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The Dyspepsias of Southern India

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The Dyspepsias of Southern India Special Article INDIA* fills the pockets between the rugae. The THE DYSPEPSIAS OF SOUTHERN body of the stomach as a whole may be affected and v thus the By IAN M. ORR, m.d? f.r.c.s. (Edin.) acid-secreting glands which are-situated in the are London Mission Hospital, Neyyoor, Travancore mainly body seriously interfered with 1 with a resulting fall in free hydrochloric we aus acid,' * ^ ^le conditions which or the of ? the stomach is more only pyloric portion may m n are called on to deal with, nothing be affected and the manifold hydrochloric acid in the an in one of its or ^ysPePsia stomach remain normal we a to treat- high, i.e., have for*1111011-!??s- ^ew diseases are so resistant and an acid and hypoacid gastritis gastritis. n , so persistent in their symptoms, /Etiology.?This will be discussed more fully as do the use so much chronic invalidism below, but it may be said here that the come to our taking dyspeptics of over-spiced and indigestible food, and irreg- ZS?TlaS-& rooms and outpatient departments ular habits about meals all tend to exaggerate wo su, ulcer ^or sif?ns of duodenal it. Oral no doubt a we sepsis plays part. The i f to evidence of that, , failing find definite exhibition of certain drugs for periods also which nearly long escribe an alkaline mixture, predisposes towards it; e.g., sodium of com- salicylate, ways gives some measure temporary arsenic, silver, mercury and the disease quinine, copaiba. ^ sufferer, but leaves An atrophic form may be found in association a j iinl oca and untreated. with in fact it be ted, undiagnosed, on the malignant disease; may said do not to at length wish dwell that malignant disease of the stomach is always < ulcer, imhar subject of duodenal and gastric associated with atrophic gastritis and malignant * is Ce^ ^ar as the peculiar disease of other such as the : , so. pathology organs, colon ,ln, to deal with the south India. Nor do I wish etc., and rise to it rather I breast, they usually give by ause of acute abdominal but the of toxins from the pain, and absorption disintegrating ould call your attention to the interesting tumour. rise to symp- aried list of conditions that give Symptoms.?Discomfort and sensation of mainly by oms somewhat similar, characterized fullness which may amount to about one and whose pain pain, indigestion and flatulence, hour after food. Appetite is diminished, and so varied. a Pathology nevertheless is there is nausea, bad taste in the mouth, dizz- iness, regurgitation and flatulence. This is due Stomach to the lack of acid ' and all who allowing decomposition and *S n?^ gutters carbon dioxide formation. Hydrochloric acid is 1 and epigastric lave hunger pain, vomiting, diminished and mucus is found in excess in suffering from the enaerness, are not necessarily fasting juice. If the pyloric portion of the gastric or duodenal ulcer. stomach is alone affected the hydrochloric acid is the first and most Chronic gastritis.?This may be high. I would draw your common condition to which Treatment.?Remove all bad teeth, septic attention. and deal with sinus infection if of the stomach tonsils, any. Pathology.?The lining with an ounce to the which blocks the Lavage hydrogen peroxide, ecomes coated with mucus of serves to remove the mucus The deeper pint water, and mouth of the secreting glands. allows the to be secreted cells and in gastric juice freely. becomes infiltrated with round ayer undergo This may be repeated daily for a week or until an the cells of the glands extreme degree the mucus disappears. If there is hypoacidity, cloudy swelling and may atrophy. acid in water with become larger, give hydrochloric meals. A The ruga3 of the stomach tonic containing iron, arsenic and this may be demon- general strych- firmer and more tortuous; of nine may be but if not well tolerated a small meal given, by aj-ray, giving it be by by the walls the stomach may injected in ampoule stratedbarium and water only, and pressing barium just form. ?t the stomach together, so that the Diet.?Avoid hot curries, spices, raw fruit, shell fish. Take milk, barley water, congee * Paper read to the Travancore and Tinnevelly water, wheat, junket, chicken soup, Horlick's Medical Association on 10th March, 1935. 