There are several disorders referable to the stomach and its functions that do not present organic lesions. They are traced directly to disorder of the nervous system, to deficient, altered or perverted nerve supply. Some of these so closely resemble rare lesions that it is with difficulty that a differential diagnosis can be made. Careless diagnosticians are in danger of classing the real lesion, when obscure and difficult of confirmation, as a neurosis. On the other hand, it is not uncommon practice to treat the lesion as local, and entirely overlook the fact that the nervous system alone is at fault. There are times, when the actual condition cannot be assured, that it is far safer to treat both the local condition and the nervous system also.
We must consider inefficient action of the stomach as due to inefficient supply of nerve force. This is the case in neurasthenic patients. This may result also in perverted functional action, as described in several conditions hereafter considered.
In other cases there is actual disease in the central nervous system. In yet other cases the action of the nerves of the stomach may be perverted or irritated by development of tumors or other growths in adjacent tissues or structures. A common cause of pain which may recur at intervals, and which may be- invariably referred to the stomach, may be due to organic disease elsewhere.
Note:—I have given the treatment of those neuroses, which, while local, have a more general influence, in the article. The treatment of all of those in which the influence is local, is considered under the one head, on page 138.
Synonyms:—Gastric neurasthenia; neurasthenia gastrica.
Definition:—A functional disorder of the stomach, resulting from insufficient nerve force, characterized by either regularly recurring attacks of pain and eructation of gas, or attacks, erratic in character, occurring when the patient is exhausted, or when there is irritability of the nervous system, or by the absence of such symptoms when the patient is quiet and restful. While there are no organic lesions at the onset, persistency of functional derangement, especially of hyperacidity, may ultimately induce them.
Etiology:—This condition results from general or local neurasthenia. It may be temporarily induced by persistent exhausting mental labor, by extreme anxiety, or great grief, or uncontrolled anger, social excesses, or sexual excesses and dissipation. While the condition is common in highly emotional or hysterical patients—those who do not exercise self-control—it is found quite commonly among those who are apparently in good health and well nourished, with an absence of constitutional or organic disease. At other times the condition results from causes reflex in character. It has been observed in patients suffering from nasal polypi, or from other chronic disease of the nose, throat or of the ears. It follows or accompanies ovarian or uterine irritation, or phymosis, piles or rectal fistulse.
Symptomatology:—Usually the symptoms are similar to those of chronic gastric catarrh, the hyperacidity, local tenderness, eructations of gas and discomfort from food in any form being the most common. However, all symptoms vary with the cases. In some patients the food will digest within the proper time, and will be properly absorbed. There will be found no changes in the gastric fluids, and yet the patient will complain of great discomfort. In other cases, with no discomfort at first, there will be very imperfect digestion and ultimately eructations of gas, which may interfere with the action of the heart and induce palpitation. In yet other cases the symptoms may all be acute, and immediately follow the hearing of bad news, sudden grief, anger or intense anxiety.
Sudden vomiting may be induced, with some prostration and perhaps severe cramping pain in the abdomen, with diarrhea. Occasionally the symptoms are only those of increased peristalsis, in which the patient may have an immediate bowel movement. In an occasional case gastric peristalsis may be plainly apparent upon physical examination.
The repeated occurrence of this condition results in impairment of the health, and after two or three attacks there is an inclination to a return of the condition at progressively shortening intervals. These patients have usually but little appetite and are inclined to eat at irregular times or with irregular intervals between the meals. They complain much of eructations of acid liquids, and occasionally there is simple regurgitation of the food.
Diagnosis:—The diagnosis depends upon the exclusion of organic disease and upon the presence of a more or less weakened condition of the nervous system, usually with a neurotic tendency, or it depends upon the presence of a reflex cause, for the disturbance.
Prognosis:—This depends upon the ability to remove the cause of the disease. Serious results seldom occur. Treatment of the gastric condition alone will postpone the development of the trouble, especially in those cases where the cause is reflex and obscure, but constitutional measures will be found necessary in nearly all cases.
Treatment:—No class of cases should have a more thorough examination to determine the exact cause of the condition than this. I am impressed that only in a very small percentage of the cases will it be found that the nervous system is not involved. Primary restoration will be found imperative. The patient must be removed from mental anxiety and overwork to congenial and pleasant surroundings—to a condition in every way desirable to the patient. He must have long hours of rest and sleep with abundance of outdoor exercise. There must be no excesses of any kind, and alcohol and tobacco must be excluded. As sexual neurasthenia is a common cause, this must be inquired into at the onset, and clear instructions must be given in overcoming this condition. If the patient suffers from despondency, the physician must at once establish his confidence in an ultimate complete cure. With young men mental anxiety from spermatorrhea, especially if there has been previous masturbation, is a very common cause.
