OF THE ALIMENTARY CANAL lis 



first appendicitis, then hyperchlorhydria, and thirdly 

 ulceration. 



Chronic dyspepsia is often the only complaint in 

 persons who have no hyperchlorhydria, show no 

 local symptoms of trouble in the appendix, but are 

 cured by removal of that organ. The majority of 

 patients diagnosed as gastric ulcer in the medical 

 wards of a hospital, and recovering without operation, 

 in all probability have no ulcer at all, but only reflex 

 gastric symptoms following on gall-stones, movable 

 kidney, or appendicitis. In 20 per cent of patients 

 with symptoms of gastric ulcer operated on at the 

 Bristol Royal Infirmary, no ulcer was found. Why 

 disease of the appendix, or gall-bladder, should cause 

 these symptoms it is difficult to decide. It can 

 scarcely be due to toxic absorption, as the appendix 

 may be quite fibrotic. Perhaps the simplest explana- 

 tion is that the ileocaecal sphincter remains tightly 

 closed and produces back-pressure. In other cases 

 there may be irregular gastric peristalsis and hyper- 

 cWorhydria as a nervous reflex. 



The treatment of hyperchlorhydria is as follows. 

 Medical means will often give a large measure of 

 relief. Taking food, and especially a hard-boiled 

 egg, when the pain comes on will generally abate the 

 symptoms. Alkalies are indicated, especially mag- 

 nesia, which has two advantages : it does not dis- 

 solve and exert all its effect in a few minutes, and it 

 does not give off carbon dioxide as the carbonates do. 

 The bismuth lozenges of the B.P. are convenient 

 to carry and very successful in stopping the dis- 

 comfort. We will barely mention such useful 



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