556 DISEASES OF THE STOMACH. 



that this anomaly increased the inclination to chronic catarrh of the 

 stomach, because, as the ingesta readily decomposed, their products 

 excited intense irritation of the mucous membrane. To what has been 

 said, we must add that the gastric mucous membrane is not affected in 

 all the cases where the contents are abnormally decomposed, and that 

 the cases where this membrane remains healthy should be carefully 

 distinguished from those where it becomes diseased. The symptoms 

 induced by restricted secretion of gastric juice are, it is true, frequently 

 similar to those occurring in chronic catarrh, and even to those of 

 chronic ulcer of the stomach. In this form of dyspepsia, also, the ap- 

 petite is less, or is satisfied after eating very little. After eating, the 

 epigastrium swells, and there is eructation of gases, or sour and rancid 

 liquids; the patients suffer from flatulence, and are disturbed and 

 anxious about their condition. Besides the nervous cardialgia occur- 

 ring in anaemic and chlorotic patients, the excessive formation of acid 

 may cause griping pain in the stomach (in the substances vomited by 

 chlorotic patients, Frerichs found acetic acid and quantities of yeast 

 fungus), and these cases may very readily be mistaken for chronic ulcer 

 of the stomach. The diagnosis of this form of dyspepsia depends 

 chiefly on the etiology. If the symptoms occur in chlorotic girls, about 

 the age of puberty, or in persons weakened by venereal excesses, par- 

 ticularly onanism, or in those exhausted by care and anxiety, by con- 

 tinued work, or night watching, or if they come during convalescence, 

 from protracted and exhausting diseases, and particularly if we can 

 find that the nutrition was impaired before the appearance of the 

 digestive difficulties, the chances are in favor of its being the so-called 

 atonic dyspepsia, and against the existence of structural change of the 

 stomach. 



The condition of the tongue gives another point in diagnosis. 

 While in chronic gastric catarrh there is a coated tongue and other 

 signs of oral catarrh, in the dyspepsia of anaemic patients the tongue 

 is usually clean, the taste unchanged, and there is no fetor from the 

 mouth. In many cases the diagnosis is decided by the effect of fast- 

 ing and of eating. Spiced and irritating substances, which increase 

 the difficulty in chronic catarrh and chronic ulcer of the stomach, are 

 well borne in atonic dyspepsia, and ease the painful symptoms which 

 accompany it. 



Above all, a mode of life that improves nutrition, the administra- 

 tion of iron, and sea-bathing, which have but little effect on chronic 

 gastric catarrh, or chronic ulcer of the stomach, produce most brilliant 

 results in dyspepsia dependent on anaemia or hydrsemia. In some of 

 these cases, particularly where the dyspepsia is accompanied by irrita- 

 oility or sensitiveness of the stomach, the pure bitters, such as quassia 



