38 STUDIES IN DIGESTION 



In infants, Willcox and R. Miller have stated that 

 there are two types of dyspepsia causing pain, 

 wasting, vomiting, and constipation. One is con- 

 genital stenosis of the pylorus, in which the HC1 is 

 subnormal but the pepsin (which may be conveniently 

 tested by the curdling effect on milk) is excessive ; 

 and mucin is also in excess. The other is " acid 

 dyspepsia," in which the HC1 is excessive and the 

 ferments are subnormal. In this case peristaltic 

 waves may be seen, but the pyloric tumour is not 

 felt. The prognosis is very much better than in 

 congenital stenosis, and operation is not needed as 

 it so often is in the more serious condition. 



Enough has been said to show that hyperchlor- 

 hydria and its advertisement, " hunger-pain," are 

 more than an inconvenience to the patient ; they 

 are in many cases the consequence and in other cases 

 the precursor of serious organic mischief which may 

 lead to dilated stomach, to chronic gastric ulcer 

 which in its turn is very apt to become malignant 

 or to an abdominal catastrophe from perforation of 

 the stomach or duodenum. 



Medical means will often give a large measure of 

 jelief. 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 



