This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
According to Monneret, "pain arising during digestion, from whatever cause," may be relieved by mixing the subnitrate freely with the food, but more definite indications may be given. Gastric pains dependent on indigestible food, marked constipation or hepatic congestion, require emesis or purgation, while in vomiting connected with fermentation of food, dilatation of stomach, etc., antiseptic remedies and perhaps washing out of the viscus may be necessary.
Bismuth is specially indicated in cases of difficult digestion with tendency to diarrhoea, in subacute or chronic gastritis, and gastralgia with marked irritability of mucous membrane: for such cases, Odier first introduced it (in Geneva, 1786); he describes severe gastric pain as frequent among the servants there who lift and carry on their heads large vessels of water - the pain was either spasmodic, sudden, intense, and relieved by pressure, or more persistent and accompanied with sensations of gnawing, sinking, and pulsation; eructation, nausea, and vomiting occurred in greater or less degree, and the general health and mental state became much depressed. Such cases were much relieved by bismuth in moderate doses; and Marcet, Bardsley, and other English physicians have published similar experiences.
Nothnagel finds it especially useful when pain occurs after food in badly nourished overworked persons; but when there is marked anaemia or a general neuralgic condition it is not so serviceable alone, nor is it very permanent in its good effects. Prussic acid, or opium, alkalies, and later iron and bitters, may be conjoined with it. Caizergues especially praises a combination of 4 gr. with 1/3 gr. of extract of belladonna in the gastralgia of chlorosis (London Journal of Medical Science, 1851).
When acid pyrosis is a marked symptom, bismuth is particularly indicated either alone, or, if acidity be marked and constipation usual, then combined with magnesia. According to Trousseau, if the rejected fluid be insipid, glairy, or sour ropy phlegm, bismuth alone is contra-indicated, but in most cases it deserves trial, requiring only that constipation be remedied. The nausea and vomiting of gastric irritation is commonly amenable to bismuth, reflex vomiting, such as that of pregnancy, not so
(Husemann); this is an argument in favor of the local protective effect of the drug.
In infantile vomiting, which is frequently dependent on acidity or ill-digested food, and accompanied by diarrhoea and pain, bismuth is exceedingly useful, being, as it is, practically harmless and tasteless - 1 to 2 gr. may be placed on the infant's tongue with a moistened finger. A minute dose of creosote, 1/10 of a drop, may often be usefully combined (British Medical Journal, ii., 1875).
In Ulceration of the Stomach, when pain is very severe and exhausting, and when vomiting is frequent, much relief may be given by full doses; and I have noticed that distressing thirst has been rather relieved than increased by the remedy. Dr. Brinton attached great value to it; it is often given with opium in such cases.
In Malignant Disease even, I have found bismuth palliate for a time the most severe symptoms; and in both these conditions it acts mainly by forming a smooth layer over exposed and hypersensitive nerves, and so preventing the contact of food and unhealthy secretions: to obtain such a result it is evident that more than ordinary doses are required.
Although iron is contra-indicated in cases of acute and irritative dyspepsia and mal-assimilation, yet certain forms of "atonic dyspepsia" which are connected with debility and impaired blood-condition are well treated by it. There are the general symptoms of anaemia, and also a sense of weight and heaviness after food, and impaired appetite, rather than of acute pain, and the preparations usually most suitable are such as the citrate or ammonio-citrate combined with soda and ca-lumba, or reduced iron with nux vomica: the headache which often accompanies this condition is also relieved by these medicines: when there is much general relaxation, or gastric catarrh of chronic character, the perchloride, preferably with quassia, is valuable. In the dyspepsia of chlorosis, iron will often not agree if the tongue be furred, or the urine loaded; but if these conditions are present only in a minor degree, then the citrate may be used in effervescence with soda (Budd: "On Dyspepsia"). Dr. Milner Fothergill, in an article "When not to give Iron," insists on the importance of clean tongue and freedom from "biliousness;" and he quotes Sir J. Fayrer to the same effect (Practitioner, 1877); he remarks also that toleration of it diminishes with age.
