DYSPEPSIA (from the Gr. prefix Sur-, hard,

See also:

• ILL

ill, and 'irirreiv, to

See also:

• DIGEST

digest)  , or indigestion, a term vaguely given to a group of pathological symptoms . There are comparatively few diseases of any moment where some of the phenomena of dyspepsia are not present as associated symptoms, and not infrequently these exist to such a degree as to mask the real disease, of which they are only complications . This is especially the case in many organic diseases of the alimentary canal, in which the symptoms of dyspepsia are often the most prominent . In its restricted meaning, however (and it is to this that the present article applies), the term is used to describe a functional derangement of the natural process of digestion, apart from any structural change in the organs concerned in the act . The causes of this trouble may be divided into (a) those which concern the food, and (b) those which concern the organism . Among the causes connected with the food are not only the indulgence in indigestible articles of diet, but the too commonpractice of eating too much of what may be otherwise quite wholesome and digestible; and irregular, too frequent or too infrequent meals . The quantity of food required by different individuals varies between wide limits, but also the quantity required by the same individual varies considerably according to circumstances, more food being needed in cold than in warm weather, and more in an active open-air occupation than in a sedentary one . The thorough mastication of the food is a very important precursor of digestion,' and this only too often fails, either owing to haste over meals or because of painful or deficient teeth . Again, the quality of the food is of importance, some kinds of flesh being harder and more difficult of mastication than others . This is especially the case with meat that has been smoked or salted, and with that cooked too soon after the death of the animal . Drinks are a common source of dyspepsia . Beer when new and its fermentation not completed is especially bad .

Vinegar and acid wines, if taken in large quantities, tend to produce gastric catarrh, and tea is a very fruitful source of this trouble . Even too much water at meal-times may cause indigestion, since the food in the mouth is apt to be softened by the water instead of saliva, and also the gastric juice becomes unduly diluted, rendering the digestion in the stomach too slow and prolonged . Carious teeth and oral sepsis, from whatsoever cause, lead to the same trouble . Of the causes which concern the organism, nervous influences come first . Bad news may take away all power of digestion and even provoke vomiting, and any worry or mental trouble tends to bring on this condition . General weakness and atony of the body affects the stomach in like degree, and, if the muscles of the abdominal wall be much wasted, they become too weak to support the abdominal viscera in place . Hence results a general tendency for these organs to fall, giving rise to a condition of visceroptosis, of which an obstinate dyspepsia is a very marked feature . Adhesions of the intestines from old inflammatory troubles, floating kidney and bad circulation may each be a cause of painful digestion . Again, a dyspepsia that will not yield to treatment is often one of the symptoms of renal disease, or, in young people of fifteen to twenty years of age, it may be the earliest sign of a gouty diathesis, or even of a more serious condition still—incipient phthisis . Chronic dyspepsia, by weakening the organism, renders it more liable to fall a prey to the attacks of the tubercle bacillus, but, on the other hand, the tuberculous lesion in the lung is often accompanied by a most intractable form of dyspepsia . From this it is clear that any condition which lessens the general well-being of the organism as a whole, apart from its producing any permanent morbid condition in the stomach, may yet interfere with the normal digestive processes and so give rise to dyspepsia . The symptoms of dyspepsia, even when due to a like cause, are so numerous and diversified in different individuals that probably no description could exactly represent them as they occur in any given case .

All that can be here attempted is to mention some of the more prominent morbid phenomena usually present in greater or less degree . Very briefly, a furred

tongue, foul breath, disturbance of appetite, nausea and vomiting, oppression in the chest, pain, flatulence and distension, acidity, pyrosis and constipation or diarrhoea are a few of the commonest symptoms . When the attack is dependent on some error in diet, and the dyspepsia consequently more of an acute character, there is often pain followed with sickness and vomiting of the offensive matters, after which the patient soon regains his former healthy state . What are commonly known as " bilious attacks " are frequently of this character . In the more chronic cases of dyspepsia the symptoms are somewhat different . A sensation of discomfort comes on shortly after a meal, and is more of the nature of weight and distension in the stomach than of actual pain, although this too may be present . These feelings may come ' This aspect of the matter—" buccal digestion "—has been specially emphasized in recent years by Horace Fletcher of the United States, whose experience of the results of systematic " chewing," confirmed by Sir M . Foster, Prof . Chittenden and others, has almost revolutionized the science of dietetics . on after each meal, or only after certain meals, and they may arise irrespective of the kind of food taken, or only after certain articles of diet . As in most of such cases the food is long retained in the stomach, it is apt to undergo fermentive changes, one of the results of which is the accumulation of gases which cause flatulence and eructations of an acid or foul character . Occasionally quantities of hot, sour, tasteless or bitter fluidpyrosis—or mouthfuls of half-digested food, regurgitate from the stomach .

