In chronic dyspepsia the attacks are much less severe, but practically continuous. This often depends on other morbid states of the stomach such as cancer; or on disease of other organs, for instance, the kidney, or of the system generally, such as gout, or tuberculosis. The muscular power of the stomach also becomes weak in chronic dyspepsia, the peristaltic movements less vigorous, the organ possibly dilated, and the action of the orifices disordered.

IV. Natural Recovery

Acute dyspepsia generally passes off within so many hours or days if left entirely without treatment, vomiting being obviously a natural provision for its relief, and the subsequent nausea or anorexia a means of preventing the introduction of fresh food and affording the stomach temporary rest. These are valuable suggestions for treatment. The duration and degree of suffering in acute indigestion may, however, be considerable; and the violence of the symptoms, such as vomiting, may lead to injury or permanent disease. Therapeutical interference is therefore essential. Organic diseases of the stomach are frequently beyond treatment in themselves, but most of the distressing symptoms by which they are attended, are perfectly capable of relief.

V. Therapeutics

The conclusion to be drawn from the considerations in the preceding sections is manifestly to the effect that certain disorders and diseases of the stomach are capable of rational treatment.

1. Prophylactic Treatment

Prophylactic Treatment. Prevention is essentially the proper means of treating dyspepsia. The common causes of disorder, and the opportunity of removing them, are constantly at hand. Prevention here lies almost entirely in the direction of diet, and includes care with respect to the quantity and quality of the food, the frequency and general arrangement of the meals, the circumstances, social and otherwise, under which the food is taken, the thorough performance of digestion in the mouth, the amount of fluids with meals, including alcohol, and other matters which do not call for discussion here. Dieting is the most important part of the treatment of indigestion: without attention to it, medicinal treatment is of no avail.

Next to the food, the most ready, but not the most advisable, means of preventing dyspepsia is furnished by the gastric juice itself, or its important constituents, artificially administered. Hydrochloric Acid and Pepsin may be given alone or combined, either during or immediately after meals; or the food may bo previously peptonised by the addition to it in the process of cooking, of a digestive extract, made from the mucous membrane of the stomach, or from the pancreas, of the calf or pig.

The therapeutist should endeavour, however, to adopt a much less artificial method of treatment than this. He should try to call into play some of the influences to which the gastric flow is peculiarly sensitive, and thus to increase the natural juice, instead of borrowing its constituents from other sources. First, he will ensure a certain mechanical effect of the food on the stomach, by seeing that "slops" are not indulged in, at the same time remembering that a small quantity of a warm nutritive fluid dish, such as soup, which will be quickly absorbed and stimulate the follicles, is the best commencement of a considerable meal. Drugs will also be prescribed. The most powerful medicinal stimulants of gastric activity must reach the stomach distinctly before meals. Those which increase the activity of the nerves and vessels, and indirectly the activity of the glands and muscles, namely alcoholic, aromatic, bitter and pungent stomachics, are best given in combination, e.g. the tinctures of Gentian, Orange, Cascarilla, Chiretta, etc., variously combined with spirits such as Spiritus Ammoniae Aromaticus, Spiritus Myristicae, Spiritus Armoraceae, or Spiritus Chloroformi. A still more powerful gastric stimulant is to be combined with these, viz. an alkaline stomachic, in the form of a preparation of Potash, Soda, or Ammonia, the Bicarbonate of Soda being, for many reasons, the salt most frequently selected. Let it be carefully noted that the alkali must be given with the aromatic bitters, shortly before meals. This constitutes the routine medicinal treatment of dyspepsia, and we may repeat that the same result is obtained by successful insalivation of the food, of which the method is but an artificial imitation. The mental occupation and general surroundings of the patient, as well as the times and amount of physical exercise with relation to meals, will also require to be carefully regulated.

2. Immediate Treatment

Immediate Treatment. If acute dyspepsia be actually present, it is too late to attempt to stimulate the gastric flow. We must make our choice whether we shall evacuate the stomach, or neutralise the acidity and absorb the gas which are causing the distress. The use of emetics will be described in the next chapter. If the alternative measure be chosen, we give a dose of alkali or an alkaline earth-not, let it be observed, as an alkaline stomachic, but purely as an antacid to the contents of the stomach. Bicarbonate of Soda is again the means commonly chosen for the purpose, combined probably with Carbonate of Ammonia and an aromatic oil, such as Peppermint or Ginger, or more elegantly with Spiritus Ammoniae Aromaticus, to act as a carminative. The result is that the acidity of the contents is reduced-and it is remarkable how small may he the quantity of alkali required for this purpose-so that the mass passes with comparative safety into the duodenum. Instead of Soda, Magnesia or its Carbonate is occasionally used as an antacid, which, being also a purgative, hastens the expulsion of the offending contents. Gas may be partly absorbed by charcoal, given in powder or in the form of lozenges or biscuits, and partly removed by eructation induced by the carminative, which will further help to arrest decomposition, relieve pain, and rouse the heart and nervous system from the state of depression caused by the attack.