Treatment. Hygienic Regimen

In view of the fact that hyperchlorhydria is most frequently caused by too much mental work, the daily life of the patient as to amount of work, bodily exercise, mental rest, and pleasure must be regulated. With regard to this point, the same rules will not apply to all, but it will be necessary to individualize each case for itself. Thus business men with a great deal of responsibility resting upon them, lawyers, politicians, and physicians must be sent away from their work to some country place, so as to relieve their brains temporarily from the strain. Ladies moving in high social circles, and participating in all manner of festivities, will have to be restricted to a more quiet life. Again, there are people with large fortunes and without any occupation whatever, who become sick from paying too much attention to their own bodily functions. Here it will be necessary to occupy the mind of these patients with some kind of work.

Cold sponge baths in the morning, bodily exercise of about eight to ten minutes' duration every morning are in most instances of value. Walking once or twice a day for half an hour to an hour, horseback riding, driving, bicycle riding should be highly recommended.

Diet

All substances that are liable to excite intensely the glands of the stomach must be excluded from the dietary of such patients. Therefore all kinds of acids, including organic acids citric, tartaric, acetic acid;; all kinds of spices, such as pepper, mustard, horseradish, and the like, must be forbidden. The food should consist of material rich in albumin, while the quantity of starchy substances should be dimin-ished. Thus all kinds of meat (even game), fish, oysters. eggs, milk, should be taken in large quanti-ties. Bread and butter are permitted. Potatoes. spinach, asparagus, green peas, farina, and rice should be taken only in small amounts. Whisker and wines should, as a rule, be avoided. Cacao. weak tea. weak coffee, and beer can be given in moderate quantities.

As a rule, it is advisable to have the patient partake of five or six meals daily, three heavy and two or three lighter ones. The heavier meals should not deviate much from the ordinary bill of fare, while the lighter meals should consist either of a glassful of milk or matzoon, with bread and butter or a cup of cocoa and a few crackers, or occasionally a cup of bouillon with an egg beaten up in it, and some bread, or half a dozen oysters, a few crackers, and a glass of beer. The patient must be impressed with the importance of thoroughly masticating the food and eating slowly, be-side resting fifteen to twenty minutes after each meal.

Outline Of Diet In Hyperchlorhydria

Medicaments

All kinds of alkalies can be used in the treatment of this affection. Where hyperchlor-hydria is not complicated with constipation, bicarbonate of soda may be given, either alone or in combination with sugar of milk or peppermint sugar (German Pharmacopoeia), in doses of half a teaspoonful to about one teaspoonful three times a day, two hours after meals. Calcined magnesia and magnesia am-monio-phosphorica neutralize four times as much acid as bicarbonate of soda. The following prescriptions are therefore very serviceable:

℞ Sodii bicarbon.,

Magnes. ust.,.......aa x20.0 Ʒ v.

M. exactissime, f. pulv. D. ad scatulam. S. Half a teaspoon ful to a teaspoonful three times daily, two hours after meals.

Or,

℞ Sodii bicarbon.,......20.0 Ʒ v.

Magnes. ust.,

Magnes. ammonio phosph., aa 10.0 Ʒ iiss.

M. exactissime, f. pulv. D. ad scatulam. S. Half a teaspoon-ful to a teaspoonful three times daily, two hours after meals.

In cases which are accompanied by constipation, magnesia usta and some rhubarb can be added, and here I frequently prescribe the following:

℞ Magnes. ust.,

Pulv. rad. rhei,.....aa 7.5 Ʒ ij.

Sodii carbon, exsiccat,

Sodii bicarbon.

Elaeosacch. month, pip......aa 15.0 3 iv.

M. exactissime, f. pulv. D. ad scatulam. S. Half a teaspoon-ful to a teaspoonful three times daily, two hours after meals, to be taken in plain water or in Vichy water.

Bouveret uses sodium bicarbonate in 2 gm. doses, to be taken two hours after lunch and after supper, and to be repeated after an hour's interval. The alkaline treatment can be continued for very long periods without any ill effects whatever. In cases in which the nervous element is more disturbed (sleeplessness, headaches, over-excitability, etc.), we should give a good dose of a bromide salt. I am in the habit of prescribing strontium bromide:

℞ Stront. broni. puriss., .... 12.0 Ʒ iij.

Aq. month, pip....... 60.0 Ʒ xv.

S. One teaspoonful twice daily in milk at mealtime.

Sodium bromide and ammonium bromide can be employed in the same way. The bromides should, however, be given only for a week or two, and their use then discontinued for a short time, after which they may be resumed for the same length of time. Boasadvises the administration of small doses of morphine or codeine. He frequently prescribes the following:

℞ Magnes. ust,......15.0 Ʒ iij3/4

Morphinae hydrochlor......0.1 gr. 1 2/3.

M. f. pulv. D. ad scat. S. A point of a knife to a teaspoonful three times daily.

I have very seldom seen the necessity of prescribing either morphine or codeine in this affection.

Of the watering-places, Vichy and Neuenahr are to be highly recommended. For the treatment of these patients at home these mineral waters are taken most advantageously in small quantities.

Electricity

In cases of a protracted nature, the direct application of the electric current to the inside of the stomach is frequently of the greatest benefit. In most instances the faradic current should be applied, but in cases in which the pains are very severe galvanization should be employed. As to the mode of application of the current and the length of time required for this treatment, see the section on electricity. The electric current applied in this manner exerts a stimulating tonic influence, not only upon the stomach, but also upon the small and large intestines. I have frequently seen cases of hyperchlorhydria, accompanied by the most obstinate constipation, perfectly cured by means of the current, even when no drugs whatever had been given.