Temporary

relief may be obtained when another meal is taken, but soon the uncomfortable sensations return as before . The appetite may be craving or deficient, or desirous of abnormal kinds of food . The tongue registers the gastric condition with great delicacy: —a pasty white fur on the tongue is considered a sign of weakness or atony of the digestive tract; a clean pointed tongue with large papillae, and rather red at the edges and tip, is a sign of gastric irritation; and a pale flabby tongue suggests the need of stimulating treatment . Constipation is more common in the chronic forms of dyspepsia, diarrhoea in the acute . Numerous disagreeable and painful sensations in other parts are experienced, and are indeed often more distressing than the merely gastric symptoms . Pains in the chest, shortness of breathing, palpitation, headache, giddiness, affections of vision, coldness of the extremities, and general languor are common accompaniments of dyspepsia; while the nervous phenomena are specially troublesome in the form of sleeplessness, irritability, despondency and hypochondriasis . As regards treatment only a few general observations can he made . The careful arrangement of the diet is a matter of first importance . Quantity must be regulated by the digestive capabilities of the individual, his age, and the demands made upon his strength by work . There is little doubt that the danger is in most instances on the side of excess, and the rule which enjoins the cessation from eating before the appetite is satisfied is a safe one for dyspeptics . Due time, too, must be given for the digestion of a meal, and from four to six hours are in general required for this purpose . Long fasts, however, are nearly as hurtful as too frequent meals .

Of no less importance is the kind of food taken, and on this point those who suffer from indigestion must ever exercise the greatest care . It must be

borne in mind that idiosyncrasy often plays an important part in digestion, some persons being unable to partake without injury of sub-stances which are generally regarded as wholesome and digestible . In most cases it is found very helpful to separate the protein from the farinaceous food, and the more severe the dyspepsia the more thoroughly should this be done, only relaxing as the dyspepsia yields . No fluid should be drunk at meal-times, but from one to two tumblers of hot water should be drunk from an hour to an hour and a half before food . This washes any remnant of the last meal from the stomach, and also supplies material for the free secretion of saliva and gastric juice, thus promoting and accelerating digestion . The only exception to this is in the case of a dilated stomach, when it is wholly contra-indicated . With regard to mastication, Sir Andrew Clark's rule is a very good one, and is more easily followed than the ideal theory laid down by Horace Fletcher, according to whom any food is digestible if properly treated while still in the mouth . Clark's rule is that as the mouth normally contains thirty-two teeth, thirty-two bites should be given before the food is swallowed . This, of course, is a practical doctor's concession to human weakness . Mr Fletcher would train every one to " chew " till the contents of the mouth were swallowed by reflex action without deliberate act; and he applies this theory of mastication and salivation also to drinks (except water) . Again, a lack of warmth being a source of dyspepsia, this should be attended to, the back of the neck, the front of the abdomen and the feet being the parts that require special attention . The feet should be raised on a stool, the ankles protected with warm stockings and a woollen " cummerbund " wound two or three times round the body .

Experience has shown that in this complaint no particular kind of food or avoidance of food is absolutely to be relied on, but that in general the best diet is one of a mixed animal and vege-table kind, simply but well cooked . The partaking of many dishes, of highly-seasoned or salted meats, raw vegetables, newly-baked

bread, pastry and confectionery are all well-known common causes of dyspepsia, and should be avoided . When even the simple diet usually taken is found to disagree, it may be necessary to change it temporarily for a still lighter form, such as a milk diet, and that even in very moderate quantity . The employment of alcoholic stimulants to assist digestion is largely resorted to, both with and without medical advice . While it seems probable that in certain cases of atonic dyspepsia, particularly in the feeble and aged, the moderate administration of alcohol has the effect of stimulating the secretion of gastric juice, and is an important adjuvant to other remedies, the advantages of its habitual use as an aid to digestion by the young and otherwise healthy, is more than questionable, and it will generally be found that among them, those are least troubled with indigestion who abstain from it . Rest should be taken both before and after food, and general hygienic measures are highly important, since whatever improves the state of the health will have a favourable influence on digestion . Hence regular exercise in the open air, early rising and the cold bath are to be strongly recommended . The medicinal treatment of dyspepsia can only be undertaken by a physician, but the following is a very brief resume of the drugs he depends on to-day . Bicarbonate of soda with some bitter, as quassia, gentian or columba, is much in vogue as a direct gastric stimulant . In irritable dyspepsia some form of bismuth in solution or powder; and, to assist digestion through the nervous system, nux vomica and strychnine can be relied on . To give directly digestive material, hydrochloric acid, pepsin and rennet are prescribed in many forms, but where there is much vomiting ingluvin is more efficacious than pepsin . When farinaceous food is badly borne, diastase is helpful, given either before or with the meal .

To prevent fermentation, phenol, creasote and sulpho-carbolate of soda are all extremely useful in skilled hands; and for intestinal decomposition and flatulent distension, bismuth salicylate with salol or 0-naphthol is much used . Cyllin, and

charcoal in many forms, may be taken both for gastric and intestinal flatulence . But all these drugs, of proved value though they are, must be modified and combined to suit the special idiosyncrasy of the patient, and are therefore often worse than useless in inexperienced hands . The condition of the bowels must always have due attention . See also DIGESTIVE ORGANS; NUTRITION and DIETETICS .