In acidity, pyrosis, and allied symptoms of irritative dyspepsia, such as heartburn, flatulence, colic, or constipation, magnesia and its carbonate are very useful, and their efficacy may be increased by the addition of bismuth or of carminatives: such symptoms are often brought on by food containing too much fat, and this point should be attended to. Headache, accompanied with nausea and mental depression, often occurs in the conditions described, and may be relieved by magnesia. When vomiting is a troublesome symptom in the dyspepsia either of children or adults, and in the vomiting of pregnancy, magnesia often acts well. An effervescent solution of the carbonate or citrate is a good form, but 5 to 10-gr. doses of the sulphate will sometimes act better. I have known this succeed in the vomiting of albuminuria, and in cases where hepatic derangement was more marked than acidity.
In cases of irritative dyspepsia, especially when occurring in stout and rheumatic or gouty persons, and marked by red tongue, acid eructations, or pyrosis, with nausea and discomfort after meals, the liquor potassae or bicarbonate of potash, taken at that time (after meals), often gives relief; in gouty cases, and when the urine is loaded, they are to be preferred to soda. In cases of atonic dyspepsia, however, with pale coated tongue and much weight after food, small doses of alkali are best given before a meal, and if continued for some time should be combined with a bitter infusion. In cases of "biliousness," with yellowish complexion and conjunctivae, headache, nausea, etc., and even in actual catarrhal jaundice, salts of potash are good adjuvants (Golding Bird, Bartholow). Dr. Todd recommended the sulphuret (10 gr.) when the. "mucous follicles were implicated."
In vomiting connected with the condition just described, or with other functional or even organic gastric disorder, or occurring at the commencement of inflammatory fevers, the bicarbonate of potash is advantageously given in effervescence with citric acid.
Soda salts are very useful in several forms of indigestion, but the dose and mode of administration vary somewhat according to the conditions present. In cases of atonic dyspepsia connected with deficient secretion of gastric juice, the bicarbonate in small doses of 5 to 10 gr. should be given, and shortly before a meal, on the principle already alluded to, viz., that an alkali causes increase of an acid secretion, for though on first contact it neutralizes the acid it meets with, additional acid is very quickly poured out so as to leave an excess. The alkali may, in some cases, be very suitably combined with an aromatic, as ill
"Gregory's powder," with ginger only, or with a bitter-like tincture of orange or infusion of gentian. On the other hand, in cases of acid dyspepsia, with thickly coated or red shining tongue, sour eructations, heartburn, and flatulence, larger doses of the bicarbonate (15 to 20 gr.) should be given an hour or more after a meal, according to the time at which the symptoms come on; in this case, also, the remedy may be well combined with an aromatic or stimulant, as ammonia or peppermint. Soda is especially useful for the dyspepsia of those who live in towns, eating and drinking freely, and taking little exercise. If the urine be scanty and irritating, nitre may be given at the same time, and according to Dr. Budd, an occasional blue pill. A dry skin and very furred tongue are other indications for soda, while for those who live in the country, take more vegetable food, and perspire freely, acids usually agree better (Medical Times, i., 1854). If larger closes of soda be continued too long, or taken at the wrong time, "it becomes a contest between the stomach and the doctor."
The familiar use of salt is of no small importance in stimulating appetite and digestion, and advantage is sometimes gained by varying the kind used: thus, Maldon salt is in crisp flakes, Lymington salt in deliquescent cubes, etc. (Medical Times, i., 1864). The principal ingredient in Vichy water is the bicarbonate of soda, but it contains minor or minute quantities of sulphate, phosphate, arseniate, borate, and chlorine: this saline water may be very useful in simple slow digestion, with constipation and loss of appetite, and when gastralgia is not a prominent symptom (H. Weber: Medical Times, ii., 1861). Dr. Symonds states that "duodenal dyspepsia," with its attendant "bilious headache," may often be obviated for a long period by the daily taking of a tumblerful of "salt and water" before breakfast (Medical Times, i., 1858). An effervescent soda carbonate, or sulphate, is often efficacious in such headaches.