DYSPEPSIA. 557 



or hops, are very serviceable. "We cannot explain the unmistakably 

 favorable influence of these remedies on the gastric mucous mem- 

 brane ; for, while they are very irritant to the gustatory nerves, they 

 have no effect when applied to the other mucous membranes, or to the 

 skin. Quassia is generally ordered as a cold infusion. In the evening 

 we may pour a cupful of cold water over about a teaspoonful of 

 quassia-chips ; by the next morning a bitter infusion will have formed, 

 which is to be drunk fasting, or else water may be left for a while in 

 a cup, turned from quassia-wood, and then drunk. Hop-bitter is gen- 

 erally used in the form of Bavarian beer, which is now brewed all over 

 Germany ; but we must take care that it comes from a trustworthy 

 brewery, where, instead of hops, some injurious substitute is not used. 

 The strong malt-extract, of which we previously spoke (page 246), has 

 proved very efficient, in my hands, in several cases of dyspepsia, char- 

 acterized by irritable indigestion. Occasionally it was almost the only 

 nourishment the patients bore. It is not improbable that the prepara- 

 tions of nux vomica, which have a great reputation as stomachics, act 

 like the above remedies, by their bitterness. The preparations most 

 used in dyspepsia are the aqueous extract (gr. -J 1), alcoholic extract 

 (gr. J J), and the tincture (gtt. x xii). 



Too scanty a secretion of gastric juice, and the symptoms depend- 

 ent on it, occur also in persons accustomed to great irritation of the 

 stomach, as soon as they change their mode of life, and take their food 

 without the addition of any stimulants. Unable as we are to explain 

 how an organ becomes accustomed to irritation, there is no doubt of 

 the fact. We may aptly compare the gastric mucous membrane of 

 persons who daily use quantities of pepper, mustard, and other spices, 

 to the nasal mucous membrane of habitual snuff-takers. In most per- 

 sons small quantities of snuff excite great reflex symptoms, when 

 taken into the nose, while the habitual snuff-taker can fill the nose 

 with snuff without sneezing. Moreover, the secretion of gastric juice 

 must be regarded as a reflex symptom, excited by the irritation of the 

 hjgesta on the mucous membrane. In the persons in question, the 

 irritation from ordinary food is insufficient to produce a sufficient sup 

 ply of gastric juice. Part of the ingesta remains undigested ; it is de- 

 composed, and we have the symptoms above described. If, on the 

 other hand, the food be taken with a strong addition of spices, the 

 patients do quite well, their nutrition goes on all right, and there is 

 nothing to induce us to think that they have chronic gastric catarrh, or 

 other organic change of the stomach, till finally symptoms occur which 

 prove that the stomach has not borne these insults without injury. We 

 must go very carefully to work in the treatment of these patients 

 we cannot allow them to retain their bad habits, but we should only 