A generous, highly nutritious diet is essential, but at first some care must be exercised in the adjustment of the food; later it will be found, if the patient eats slowly and masticates the food thoroughly, that a reasonably extensive diet can be permitted. There are times when a single article of diet will seem to disturb the stomach, when later this article is craved and can be eaten with impunity. Usually it is best to give a light breakfast and an early dinner. This dinner may consist of well cooked meats, one vegetable, and a custard or ice-cream for dessert. The supper should be light and of some concentrated, easily digested food.
I am in the habit of beginning the treatment with direct nerve tonics. I administer the phosphates or the hypophosphites, or phosphoric acid, as the exact condition of the stomach seems to demand. At the same time small doses of nux vomica will usually exercise a beneficial influence which is in harmony with the nutritional effects of the above. Hydrastis canadensis is also a superb nerve tonic. It not only influences the nutrition of the central nervous system, but it restores the tone of the nerves distributed to the stomach, and soothes irritability of the terminal filaments of the sympathetic, which may cause reflex irritation. Later more stimulating tonics may be given, with iron. The condition of the intestinal canal, liver and kidneys must by no means be overlooked.
Spasm of the pylorus is a condition to be looked for in hysterical cases. This may be present, with or without spasm of the cardiac orifice. In either case from ten to fifteen drops of the tincture of lobelia seed should be added to four ounces of water, and a teaspoonful of this, given every twenty or thirty minutes. Small doses of colocynth will act similarly to lobelia. In other cases twenty drops of dioscorea may be given in an ounce of hot water. This will overcome spasmodic conditions of the stomach and will counteract the tendency to extreme peristaltic action. Decomposition of food may be antagonized with charcoal tablets, or with five grains of the sulphite or the hyposulphite of sodium. To relieve nausea and vomiting in reflex cases I have obtained better results from ingluvin or from a mixture of equal parts of ingluvin and subnitrate of bismuth. Other measures will be indicated by the exact symptomatology of the individual case.
Synonyms:—Gastric neuralgia; neuralgia of the stomach; gastrodynia; cardialgia.
Definition:—A sudden paroxysm of extreme pain, resembling that of gall-stone or renal colic, located in the stomach, but accompanied with no gastric lesion.
Etiology:—This disorder is probably due to irritation of the terminal filaments of the gastric nerves. The cause may be local, or it may be remote and thus reflex, or it may be secondarily reflex; that is, it may be caused by a condition which is itself the result of reflex irritation. Those attacked are usually of a neurotic type, highly emotional, hysterical, anemic or neurasthenic, possessed of an irritable nervous system. It is rarely brought on by incorrect diet or hyperacidity, but if so, this is the exciting cause only for the time being. At times it is relieved by the taking of food. It may be induced also by hypochondriasis, deep grief, anger, worry or intense anxiety, or any sudden or severe nervous shock.
It is more common in females than in males, and occurs during the child-bearing period, and at the menopause. Disorders of the menstrual function or uterine or ovarian irritation are common causes. At times it is distinctly periodic in appearance, and may be classed with malarial or periodic neuralgias, especially as it is amenable, to a degree, to antiperiodic treatment. It may occur also in men who are addicted to alcoholics and tobacco.
Symptomatology:—The pain, extremely severe or agonizing in character, has almost no prodromata. It is usually unannounced. It occurs suddenly and may itself produce a shock to the nervous system. It is at once located in the stomach, and may extend through to the back and radiate outward over the lower part of the chest, or around the borders of the ribs and downward to the abdomen. The pain is sharp and cutting or lancinating in character, and may last from a few minutes to perhaps two hours, leaving the patient anxious and exhausted. It may terminate with nausea and vomiting or free eructations of gas. Brief attacks may leave the patient in his usual condition. The patient may be relieved by firm, steady pressure, and as it usually occurs when the stomach is empty, some carefully selected, non-irritating food may also relieve it. With the appearance of the pain in hysterical or highly irritable patients a considerable train of nervous symptoms may appear, which must be attributed to the actual underlying condition as the real cause.
