DYSPEPSIA (from ____-, and_____, to digest), or Indigestion, is one of the most common of all complaints, but, from its intimate connection with various other morbid conditions, the term is somewhat vaguely employed. There are comparatively few diseases of any moment where some of the phenomena of dyspepsia are not present as associated symptoms, and not unfrequently 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 brief notice 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 ailment are very numerous, but are generally regarded as bearing reference either to the food, the condition of the gastric juice, or the move-ments of the stomach during the process of digestion.
Among the causes connected with the food are not only the indulgence in indigestible articles of diet, but the too common practice of eating too much of what may be otherwise quite wholesome and digestible, irregular or too frequent meals, and imperfect mastication of the food. Substances which are badly cooked, or too hot or too cold, the excessive use of condiments, the partaking of too much liquid with a meal, and over indulgence in tea, tobacco, and alcoholic liquors are likewise fruitful sources of dyspepsia. Morbid states of the gastric juice readily give rise to dyspepsia. This fluid may be diminished in quantity, or be altered in character by the presence of too much acid, or by deficiency in its active digestive principle, pepsine. These conditions are often connected with actual disease of the mucous membrane of the stomach, but they may also exist in advanced life, in depraved states of the general health (as in rheumatism, gout, Bright's disease, anaemia, <fec), or in constitutions weakened by fatigue, over-anxiety, or debauchery. It must, however, be borne in mind that not only the gastric juice but the other digestive fluids, such as the saliva, bile, pancreatic and intestinal juices, may by defects in their amount or quality materially hinder the process of digestion. Further, dyspepsia may be the result of a perverted condition of the natural movements of the stomach during digestion,—whereby, on the one hand, owing to increased activity of its propulsive power, the food may be carried into the intestines in a half dissolved state, and give rise to many of the symptoms of indiges-tion, or, on the other hand, from a weakened or atonic state of the muscular coats of the stomach digestion may be retarded, and the food retained and excite discomfort and pain consequent on its undergoing fermentive and putre-factive changes.
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.
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 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, taste-less, or bitter fluid, or mouthfuls of half-digested food, regurgitate from the stomach. Temporary relief may be obtained when another meal is taken, but soon the uncom-fortable sensations return as before. The appetite is often diminished, but may be little impaired; the tongue is in general large and flabby, and more or less furred. In some forms of this complaint, however, particularly where there is great irritability of the stomach, the tongue is abnormally red. There is generally obstinate constipa-tion.
Numerous disagreeable and painful sensations in other parts are experienced, and are indeed often more dis-tressing 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.
A disease of this nature, interfering as it does with the assimilative and nutritive processes, must necessarily exert an evil influence on the general health, and there is reason to believe that many serious ailments owe their origin to persistent dyspepsia. This is notably the case as regards phthisis; for although dyspeptic symptoms often present themselves as complications induced by the disease, yet it cannot be doubted that long-continued indigestion, particularly in youth, must have the effect of favouring the occurrence of consumption in persons at all predisposed to it.
Dyspepsia appears to be in some cases hereditary. In its chronic form, this disease may long resist treatment, but it is always in some measure influenced by the diet and regimen and by the occupation of the patient. As a rule persons of sedentary pursuits and brain-workers suffer more from dyspepsia than those leading active lives.
As regards treatment only a few general observations can be 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. Every article of diet which past experience has proved to disagree should be shunned, since what may appear trifling indiscretions to this respect are often productive of great and prolonged suffering. The tables which have been framed to show the , relative digestibility of various kinds of food, and which have been founded largely on the observations of Dr Beaumont in the celebrated case of Alexis St Martin, are only valuable within certain limits when applied to the treatment of dyspepsia. It must be borne in mind that idiosyncrasy often plays an important part in digestion, some persons being unable to partake without injury of substances which are generally regarded as wholesome and digestible. Difficulty, too, is often experienced in dealing with dyspeptics from their aversion to, or want of appetite for, those forms of diet which appear most suitable for them. Experience has shown that in this complaint no particular kind of food is absolutely to be relied on, but that in general the best diet is one of a mixed animal and vegetable 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 a3 a milk diet, and that even in very moderate quantity.
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 remedies for dyspepsia are exceedingly numerous, and a few only of them can be mentioned. Attacks brought on by errors in diet are generally relieved by small doses of rhubarb and bismuth, and by the use of small quantities of light and bland food. In chronic dyspepsia the treatment must depend on the cause of the disorder, so far as that can be ascertained. When the dyspepsia is of the atonic form without much irritability of stomach, bitter tonics such as nux vomica, calumba, gentian, or quassia, along with some of the mineral acids taken before, with, or immediately after a meal will be found highly serviceable; while on the other hand, when there is gastric irritation with acid eructations, sickness, and pain, the medicinal hydrocyanic acid along with bismuth, and antacids taken after food will often afford relief. Pepsine is a remedy of undoubted value in many cases of dyspepsia, and appears to supply the place of that ingredi-ent of the gastric juice when it is deficient in amount. It may be given along with a meal, alone, or in conjunction with diluted hydrochloric acid, which also is a remedy of great efficacy in indigestion. Strict attention must ever be paid to the regular action of the bowels, and where laxa-tives are required an aloetic dinner pill, or, what is often better, one of the mineral bitter waters (such as that of Frederickshall) which are now so commonly used, should be had recourse to.
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. See PHYSIOLOGY and DIETETICS, (J.O.A.)