In hyperaesthesia of the stomach there is an abnormal sensitiveness of the mucous membrane even after the ingestion of ordinary food. The patient experiences a sensation of fulness, of slight burning, sometimes even of pains in the gastric region after meals. Many organic affections of the stomach are accompanied by this condition. As a primary affection it appears most frequently, according to Rosenheim,1 in chlorotic girls and women. Occasionally it is met with in people with a weakened constitution; thus after excesses in baccho et in venere, or after long periods of unsuitable dieting.

Symptomatology

In the mild form of hyperaes-thesia the patient experiences a sensation of weight or fulness after meals. If the disease, however, is more pronounced, real pains occur after meals, and the stomach after a while may become so irritable that the contact of food with the mucous membrane produces vomiting. In the latter instance the food is partly rejected soon after the meal. As a rule only a small quantity of the ingested food is vomited, while the greater part is thoroughly digested. That is the reason why in these instances the patient does not emaciate. If, however, the bulk of the food be ejected, this symptom may soon lead to grave inanition. The disagreeable sensations which exist in this affection frequently lead to a diminution of the quantity of food taken (a condition develops which may be termed "sitophobia" - fear of food), and in this way again the nutrition may be impaired.

Diagnosis

In addition to the above symptoms an examination discloses that the gastric and epigastric regions are painful on pressure. The secretory and motor functions of the stomach may be found normal or a slight degree of hyperchlorhydria may exist. In the differential diagnosis we must exclude gastric catarrh, ulcer and erosions of the stomach, before diagnosing hyperesthesia as such. In catarrh of the stomach the sensation of fulness or weight appears, as a rule, not immediately after meals, but some time afterward. Besides there exist in catarrh of the stomach many other symptoms (loss of appetite, a diminished secretion, etc.), which are not met with in this condition. In ulcer of the stomach the pains are more violent. They are also dependent upon the quality of the food ingested, while in hyperesthesia the abnormal sensations are pretty much the same whether coarse substances or very light food be ingested. In erosions of the stomach the pains are also usually of a light nature, but here, as in ulcer, we find that the pains depend to a certain extent upon the quality and quantity of the food taken. Another point of importance in this condition is the results obtained after the washing out of the stomach in the fasting condition of the patient.

In erosions of the stomach, as a rule, several (two to four) small pieces of gastric mucosa are found in the wash-water; in hyperesthesia this does not occur.

1Th. Rosenheim: Berl. klin. Wochenschr., 1890.

Treatment

For the hyperesthesia occurring in chlorotic persons Rosenheim proposed the following treatment: The patient should be kept in bed, and the Priessnitz compress applied to the gastric region. The diet should consist at first of milk, to which small amounts of lime water are added, and which should be taken with a spoon. The addition of small quantities of tea or coffee to the milk is permissible. After a while the yolk of an egg with sugar and small quan-tities of cognac, wine jelly, scraped meat, or toasted bread are given. Of medicaments, Rosenheim advises the internal use of nitrate of silver.

℞ Arg. nitr.........0.2 gr. iij.

Aq. desk,.......100.0 ℥ iij.

S. Half a tablespoonful in a wineglassful of water, three times daily, half an hour before meals.

When the stomach has become less irritable, the patient should begin cautiously with solid food and tonics like iron and arsenic, in order to restore the organism to its normal condition.

In cases of hyperesthesia not originating from chlorosis the best treatment consists in the administration of the bromides for a period of one or two months.