558 DISEASES OF THE STOMACH. 



break them off gradually. If we break either of these precepts, 

 we may readily induce gastric catarrh or some other disease of the 

 stomach. 



Among the stomachics, which are indicated in the last-described 

 form of dyspepsia (well called "torpid indigestion"), rhubarb is the 

 best; it is given as powder or pills, or as the aqueous tincture ( 3 j), 

 but best as the vinous tincture (gtt. xx xxx). In torpid dyspepsia, 

 ipecac, (gr. J -J) has also a good reputation, particularly with English 

 physicians. Finally, the bitter medicines containing an ethereal oil 

 are good in torpid indigestion ; among the most popular remedies of 

 this class is elixir aurantiorum comp. (gtt. xxx xl). 



The dyspepsia of old persons also appears to be caused by too 

 scanty a secretion of gastric juice, which partly depends on a lack of 

 he materials necessary to its formation, and partly on diminished 

 excitability of the gastric nerves. It is difficult to decide- how far the 

 disturbance of digestion in this, as well as in the first-mentioned form 

 of dyspepsia, depends on bad nutrition of the muscles of the stomach ; 

 and it is sufficient to call attention to the fact that the retarded move- 

 ments of the stomach consequent on this deficient nutrition may lead 

 to incomplete mixture of the ingesta with the gastric juice, and hence 

 to dyspepsia. 



Abnormally-increased secretion of gastric juice does not cause dys- 

 pepsia, it is true ; nevertheless, we will here relate the symptoms that 

 it appears to excite, particularly when the stomach is empty. Vomit- 

 ing is seen to result from irritations which do not affect the walls of 

 the stomach itself, but neighboring organs, particularly the ureters or 

 the ductus choledochus, or even distant organs, as the uterus. This is 

 usually considered as depending simply on reflex movements. Budd, 

 however, in a spirited and striking manner, calls attention to the fact 

 that in such cases the nerves causing secretion of the gastric juice have 

 become more active from the reflex irritation. When Spattanzani 

 induced vomiting in himself before breakfast, by tickling the fauces, 

 he threw up an acid fluid, which dissolved meat ; this shows that 

 mechanical irritation gf the fauces may excite secretion of gastric 

 juice, even when the stomach is empty. Budd further says that, 

 where there is impaction of biliary or urinary calculi, the vomited 

 masses are often very acid, even when the stomach was previously 

 quite empty of food, and that the acid they contained was found by 

 Prout to be muriatic. This circumstance and the decided and rapid 

 removal of these gastric difficulties by alkaline remedies render it 

 probable to him that part of the pain, and perhaps also the vomiting, 

 depended on the irritation of the gastric mucous membrane by the 

 juice poured into the empty stomach. At all events, the urgent 



