) " Oval Cheese biscuits," and "Lunch bis- cuits." For breakfast there is one cold article of diet dyspeptics may take, and that is the fat of very good cold boiled bacon. The}^ may have this with toast. Tea is bad for the digestion, and the habit of drinking tea in the after- noon is an exceedingly objection- able one. It breaks up the proper interval between lunch and dinner, and gives the tea its best possible chance of working its evil effects on the stomach. Coffee is not so injurious to the digestion as tea. It rather assists the digestion of 126 Diet in Dyspepsia. fats which tea hinders. Though coffee has more tendency to cause headache, and with some persons flatulence and constipation, with others it assists the action of the bowels. Tea should never be taken without milk or cream, and it should never be strong, or taken after it has been made more than a few minutes. The teas of China are less in- jurious than those of India and Ceylon. Green teas are especially poisonous, and should never be taken under any circumstances. Cocoa possesses more of the nutrient and sustaining properties, and is less of a pure stimulant than either tea or coffee. Some object to it on that account, as they say they want a drink rather than a Diet in Dyspepsia. 127 food. This difficulty may be avoided by using some of the lighter forms of cocoa, as Epps' Cocoaine, an extract made from the nibs ; or the nibs themselves, or the shells may be used for making the beverage. When meat cannot be taken, beef-tea must be substituted. Mut- ton is more digestible than beef, because in beef the fat is more intermixed with the fibre of the meat, and the fat is more difficult to digest, and the fibre is harder. In cases where there is manifest ulceration of the stomach, koumiss is the best food. It may be given alone every hour or every two hours, until the pain and vomiting have ceased and other food can be 128 Diet in Dyspepsia. taken. When koumiss is not ob- tainable, milk and lime-water, or milk and soda-water may be sub- stituted. When dyspepsia is constitutional the particular constitution must be studied. Gouty patients should avoid all rich or highly-spiced foods, and eat little butter and milk except with tea or coffee. These should be taken not strong, and the tea only when freshly made. Meat should be taken once a day, never cold, and never cooked a second time. The less flatulent kinds of vegeta- bles are good, as French beans, spinach, young peas, also stewed celery. Potatoes should be avoided, and cabbage. Malt liquors, wines, Diet in Dyspepsia. 129 and spirits should be avoided. Water is the best drink at meals ; Salntaris water or toast water may be substituted. Hard water should be carefully avoided. Gouty pa- tients should drink freely of liquids. Those who have a tendency to rheumatism should observe most of the rules indicated for the gouty. Excess of meat and milk are not good. Oatmeal porridge should be taken at breakfast; at lunch or dinner, soup, meat from the joint, with vegetables, plain rice or other farinaceous pudding without eggs, and no fruit. Toast-water should be the drink with the meals. Fresh- water fish, and watery fruits and vegetables, must be avoided. For the psoric no special rules 130 Diet in Dyspepsia. can be laid down. They innst be dieted according to their symp- toms. The chilly " sycotic " patients mnst avoid all cold foods and watery foods, as the rheumatic. They may drink hot water, but never cold water. It will often be found beneficial to the circulation to sponge them every morning all over with spirit of wine before dressing. Fruit, milk, melons, mushrooms, hard-boiled eggs must be avoided. Oysters can sometimes be taken when nothing else can, and they contain a considerable amount of nourishment. They may be taken raw or cooked as desired. Pepsine and all the artificial di- gestives I do not like, except for short periods. The stomach is Diet i?i Dyspepsia. 131 ready enough to accommodate itself to inaction ; and when it finds the food put into it already pepton- ised, it will not trouble itself to se- crete any pepsine itself. Hence it falls into bad habits, and finally the artificial pepsine ceases to suit the patient, whose stomach is then really weaker than before the pep- sine was given. An exception must be made in favour of a preparation I have found very useful, namely, Bullock? s Acid Glycerine of Pepsine, a teaspoonful being mixed in half a tumbler of hot water, and drunk at meals as a beverage. This is very pleasant to take, as well as efficient. It must not, however, be used continu- ously. 