THE USE OF STOMACHICS. 411 



of cooking, of a digestive extract, made from the mucous 

 membrane of the stomach, or from the pancreas, of the calf 

 or pig. 



The therapeutist should endeavour, however, to adopt a 

 much less artificial method of treatment than this. He should 

 try to call into play some of the influences to which the gastric 

 flow is peculiarly sensitive, and thus to increase the natural 

 juice, instead of borrowing its constituents from other sources. 

 First, he will ensure a certain mechanical effect of the food on 

 the stomach, by seeing that " slops " are not indulged in, at 

 the same time remembering that a small quantity of a warm 

 nutritive fluid dish, such as soup, which will be quickly 

 absorbed and stimulate the follicles, is the best commencement of 

 a considerable meal. Drugs will also be prescribed. The most 

 powerful medicinal stimulants of gastric activity must reach 

 the stomach distinctly before meals. Those which increase the 

 activity of the nerves and vessels, and indirectly the activity of 

 the glands and muscles, namely alcoholic, aromatic, bitter 

 and pungent stomachics, are best given in combination, 

 e.g. the tinctures of Gentian, Orange, Cascarilla, Chiretta, 

 etc., variously combined with spirits such as Spiritus Ammoniae 

 Aromaticus, Spiritus Myristicae, Spiritus Armoracese, or 

 Spiritus Chloroform!. A still more powerful gastric stimulant 

 is to be combined with these, viz. an alkaline stomachic, in 

 the form of a preparation of Potash, Soda, or Ammonia, the 

 Bicarbonate of Soda being, for many reasons, the salt most 

 frequently selected. Let it be carefully noted that the alkali 

 must be given with the aromatic bitters, shortly before meals. 

 This constitutes the routine medicinal treatment of dyspepsia, 

 and we may repeat that the same result is obtained by 

 successful insalivation of the food, of which the method is but 

 an artificial imitation. The mental occupation and general 

 surroundings of the patient, as well as the times and amount 

 of physical exercise with relation to meals, will also require to 

 be carefully regulated. 



2. Immediate treatment. If acute dyspepsia be actually 

 present, it is too late to attempt to stimulate the gastric flow. 

 We must make our choice whether we shall evacuate the 

 stomach, or neutralise the acidity and absorb the gas which are 

 causing the distress. The use of emetics will be described in 

 the next chapter. If the alternative measure be chosen, we 

 give a dose of alkali or an alkaline earth not, let it be observed, 

 as an alkaline stomachic, but purely as an antacid to the contents 

 of the stomach. Bicarbonate of Soda is again the means com- 

 monly chosen for the purpose, combined probably with Carbonate 

 of Ammonia and an aromatic oil, such as Peppermint or Ginger, 