Diagnosis:—Organic disease may be quite readily excluded. There have usually been similar previous attacks, the history of which the patient takes apparent pleasure in relating. These have left no local disorder. The sudden paroxysm and the character of the pain are diagnostic. It must be distinguished from bilious colic, from distention from gas, from the acute pain of gastric ulcer, and from the gastric crises of locomotor ataxia.
Prognosis:—The prognosis as to recovery from the attack is good. As to the prevention of future attacks, the prognosis depends upon the possibility of determining the character of the cause and its removal.
Treatment:—For immediate relief of the pain in mild cases ten drops of chloroform, or this amount of chloroform and five drops of the tincture of aconite, may be poured into the palm of the hand and held over the pit of the stomach, with the hand pressed firmly flat against the skin until it induces an extreme burning sensation. The effect, if favorable, is immediate. At other times a large hot mustard poultice alone over the entire epigastric region, or one over the stomach and another across the middle of the back, will relieve the pain. When the pain is radiating in character and accompanied with some diffused soreness, from fifteen to thirty drops of specific dioscorea in hot water will relieve it. This may be repeated every fifteen minutes for a few doses. If it will prove beneficial at all, it will act almost immediately. Occasionally ten drops of gelsemium at the onset will stop the pain, or a single full dose of lobelia. If there is gaseous distention, colocynth and peppermint, or a few drops of turpentine, will relieve the pain. In cases where the onset is abrupt and the pain excruciating, there should be no hesitancy in administering one-fourth of a grain of morphin hypodermically. In some hysterical cases an idiosyncrasy against this remedy may exist, which must be inquired into, and if known, the remedy must be avoided. In strong men a half grain of morphin may be given at the first, or one-fourth of a grain may be repeated in half an hour. Prof. Whitford relieves this variety of neuralgia with full doses of belladonna, about five drops of a good fluid extract, and ten grains of ammonium chlorid at each dose. In extreme cases three doses may be given an hour apart.
In the absence of an attack the patient must be treated with reference to the permanent removal of all causal conditions whatsoever. The nervous system must be built up and enforced by the best known measures. Thisr is the only correct foundation for a permanent cure. Every source of reflex irritation must be relieved, whether it be in the nervous system, in the liver, kidneys, ovaries, uterus, or in the intestinal tract or rectum. Menstrual derangements will be best treated by our direct uterine regulators, and by local measures. Dr. Woodward has cured his cases during the menopause by frequently washing the uterine cavity with hydrogen peroxid and a mild antiseptic, according to his method. The course is simple and mild, but efficient. Surgical measures must not be neglected when indicated.
In hysterical patients with amenorrhea, pulsatilla will be indicated. When there is muscular relaxation and muscular soreness, cimicifuga must be given. Helonias will relieve those who complain of dragging pains in the lower abdomen.
Where there is lithemia or a rheumatic tendency, cimicifuga, bryonia, rhus toxicodendron and gelsemium will be of benefit, according to their several indications. When periodicity suggests malaria as the cause, this must be carefully treated with quinin, leptandrin, iris, gelsemium, and other remedies which may be indicated. In one of my cases, where the pain was referred to the abdomen, I produced a cure by frequent small doses of ammonium chlorid, given with one-sixteenth of a grain of morphin. The use of the galvanic current, or the faradic current, if the cause is rheumatic in character, or vibration, will be found of signal service in an occasional case, often resulting in a complete cure. I first stated that at the onset the nervous system must receive first and careful attention and must be freely restored and relieved of all irritation; this must not be overlooked.
Definition:—A condition in which there is an over-secretion of the free hydrochloric acid of the gastric juice.
Etiology:—It is a result of disorder of the nervous system, and is caused by the conditions named as the causes of nervous dyspepsia. It is common in the large cities, among the brain workers of the learned professions, those especially who confine themselves closely to their business, who are of sedentary habits, and who neglect physical and outdoor exercise. The exciting cause may be the habits of using alcohol and tobacco, and the use of highly seasoned food or food difficult of digestion, eaten at irregular hours and in irregular quantities, or over eating.