132 Diet in Dyspepsia. Vitalia contains nourishment in the most concentrated form. It is valuable as a restorative and stimu- lant as well as a nutrient. Bovinine is another preparation of beef of great value. It is in a form to be absorbed almost imme- diately without digestive effort. Brand's beef jelly is the next best thing to good home-made beef- tea. Liebigh beef -tea is more of a stimulant than a nutrient. But if taken with biscuit it is nourishing. Among Milk preparations Hor- lic&s Malted Milk is one of the most valuable. It is in dry pow- dered form, and can be mixed with either hot or cold water, requiring no cooking. Diet in Dyspepsia. 133 The various invalid foods are almost all good. Neave's, Ridge's and Du Barry's Revalenta (which consists chiefly of lentil flour, and may be replaced by the lentil flour itself) have obtained well-deserved reputations. In dieting dyspestics the most important thing is the times of eating ; next in importance is the quantity they take, most dj^speptics taking either too much or too little; and last, and less important than either of these two, is the regula- tion of the quality. CHAPTER VII. MATERIA MEDICA. 'THERE is another way of classi- fying the different kinds of dyspepsia besides the one I have adopted above — that is, by taking the leading feature of each case. There are thus— flatulent dyspepsia, painful dyspepsia, acid dyspepsia, and many others. A division of this kind would cut through the classification I have already given, as examples of all these could be taken from any one of the kinds I have described. I have, therefore, decided to add this chapter of Materia Medica. 135 Materia Medica, giving under each drug the particular symptoms which indicate its use in indiges- tion. By looking through the list of drugs I have given, the various dys- pepsias — flatulent, acid, and the rest — will find their counterparts de- scribed. The medicines are ar- ranged in alphabetical order, and only those characteristic S3^mptoms which indicate the medicines in cases of dyspepsia are given. Dose, — Unless otherwise stated, the dose of each medicine named should be one drop in water or on a small piece of sugar, or two pilules, of the 3d attenuation. It should be taken about an hour or half an hour before each meal. Abies nigra, — Loss of appetite 136 Materia Medica. in the morning, but great craving for food at noon and night. Severe pain in the stomach after eating; sensation as if an undigested hard boiled egg were there. Actcza racemosa (also called Cimicifuga racemosa). — Great de- pression of spirits and feeling as if under a cloud. Severe head- ache, with aching in eyeballs. Un- pleasant taste in mouth, unpleasant breath, nausea, sinking faintness at pit of stomach, vomiting. Tea dyspepsia. Antimonium crudum. — Milky white tongue, or thickly coated tongue; eructations of wind, and fluid tasting of the food taken. Antimonium tartaricum. — Milky white tongue; nausea; vomiting and Materia Medica. 137 prostration ; tremulousness. Use- ful in the dyspepsia of drunkards. Argentum nitricum. — Flatulent dyspepsia — the flatulence coming away easily and in great quantity. Great pain and tenderness at the stomach-pit, the pain being worse after any food. Palpitation and short breath ; anaemia. This medi- cine is especially useful in anaemic girls, and also for flatulent dys- pepsia resulting from eating cold food. Threatened ulceration of the stomach. Arsenicum. — Irritable state of digestive mucous membrane. (Red tongue, or red with thin, white silvery coat) ; thirst ; burning pain at the stomach ; faintness ; nausea, and vomiting. The bowels are 10 138 Materia Medica. generally loose ; there is a low feverish state ; wasting ; anxiety ; restlessness. This medicine is useful in ulcera- tion of the stomach, and in all cases of irritative dyspepsia with great vital exhaustion and depression. Baptisia. — When there is great dulness and heaviness approaching the typhoid type, tongue foul, no appetite, often vomiting and diar- rhoea. The head is heavy, and the face has a heavy expression. This medicine is very useful in indiges- tion after overloading the stomach, and in those acute attacks of in- digestion with fever which used to be called " gastric fever " or "gastric attacks." Bryonia. — Feeling as of a stone Materia Medica. 139 at the pit of the stomach ; sharp pain going through from this region to the back ; pain between the shoulders or under one shoulder- blade ; pain across the forehead ; bilious vomiting ; white tongue ; constipation ; stools large and light- coloured in rheumatic patients. Bryonia is useful in many kinds of dyspepsia. An example has been given of its efficacy in the case of an arsenical dyspepsia. But its range is very wide, and any case presenting two or three of the above symptoms will be cured by the remedy. Calcarea carbonica 6. — Acid dys- pepsia ; everything turning to acid ; sour risings and eructations ; heart- burn ; waterbrash ; milk disagrees ; 140 Materia Medica. offensive white stools ; useful in almost all cases where acidity is the leading feature. It is often of remarkable service in those cases where dyspepsia is premonitory of consumption of the lungs. Carbo veg. 6. — Flatulent dys- pepsia ; great belching of wind ; cutting pains in the chest ; acidity ; bowels regular or loose ; gouty dys- pepsia. Carbo veg. is perhaps the most useful of all medicines in flatulent dyspepsia. The flatulence is chiefly in the stomach and passing away upwards. It is contrasted with Lycopodium, which has abdominal flatulence with constipation. Carbolic acid. — Acute dyspepsia; great flatulence, passing upwards ; Materia Medica. 