DYSPEPSIA. 165 



selves, but to show how wide a chance there is for any 

 unskilled treatment to miss its end and do more harm 

 than good. 



Appetite is primarily due to a condition of the mucous 

 membrane of the stomach, which in health comes on after 

 a short fast and stimulates its 'sensory nerves ; and loss of 

 appetite may be due to any of several causes. The 

 stomach may be apathetic and lack its normal sensibility 

 so that the empty condition does not act, as it normally 

 does, as a sufficient excitant. When food is taken it is a 

 further stimulus and may be enough; in such cases "ap- 

 petite comes with eating." A bitter before a meal is useful 

 as an appetizer to patients of this sort. On the other 

 hand, the stomach may be too sensitive, and a voracious 

 appetite be felt before a meal, which is replaced by nausea, 

 or even vomiting, as soon as a few mouthfuls have been 

 swallowed ; the extra stimulus of the food then over- 

 stimulates the too irritable stomach, just as a draught 

 of mustard and warm water will a healthy one. The 

 proper treatment in such cases is a soothing one.* In 

 states of "general debility, when the stomach is too feeble 

 to secrete under any stimulation, the administration of 

 weak acids and artificially prepared pepsin is needed, so as 

 to supply gastric juice from outside until the improved 



Describe the symptoms of some chief forms of dyspepsia. 



* When food is taken it ought to stimulate the sensory gastric nerves, so as 

 to excite the reflex centres for the secretory nerves and for the dilatation of 

 the blood-vessels of the organ; if it does not, the gastric juice will be imper- 

 fectly secreted. In such cases one may stimulate the secretory nerves by weak 

 alkalies (p. 154), as apollinaris water or a little carbonate of soda, before 

 meals; or give drugs, as strychnine, which increase the irritability of reflex 

 nerve-centres. The vascular dilatation may be helped by warm drinks, and this 

 is probably the rationale of the glass of hot water after eating which has 

 recently been in vogue; the usual cup of hot coffee after dinner is a more 

 agreeable form of the same aid to digestion. 



