DYSPEPSIA. 555 



of castor (dose, 12 drops during the attack) has been much used, and 

 apparently with good effect. Metallic remedies also, particularly 

 nitrate of bismuth, nitrate of silver, cyanide of zinc, have been recom 

 mended in spasm of the stomach ; however, as they are scarcely ever 

 given alone, but are used in combination with narcotics, their efficacy 

 is problematical. Finally, Romberg recommends aiding the treatment 

 by applying belladonna or galbanum plasters over the stomach, or rub- 

 bing in a mixture of mixtura oleosa-balsamicae (| j) with tinotura 



CHAPTER X. 



DYSPEPSIA. 



IN the preceding chapters we have often spoken of dyspeptic symp- 

 toms, i. e., of signs of impaired digestion. Hence, while giving a sepa- 

 rate chapter to dyspepsia, we shall only speak of those disturbances of 

 digestion which arise without perceptible change of structure of the 

 stomach. The different forms of this dyspepsia may be included under 

 two heads : the digestion is impaired either because the gastric juice 

 secreted is of abnormal quality, or because the movements of the 

 stomach are diminished, and, consequently, the ingesta are not suffi' 

 ciently mixed with the gastric juice. Digestion, which is a purely 

 chemical process, can only be influenced by the nerves when they 

 modify the secretions, or the movements of the stomach, and only in 

 this sense is it proper to speak of nervous dyspepsia. 



The change in the gastric juice may be either qualitative or quan- 

 titative. We know very little about the qualitative changes. They 

 may consist in alteration of the proportion of the normal constituents 

 to each other ; thus we know that too slight an amount of free acid 

 weakens the solvent power of the gastric juice ; or in the fact that for- 

 eign substances are mixed with the gastric juice, such as urea in cases 

 of retention of urine ; or because, under certain circumstances, the con- 

 stitution of the gastric juice is totally changed, some constituents 

 being added and others disappearing. The symptoms caused by quali- 

 tative changes of the gastric juice are entirely unknown, and still less 

 do we know the remedies for treating the state in question. 



As to the quantitative changes of the gastric juice, the very un- 

 suitable name of " atonic indigestion " has been given to the symp- 

 toms induced, where the gastric juice is insufficient, or where it is not 

 sufficiently concentrated. In the etiology of gastric catarrh we men- 

 tioned that too scanty a secretion, or too poor a quality of the gastric 

 juice, existed in anaemic and chlorotic persons. We there explained 