141 pains in the chest and stomach after all food ; nausea ; vomiting ; depres- sion. There is usually a good deal of nervousness connected with the cases which call for Carbolic acid. It is good for nervous dyspepsia, i.e., dyspepsia where nervous symp- toms predominate. Chamomilla. — Fretfulness and irritability are the leading indica- tions for this remedy in whatever disease calls for it. It is especially called for in the dyspepsia of teeth- ing children. The special dyspeptic symptoms are: — Fulness of upper abdomen ; belching of wind ; press- ure at the stomach as from a stone ; burning at the stomach ; irritable gastralgia; windy colic; green, watery or mucous diarrhoea ; 142 Materia Medica. biliousness. Bitter taste in the mouth in the morning. Desire for acids, and thirst. China. — Dyspepsia after ex- hausting diseases or vicious habits; dyspepsia of nervous debility ; loss of appetite ; loathing of food ; shud- dering and chilliness ; heartburn ; pressure at the stomach; nausea ; vomiting ; pain in the liver ; light stools. When given in the tincture it lessens the craving for alcohol. Hydrastis Canadensis, — " Gone- ness " or sinking sensation after meals ; yellow slimy tongue ; sour or putrid eructations ; alternate diarrhoea and constipation. Ignatia. — Indigestion with nerv- ous symptoms ; sinking at the pit of the stomach ; sensation of a lump Materia Medica. 143 in the throat. When indigestion is brought on or aggravated by worry. Aggravation by tobacco smoke. Stomach symptoms generally re- lieved by eating. Hysterical symp- toms with indigestion. Iodine. — Dyspepsia with great wasting. The appetite may be ravenons or absent. In dyspepsia from nervous causes, where there is complete failure of appetite, if Iodine is given in 3 s strength for half to a quarter of an hour before meal-times, it will often enable the patient to eat. Ipecacuanha. — Sick dyspepsia ; constant nausea ; accumulation of saliva in the mouth ; loss of appe- tite ; sensation as if the stomach hung down relaxed. 144 Materia Medica. Kali bichromicum. — Indigestion alternating with rheumatic symp- toms ; vomiting ; gastritis ; chronic catarrh of the stomach ; tongue coated yellow, red beneath ; weight rather than pain after food ; dys- pepsia of beer drinkers. Lycopodium 6. — Flatulent disten- sion of the bowels ; flatulence pass- ing downwards ; rumbling ; cannot bear the pressure of the clothes ; waterbrash ; tongue coated white ; constipation ; urine depositing a sediment ; sleepiness after dinner in gouty patients. Mercurius solubilis 6. — Pale flabby tongue ; depraved taste ; foul breath ; light stools ; depres- sion of spirits. Natrum muriaticum 6. — Bitter Materia Medica. 145 taste in the month ; waterbrash ; heartburn ; chilliness ; palpitation after food ; anaemia ; constipation ; useful in anaemic girls ; also in youths who have indulged in evil habits. Nux vomica, — From indigesti- ble food ; from beer, wine, or spirits ; from tobacco ; from excesses of all kinds. Suited to spare, swarthy persons of irascible temperament ; tongue brown at the back ; cramp- ing or spasmodic pains ; flatulence ; vomiting ; constipation. Petroleum. — Constant sickness, and loathing of all food ; bilious vomiting ; breathlessness and bloodlessness ; " green sickness. " Plumbum 6.— Cramping contract- ing pains in body and limbs, with 11 146 Materia Medico, . indigestion. Obstinate constipa- tion with colic. Sensation of a ball rising up from the stomach into the throat. Pulsatilla. — From fat food ; mucous derangement ; thickly coated, moist, white tongue ; nausea with little vomiting ; heart- burn ; absence of much pain ; feeling of distension ; clothes have to be loosened ; bowels loose or regular ; suited to persons inclined to be stout, fair, and of a mild disposition. Sulphur.— -In chronic cases gen- erally, where dyspepsia has fol- lowed the disappearance of a skin eruption ; pressure and heaviness in the stomach after eating a little, and sour or empty eructations ; Materia Medica. 147 "sinking" sensation about 11 A. M. ; bitter taste in the mouth ; tongue coated white ; griping about the navel ; constipation ; rheumatic and gouty dyspepsia. Sulphur is complementary to Nux vomica, they often do well in alternation.