Symptomatology:—The condition occurs at first within half an hour or an hour after the taking of food. It is accompanied with a sensation of heat or burning in the stomach, and with the eructation of sour gas or acid liquids. I have observed increased tenderness of the stomach in most cases. It causes a burning sensation in the throat, which may be continuous while the acid fluid is in the stomach. It causes local distress, and often severe pain, dizziness, nausea, disturbed vision, and extreme general discomfort, malaise, and frequently, headache, which is in some cases invariably preceded by the vertigo and disordered vision. This condition retards the digestion of starches and facilitates the digestion of albumenoids, which may be administered to diminish the pain. It does not prevent digestion, but delays it and produces unpleasant symptoms during digestion. It does not necessarily interfere with the general nutrition of the patient. After the chyle has escaped from the stomach there is no further disturbance until after the next meal. Early in the case, this may last for a few days and then disappear, to recur after a period of from six to fourteen days. After the condition has continued in this manner for a considerable period, it may become persistent, and there is no time that the condition is absent at the time of the digestion, and in some cases the stomach is not free from an excess of acid fluids after the digestion is complete. In those cases which Reichman describes as gastro-succorrhea, there is a considerable quantity of acid fluid in the stomach at all times, resulting in anorexia, irregular severe vomiting, extreme headache and prostration. This condition in some form is a direct cause of, or is present at some time during the continuance of most of the digestive disorders and of the gastric neuroses, which have been previously described.
Treatment:—I have described elsewhere the usual indications for the treatment of gastric acidity, but this variety suggests a course somewhat different from that usually prescribed.
The use of sodium and potassium preparations to neutralize the excessive acidity is common practice, and while it is usually at least temporarily successful, there is a question in most cases of its permanently beneficial influence. Foreign writers and eminent authorities in this country claim that an efficient method with which to prevent the hypersecretion of hydrochloric acid is the administration of reasonable doses of this acid as a medicine, well diluted, thirty minutes before each meal. Others suggest nitric acid in the same manner for this purpose. Medicines have been disappointing in many cases. I have been impressed that the use of nerve sedatives is often of much efficacy, as nerve irritation is an almost constant concomitant symptom. I have given bromid of sodium in ten grain doses, and have advised a similar dose of bromid of strontium.
Two of our physicians have advised me that they succeeded well in this condition with small doses of from five to ten minims, every three or four hours, of passiflora. Ten drops of eupatorium perfoliatum, or twenty drops of oenothera biennis every two hours, or five drops of berberis every two hours, will be of service. These remedies are all calculated to relieve irritability of the peripheries of the gastric nerves. Small doses of aconite will sometimes be found serviceable, and the free use of bismuth subnitrate is suggested. Prof. Whitford's formula as given in chronic gastritis will be of material benefit in these cases.
There is a class of cases where the tongue is pointed and thin, with a red tip, that will be benefited by the use of rhus in one-fourth drop doses every three or four hours.
Starchy foods, especially oatmeal, should be restricted; prepared breakfast foods, malted food, lean meat, taken dry usually, with eggs and milk, will be more easily digested. Some of the non-acid fruits will be very acceptable. Oranges usually are easily digested.
Spasm of the muscular fibers at the cardiac orifice of the stomach may occur, as it usually does, as a sudden, acute, violent cramp, accompanied with extreme pain. Or it may appear in a chronic form, although this is not common. This condition may be due to irritation from disease of the mucous membranes of the stomach or from excessive acidity, or it may result from distention of the stomach from the accumulation of gas, but there is always an underlying nervous irritability. The effect of the spasm may remain after the pain is relieved, in at least an apparent muscular rigidity or imperfect muscular action, from which the patient complains of difficulty in swallowing, believing that the food, at least in part, remains in the esophagus and does not pass into the stomach. In some cases this condition actually occurs, and when the food has accumulated to a considerable quantity, it is regurgitated.
There is a tendency to recurrence of the spasm, and the atresia which results becomes a serious affection. There is emaciation from inability to take food, and in some cases disease of the stomach results. While there is a neurosis in all of these cases, there is a form of cardiac spasm which is purely reflex or exclusively of nervous origin.
Spasm of the pylorus is similar in character to that of the cardia, but occurs probably with greater frequency. It is seldom that it occurs as a primary disorder. It is secondary to local irritation in the stomach, irritation from undigested food, hyperacidity or hypersecretion.
While nervous irritability usually underlies this difficulty, the condition is induced by anything which draws largely upon the system, as mental strain, anxiety, worry, sexual excess, and menorrhagia or metrorrhagia, or prolonged lactation. It occurs also in anemia, and especially with chlorotic girls, and accompanies some forms of hysteria. I am convinced that it occurs also from the excessive use of tea and coffee, as well as in alcoholics and inveterate tobacco users.
