INDIGESTION, OR DYSPEPSIA. 363 



the tongue is red and has a raw appearance, and the general symptoms are those in- 

 dicative of a certain amount of irritation of the stomach, bismuth, either alone or in 

 combination with hydrocyanic acid, is the appropriate remedy. The ordinary dose of 

 carbonate of bismuth is fifteen grains, but a larger dose, say up to thirty grains, 

 may often be taken with advantage. It should be administered suspended in a 

 little water. "We have already given a formula for a mixture containing bismuth 

 (Pr. 18), and three minims of dilute hydrocyanic acid may be added to each 

 dose. Bismuth should always be taken about half an hour before meals ; it does 

 little or no good if taken on a full stomach. A dose should be taken every four 

 hours. It is especially indicated when nausea and vomiting are prominent 

 symptoms. Should bismuth not succeed, arsenic (Pr. 40) may be tried. A tea- 

 spoonful of the mixture may be taken four times a day, shortly before meals. 

 It is a valuable remedy, especially when there is an irritable condition of the 

 stomach or intestines. 



When the tongue is large and flabby, and the symptoms generally indicate want 

 of tone in the stomach, bitters are employed. Those most commonly used are the 

 infusions of gentian, quassia, calumba, cascarilla, chiretta, and chamomile, and perhaps 

 absinthe and hop. Quinine is not much used in stomach affections, unless loss of 

 appetite is the prominent symptom. Respecting the relative merits of the different 

 infusions, it may be stated that calumba appears to present certain sedative pro- 

 perties, and may often be administered when the others would be too irritating ; and 

 that gentian, in addition to its bitter properties, has also the advantage of being a 

 slight laxative. The dose of the different infusions is from two to four table-spoon- 

 fuls, and of the corresponding tinctures from one to two tea-spoonfuls. They should 

 be taken about half an hour before meals, the infusions alone, and the tinctures in a 

 wineglassful of water. The* infusions very rapidly decompose, especially in hot 

 weather ; but the tinctures, being prepared with spirit, will keep for almost any time. 

 If the infusions are used they should be freshly prepared ; there can be no greater 

 mistake than using medicines that are not of the best possible quality. 



Alkalies, as we have already seen, have a marked power of increasing the secre- 

 tion of the gastric juice. With this view, bicarbonate of soda is usually given in 

 fifteen-grain doses about half an hour before meals. It is best administered in com- 

 bination with one of the bitter infusions. We have already given a formula for a 

 gentian and soda mixture (JPr. 14), but cascarilla or calumba, or any other bitter 

 may be substituted for the gentian. Acids given about half an hour after a meal are 

 often a great aid to digestion. Weak hydrochloric acid is usually employed for this 

 purpose, it having been ascertained that the natural acidity of the gastric juice is due 

 to this substance. The acids, like the alkalies, are usually given with some bitter 

 infusion. The acid and gentian- mixture (Pr. 15) is a good formula, but the gentian 

 may, if thought desirable, be replaced by one of the other infusions. Acids, if given 

 before meals, lessen the secretion of gastric juice, and should consequently always be 

 given after food unless acidity is the prominent symptom. 



Pepsin enjoys a high reputation in the treatment of many forms of dyspepsia. 

 It is the active principle of the gastric juice both in man and many of the lower 

 animals. The pharmacopceial preparation is obtained from the stomach of the pig. 



