The Symptoms of Painful Dyspepsia

Most characteristic is pain at the pit of the stomach, with tenderness on pressure just at the tower end of the sternum; also tenderness on right side under lower border of ribs; pain in stomach, described as "tearing," "burning," "gnawing," or "rasping," coming on soon after taking food, and ceasing when digestion is completed; when due to congestion of mucous membrane, all-gone feeling when stomach is empty, relieved by bland food; pulsation at pit of stomach or below.

The Causes of Painful Dyspepsia

Painful dyspepsia may be developed from acid or bilious dyspepsia. It is most often the result of gastritis. Not infrequently the congestion to which this pain is sometimes due is caused by compression of the abdominal organs, obstructing free circulation. Hence, women who wear corsets are very liable to be affected by it, though they will rarely admit the cause, and still more rarely can be induced to remove it. It is also sometimes due to the pressure of some firm object against which the individual leans in his daily business; in this way various trades are productive of painful dyspepsia.

The Treatment of Painful Dyspepsia

Meat and all coarse vegetables must be carefully avoided in this affection. Preparations from the grains, as farina, cornstarch, well-boiled oatmeal porridge, and other farinaceous substances, as sago, tapioca, etc., agree best. It should be borne in mind, however, that in this class of cases such articles as cracked and crashed wheat, samp, graham bread, and other foods containing the coarser parts of the grain, are likely to do harm, the outside woody parts of the grain acting as a mechanical irritant to the sensitive mucous membrane of the stomach. It is this fact that has given the seeming occasion for a class of ignorant individuals who have mercenary ends to serve, to declaim so loudly against the use of whole-wheat flour. The fact that the coarser parts of the grain can be removed with advantage for this class of cases is no evidence against its utility in many other forms of indigestion.

In extremely bad cases, it is often necessary to put the patient on extremely simple diet. In cases of this sort, nothing generally answers the indications so well as milk. It should be taken fresh as possible, and should be given to the patient about as warm as can be taken with comfort, unless there is considerable fever, when it may be taken in small quantities iced. In extreme cases, the irritability may be so great that the food will be rejected if taken in any considerable quantities. In these cases, it becomes necessary to take the food, milk by preference, in very small quantities often repeated. If necessary, so small a quantity as one or two spoonsful may be given once an hour at first, gradually increasing the quantity and the intervals, until the necessary quantity is taken at the usual intervals for meals. Then a little well-boiled and strained oatmeal or graham gruel may be added, the quantity being increased until the patient can bear semi-solid food. Many lives have been saved by this plan when death seemed imminent from inability to digest sufficient nourishment. In some cases, we have found even milk intolerable, and have then secured the most successful results by the use of the white of egg beaten to a froth, and made palatable by the addition of a few drops of lemon juice or wine. In the worst cases we have even found the employment of nutritive enemata necessary for a short time until the irritability of the stomach subsided sufficiently to tolerate nourishment.

In many cases of this form of dyspepsia, the patient feels a terrible faintness as soon as the stomach is empty, which is in some degree relieved by taking proper food. This often leads the patient to resort to frequent eating when there is no requirement for so doing, and with great detriment. The difficulty referred to occurs particularly before breakfast; and the unpleasant sensations sometimes become so great that the appetite is destroyed. While the faintness described is not real hunger, it is best to relieve it sometimes by the taking of some simple food, or a little warm drink. When troublesome at night, the patient may take a few sips of warm milk; or if inconvenience is experienced from this, a little very weak hot lemonade may be taken. It should bo made by pouring boiling water on a slice of lemon or a little lemon peel. Add very little sugar, better none at all. Drink after allowing it to stand a few minutes. A few sips of cold water will often relieve the difficulty. In many cases a cup of warm drink may be taken an hour before breakfast with great advantage.

Further treatment consists in the employment of hot fomentations over the stomach two or three times a day, and if necessary after each meal. Hot and cold applications to the spine, just opposite the stomach, are also a valuable means of relief. All measures calculated to improve the general health should be thoroughly employe