Kussmaul described a condition of constant peristaltic movement on the part of the muscles of the stomach which he designates as peristaltic unrest. This is actually a spasm of the muscular structure of the stomach walls. It occurs also when there is dilatation of this wall following stricture of the pylorus, as in cancer. Usually the condition is most active after meals, but it will continue when the food is digested and the stomach is empty, often plainly apparent during the night. It does not usually induce severe pain, at times even a great degree of distress is not present, but the sensation of constant movement is productive of much discomfort. The movement occurs from the left to the right, is wavelike in character and can be felt through the stomach walls. In an exceptional case this spasm will be so severe as to expel food immediately it is taken into the stomach.
Reflex irritation is the first cause of this condition. Pyloric stricture is the next most common exciting cause, and gastric hyperacidity will be found to be the next in order. Underlying the whole there is usually a neurosis more or less remote.
In any condition where vomiting is present the influence of the nervous system is estimated. It will be only necessary to group the various forms of nervous vomiting under this head, as most of the conditions will be found considered elsewhere.
Vomiting induced from reflex causes, with no lesion of the stomach as a primary cause, is the condition here considered. It usually occurs without previous nausea, and does not occur from presence of the food. Those common forms are hysterical vomiting, the vomiting of pregnancy and seasickness. While sick headache is a form of nervous vomiting, the nervous irritation is usually induced by gastric hyperacidity, or stomach or intestinal disturbance. Nervous vomiting may also occur from severe injury or pain in some other organ, or in a remote part of the body. It may also occur from shock, sudden grief or severe mental strain. Injury to the brain and convulsions from nerve irritation induce vomiting. Chronic brain disease or the development of tumor in the brain will cause frequent vomiting. The passage of a gall stone or a renal stone will induce vomiting, and it is sometimes present in Bright's disease. There is a condition of autointoxication which results in a form of vomiting known as cyclic vomiting, of a most severe and persistent type, sometimes with great difficulty controlled, if at all. An extreme acid condition of the fluids of the body, and diacetic acid and acetone are found present in the urine before the attack. This latter form is readily relieved by the administration of an active alkaline remedy, which neutralizes the acidity and thus confirms the diagnosis of acid intoxication.
In nervous vomiting there is usually less muscular effort, less violence, than in vomiting from strictly local gastric causes. The food is returned without nausea and with no great degree of discomfort. Occasionally certain articles of food only will be vomited; at other times the patient, having made up her mind that a certain article of diet will cause neausea, it will be found that vomiting will follow the taking of that article at all times.
Nervous eructations of gas or air, independent of marked fermentative changes in the stomach, occur irregularly, often at the will of the patient, and are noisy and persistent. Often the air that is belched is swallowed by the patient, and is expelled by voluntary muscular contraction. There is usually no odor with this expulsion and often there is no discomfort. Occasionally, when the muscles of the cardia are not readily controllable, gastric distention, palpitation, discomfort or pain and anxiety may occur.
This condition occurs both as the result of organic disease and as a neurosis not uncommon among hysterical patients and chlorotic girls. There is a constant sensation of soreness or tenderness in the stomach, or a sensation of gnawing or burning. This increases to acute pain upon the taking of any food, and sometimes upon the taking of fluids into the stomach. Where the condition is purely nervous in character, it may be relieved by taking food, and increased by fasting. During the process of digestion it is usually increased. The patients are usually neurasthenics, or they may be hysterical, or epileptics.
This condition is usually classed as atony of the stomach. The condition of deficient or imperfect peristalsis is included in this, with relaxation of the pylorus, muscular insufficiency of the cardia, and a form of dyspepsia, in which the chyme remains in the stomach after a period of very slow digestion. This results in a sensation of oppression. The stomach is distended and there are eructations of gas. There is anorexia and constipation. In relaxation of the pylorus the contents of the stomach pass into the duodenum in a state of partial digestion, or the contents of the duodenum may be regurgitated into the stomach. The condition is a rare one, and depends upon general debility, or upon general nervous debility. It also occurs with some forms of paralysis, and may be due to partial paralysis of the gastric nerve.
