Leube2 originated the name of nervous dyspepsia (neurasthenia gastrica of Ewald) to describe a condition characterized by manifold subjective symptoms, which appear during the act of digestion, but cannot be referred to any abnormal condition in the organ susceptible of objective demonstration. All cases in which dyspeptic symptoms existed and in which after a test dinner hydrochloric acid was detected and the organ was found empty seven hours after this meal, Leube diagnosed as nervous dyspepsia. Later, when attempts were made to estimate the degree of acidity quantitatively, all the cases of byperchlorhydria had to be separated from this condition. For here the subjective complaints of the patients could be referred to the abnormal condition existing in the undue secretion. Nervous dyspepsia may best be characterized by the existence of manifold clinical symptoms, without any organic lesion whatever.

1 Nervous dyspepsia is in reality a mixed neurosis in which the sensory, motor, and secretory nerve mechanism, either combined or alternately, may play a part.

2Leube: "Ueber nervose Dyspepsie. " Deutsch. Arch. f. klin. Medicin, Bd. 28. 1879.

Etiology

The disease appears more frequently in men than in women. Although it may occur at the most diverse ages, still the years between thirty and forty-five show the greatest frequency. Many debilitating conditions give rise to the development of this trouble: chlorosis, lung troubles, grippe, malaria; abnormal conditions of the genito-urinary organs, sexual excess, excessive use of tobacco and alcohol predispose to this affection. Organic troubles of the stomach, such as ulcer or chronic gastric catarrh, may also give rise to this complication. It is hardly necessary to say that both neurasthenia and hysteria are often complicated with nervous dyspepsia, or, speaking more correctly, the nervous dyspepsia in reality forms a part of these two conditions.

Symptomatology

The appetite is generally irregular and capricious. Sometimes it is increased, more frequently, however, it is lessened. The tongue, as a rule, is clean and only occasionally slightly coated. Very soon after a meal various symptoms appear: slight pains in the gastric region, frequent belching, sometimes an irresistible desire to sleep, occasionally a feeling of burning in the head, especially in the forehead. All these disagreeable sensations frequently. last as long as there is food in the stomach. Sometimes, when the stomach is empty, a weak feeling and slight dizziness overcome the patient, so that there is really no time whatever during which the patient feels perfectly well and enjoys the feeling of a healthy person. This explains the marked depression existing in these patients. Most of them look at everything from the darkest point of view, and any small inconvenience, which would hardly be noticed by a healthy person, may give them great anxiety and fear. At first the nutrition of the body appears to be in good condition.

But sooner or later the patient begins to lose in weight, the sleep is also very soon impaired, and all the symptoms are aggravated.

Besides the gastric symptoms there are also manifold symptoms which refer to the intestines. Sensations of fulness or of tension, and sometimes also pain, are experienced in different regions of the abdomen. Frequently these abnormal sensations are caused by an accumulation of gas in the intestinal tract and relief is felt after the passing of flatus. The bowels are almost always constipated. The movements sometimes appear in the form of small balls and occasionally in the form of a very thin long cylinder the size of a quill. The latter is always the result of the spasmodic form of constipation. Diarrhoea is very seldom met with in this disease.

Burkhart1 has described the existence of certain points in the abdomen which are painful to pressure, and believes them to be characteristic of this affection. Leven 2 likewise attributes great importance to the appearance of these painful spots, which Ik? ascribes to an irritation of the solar plexus. He describes three such painful areas, one immediately below the ensiform process, the others near the navel, especially to the left of it. Ewald, Eichter,1 and Bou-veret are of the opinion that this symptom is by no means characteristic of nervous dyspepsia, as they have met with cases of the affection in which no such painful points could be found. The condition of the gastric juice does not present anything characteristic of this affection. Frequently the juice will be found normal. Sometimes the degree of acidity will be diminished and occasionally increased. In many cases the condition of the gastric juice will reveal manifold variations from time to time. I agree with Bouveret that more frequently a diminished acidity is met with in this affection. If the affection has lasted quite a while, atony of the stomach is usually present. In women enteroptosis very frequently occurs as a complication.

In both sexes, but more frequently in the female, membranous colitis may develop in consequence of the high degree of constipation and of the irritation of the colon through scybala. Besides all these symptoms, which refer to the digestive tract, manifold nervous symptoms usually occur: headache, insomnia, pains in the back, frequent emissions, sometimes impotence, vertigo, palpitations of the heart after slight exertions or after meals, feeling of extreme weakness, loss of energy and ambition, etc.

1 Burkhart: "Zur Pathologie dor Neurasthenia gastrica," Bonn, 1882.

2Leven: "Estomac et Cerveau," Paris. 1S84.

The prognosis of neurasthenia gastrica is quite uncertain. Cases of a slight nature may sometimes resist the best kinds of treatment for a long time. On the other hand, cases of a severer nature may readily yield to rational treatment. The duration of the disease can very seldom be foretold, and although life is not directly endangered, still instances of fatal issue even without apparent complications have been reported in literature.

1Richter: Berl. klin. Wochenschr., 1882.