572 THE INDIAN MEDICAL GAZETTE [Oct., 1935 milk; later, go on to toasted bread and butter, A mixture containing magnesium and bismuth boiled eggs, white fish, rice. to neutralize the acidity and belladonna to Mention may be made of atrophic gastritis in inhibit secretion and relax the sphincter is indi- contradistinction to the above hypertrophic type. cated. Sodium bicarbonate is not deserving of This is chiefly associated with the more severe the popularity it enjoys, for, though it does anaemias and chronic venous congestion. In neutralize the acid at first, it then irritates the certain inborn errors also, hydrochloric acid may gastric mucous membrane, causing more acid, be absent. The most useful method of deter- and the formation of carbon dioxide and belch- mining whether or not an absence of free ing. hydrochloric acid is merely due to mucus block- (b) Gastro-succorrhoea {i.e., excessive secre- ing the ducts or to an inborn error is to inject tion but not a hyperacid one). 0.5 c.cm. of histamine*, and immediately hydro- It is common in students at examination chloric acid will be poured out in simple gas- times, in girls at puberty, etc. It is charac- tritis. terized by nausea, belching and vomiting of Nervous disorders of the stomach.?The ner- large quantities, for no particular reason. In vous system and, particularly, the mental states bad cases the patient may be cold with a slow of fear, worry, excitement, nervous exhaustion, pulse and sometimes headache due to stimula- etc., have a marked influence over the stomach. tion of the vagus. We have all experienced the pre-examination This condition has to be diffentiated from:? feeling of not wanting a big meal, because of a acute gastritis?vomited material alkaline; complete failure of our stomach to secrete its migraine?headache worse and vomitus daily quota of free hydrochloric acid. Or the bilious; feeling of heaviness in the pit of our stomach alcoholic gastritis?occurs in early morning when we are disappointed, ill at ease, or dis- after drinking bout and vomitus is mainly tressed. Now let us examine these nervous mucus. of the stomach. upsets Treatment.?Gastric lavage 1-2,000 silver (a) in Hyperchlorhydria.?A point physiology nitrate to promote mucus formation. Bella- is to understand. Stimulation of the important donna should be given internally. causes constriction of the and vagus sphincters (c) is found in outflow of This stimulation of Hypochlorhydria.?This gastric juice. people suffering from nervous breakdown or the vagus may be reflexed from gall stones or extreme nervous exhaustion; also in states of There is a from the appendix. lymphatic path fear. It may be an inborn error, or it may be to the duodenum and it has been appendix associated with one of the severe anaemias. demonstrated that chronic inflammation of the Symptoms.?Loss of appetite, sense of full- appendix causes a spasm of the pylorus, and ness, distaste for meat and there may be diar- an increase in free hydrochloric acid, a condition rhoea, the desire to go to stool occurring imme- favourable to the formation of gastric ulcer. after taking this is a reflex action A state of chronic nerve such as is diately food; strain, and is a common cause of chronic diarrhoea. common to men dealing in big business, is Treatment.?Give a diet rich in carbohydrate associated with hyperchlorhydria. Excessive in- and and poor in protein, the reverse in and have a condiments, dulgence pickles, spices smoking of the diet. Give an acid similar effect. is that the normal hyperchlorhydria My experience mixture with nux vomica and curve for the of south India is pepsin. acidity people id) Gastric is found in than for because of the exces- hypercesthesia.?This higher Europeans neurotic who of unusual sensa- sive stimulation of the mucosa hot people complain by curry tions in the of the and belch- stuffs. region epigastrium and describe their symptoms with a wealth are sensation of fullness ing, Symptoms.?These of detail which is apt to weary the physician. and discomfort in the epigastrium and belching. There is usually a completely normal test meal There may be epigastric tenderness. The test and ?-ray, but still the patient complains of meal reveals high acidity and yet the axray and tenderness and many other things, and shows no evidence of ulcer. pain positive vomit without relief. This is a pure Treatment consists in the may avoiding anxiety neurosis and must be treated removing the state if Avoid by possible. carbohydrates, espe- from the environment of and take boiled albumin patient sympathetic cially rice, meat, milk, friends. Sea bathing, interesting occupation, water, fish and green vegetables. Oily sub- toning the body by open-air exercise, massage stances have the effect of reducing the outflow or of the abdomen, and rubbing with spirit of gastric juice and relaxing the sphincter. Such a patient will not be satisfied Hence olive butter and cream should be camphor. oil, without and a tonic containing taken. medicine, general dilute phosphoric acid, tincture of nux vomica and peppermint water will convince him that * he is treated. The usual dos? of histamine is 0.0005 gramme, so being that the author is presumably referring to a solution One might mention here that belching which is a containing 1 mgm.
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