This condition is erroneously classed by most writers with vomiting. In simple regurgitation, the food returns by a simple reversal of peristaltic action, with no nausea and no violent muscular spasm. It should be divided into two classes: (a) That which is involuntary and uncontrollable, and (b) that which is voluntary—a condition which is known as merycism or rumination. In this form the food may be returned to the mouth and remasticated, as is the habit of ruminant animals. It is common to hysterical patients, those of feeble mentality, and epileptics. It is disgusting in the extreme, but does not in any way materially affect the patient's health.
The involuntary form is common to patients suffering from prolonged neurasthenia, especially those who have a tendency toward hysteria.
Treatment of Gastric Neuroses:—Local measures will serve a partial purpose only in the treatment of these conditions. They must be selected with much care, in accordance with the exact indications. General treatment—constitutional measures—are in every case essential, as it is only through such a course, carefully adjusted, that an ultimate cure is obtained.
The course suggested in neurasthenia will be the underlying course in most of these cases. The patient should be taken entirely away from his everyday surroundings, should have a complete change of air and environment, all causes of worry, anxiety, responsibility or grief should be removed, and everything done which will conduce to his happiness and comfort. Some course of out-of-door exercise must be planned for each day, so that the patient shall have physical exercise without being aware that it is imperative, because these patients are apt to be sedentary in their habits and are averse to physical exercise of any character. Walking, some mountain climbing, horseback riding, surf bathing, croquet, tennis or golf playing are all means to the desired end. Where the patient is of very irritable disposition and inclined to insomnia, he should spend for a time one or two days of each week in bed, with congenial surroundings.
The use of mechanical therapeutics, as massage, vibration and osteopathic treatment, with electricity properly applied, are all capable of assisting in the promotion of a cure. The patient should have regular hours for sleep, and should also be encouraged to take a nap after dinner.
The food must be selected with great care, and must be carefully adjusted to each case. Concentrated nitrogenous foods are sometimes the very best that can be taken. These should be administered in small quantities at regular intervals, and usually an artificial digestive should accompany the food. However, I have observed many cases in which I have obtained the most desirable results by an exclusively vegetable diet, permitting only butter and a limited quantity of milk.
The general medicinal treatment will consist of the syrups of the phosphates in some concentrated form, or the syrups of the hypophosphites or glycero phosphates. When there is excessive acidity, these should be all non-acid. Where there is a deficiency of acids, the acid phosphate, or an acid syrup of the phosphates, or phosphoric acid, will act in a satisfactory manner. I have given a phosphorized elixir of calisaya bark and pyrophosphate of iron in a large number of my cases, with good results. Where there is much emaciation and debility, an emulsion of cod-liver oil with the hypophosphites should be given, and if there is a tendency to general organic atonicity, strychnin should be added for periods of two weeks, at least, in each month. Recourse may be had to any of the upbuilding tonic remedies, and I have observed that if they be given in conjunction with a nerve sedative—such as small doses of either bromid of sodium or strontium, or the bromid of lithium, if there is a tendency to excessive uric acid secretion, or gelsemium, or the valerianates, as the valerianate of zinc, that good results will be obtained. In muscular spasm of any of the forms named, the use of small doses of lobelia, or five grain doses of a bromid, every two hours, or occasional full doses of gelsemium, will be proved satisfactory.
In nervous vomiting the sedatives should be given with eupatorium, or with the hydrobromate of camphor. Hyperperistalsis will be temporarily relieved with cannabis indica one-fourth of a grain, morphin one-twelfth of a grain, sodium bromid five grains, every half hour or hour, for a short period. Eructations of gas should be treated with mild stimulants, such as peppermint, ginger in hot infusion, horsemint or gaultheria, and occasionally a mild infusion of capsicum.
Gastric anesthesia or atony of the stomach should be treated with nux vomica, ignatia, xanthoxylum, capsicum, or hydrastis. Occasionally it will be necessary to give full doses of strychnin in these cases, with the administration of the galvanic current to the central nervous system, and thence to the epigastric region. An electrode has been introduced within the stomach to great advantage.
Regurgitation of food should be treated with sedatives, and especially with ten drop doses of boneset in hot water every two hours, with occasional mild counter-irritation at the nape of the neck and over the upper spinal column.
Incidental conditions must receive direct symptomatic treatment. Hysterical manifestations should be controlled with pulsatilla, cimicifuga, helonias or gelsemium. Severe stomach or pelvic pain will be subdued with full doses of cannabis indica or conium maculatum.
It is often necessary to advise the regular administration of colonic flushings, or gastric lavage, or bathing at correctly adjusted temperatures to suit the individual case, and an occasional salt rub.