424 MATER i A ME DIG A AND THERAPEUTICS. 



dishes, which generally contain fats in various stages of chemical 

 decomposition. In extreme cases it may be necessary to ensure 

 the digestion of a mixture of the proximate principles of a healthy 

 diet, such as milk and bread or gruel, by peptonising them 

 with an extract of pancreas before they are eaten. Malt 

 extract, which supplies sugar in a form ready for absorption 

 and incapable of fermentation, will be suitable in some cases, 

 but attention must be paid to the time of its administration 

 with relation to meals. Next to the food, the therapeutist 

 will do wisely to attend carefully to the gastric functions, 

 remembering that it is in this way that he will most 

 rationally restore the chemical and physiological balance 

 in the upper part of the intestine. He may elect to give 

 an alkali shortly before meals to secure this end, or he 

 may prefer to administer acids after meals according to the 

 directions already given under the head of gastric digestion. 

 In the former instance he increases the acidity of the chyme 

 physiologically; in the latter instance by simple chemical 

 means. 



2. The immediate treatment of an attack of acute duodenal 

 dyspepsia will generally follow, as we have seen, upon the 

 treatment of acute indigestion in the stomach. We have 

 studied the beneficial effects of neutralising the excessive 

 acidity of gastric dyspepsia, by means of an alkali combined 

 with a carminative and stimulant, and it is obvious that this 

 will be continued after the chyme has left the stomach. When 

 treated with a full dose of Bicarbonate of Soda and Sal -volatile, 

 it enters the intestine with an acidity probably below the normal, 

 reduces the higher acidity of the irritant chyme already there, 

 and restores the normal action of the glands. If we are called 

 too late to relieve duodenal indigestion in this way, the most 

 rational course that we can adopt is to clear away the offending 

 contents by purgation. Magnesia or its Carbonate act well in 

 these cases, being immediately antacid, and afterwards 

 laxative. More frequently a simple cholagogue purgative 

 should be administered, such as Calomel, which has the 

 further advantage of not disturbing the stomach by its taste 

 or bulk. 



Any pain and excessive muscular movements (colic) which 

 may remain, must be treated by sedative remedies, such as 

 Opium or Bismuth. The treatment of diarrhoea and the use 

 of cholagogues and purgatives in chronic duodenal disorders, 

 must be reserved till the next chapter. 



