554 DISEASES OF THE STOMACH. 



tliis, nutrition is little impaired in the latter disease, and, when the 

 neuralgia is not due to anaemia, the patient may look strong and 

 healthy. 3. Dysmenorrhoea, metrorrhagia, sterility, and other symp- 

 toms which betray affection of the sexual organs, as well as decided 

 chlorosis, render it probable that the affection is nervous in character; 

 but too much weight must not be attached to these symptoms, for it is 

 in just such cases that ulcer of the stomach is apt to occur. 4. The 

 simultaneous occurrence of other neuralgic affections speaks for a 

 similar nature in these attacks of pain. 5. Finally, genuine neuralgia 

 of the stomach is excited by unknown causes, and often occurs while 

 the stomach is empty ; the attacks of pain in ulcer of the stomach 

 almost always come after eating. 



PROGNOSIS. The prognosis is favorable in cardialgia dependent on 

 poverty of the blood, which is not due to cancer, tuberculosis, or some 

 other incurable disease. Those cases, also, that are caused by uterine 

 complaints disappear with the cure of the original disease, if this be 

 amenable to treatment. The prognosis is generally favorable, also, in 

 those cases resulting from the influence of malaria or arthritis. On 

 the other hand, treatment is almost always unavailing in the cases 

 depending on affections of the brain or spinal marrow, and in those 

 arising from unknown causes. 



TREATMENT. The indications from the cause require the energetic 

 and early employment of the preparations of iron in chlorotic and 

 anaemic cases. It is a great error to delay the use of iron in the treat- 

 ment of chlorosis until the stomach is prepared for it, and the cardialgic 

 attacks have passed away. The dyspepsia and cardialgia of chlorotic 

 patients do not yield sooner to any remedies than to those which 

 improve the state of the blood. The springs of Pyrmont, Driburg, 

 and Cudowa are wonderfully beneficial in this affection. Among the 

 officinal preparations of iron, the best is the ferri carbonas saccharata 

 (Br.). Blau&s pills are also an excellent prescription (see treatment 

 of chlorosis). In hysterical cardialgia, applications of leeches to the 

 os uteri, touching ulcers on it with nitrate of silver, and other treat- 

 ment, which we shall learn when speaking of uterine diseases, may be 

 indicated, and may have a striking effect. In cardialgia excited by 

 malaria or arthritis, the fulfilment of the causal indications answers for 

 the treatment of the original disease. 



The indications from the disease are best answered by the narcotics, 

 and, among these, acetate of morphia is preferable to the extracts of 

 hyoscyamus, belladonna, etc., which have also been recommended. 

 This remedy is usually given in combination with the so-called anti 

 spasmodics, particularly with valerian, asafcetida, and castoreum. Re- 

 cently, a mixture of equal parts of tincture of nux vomica and tincture 



