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Excerpt of an article that appeared in NZMJ May 1912;9(42):117-24. Continued from part 1 at http://journal.nzma.org.nz/journal/124-1338/4778/Acute hypersecretion and acute hyperchlorhydria call only for a passing reference, The attacks closely resemble those of acute gastritis with vomiting, pain and thirst, but the vomited matter turns bitmus red, and, unlike the vomit in gastritis which is free from acid, consists entirely of acid juice. Chronic hyperchlorhydria is diagnosed by an examination of the gastric contents, when, after a test breakfast, they are found to have a total acidity, on filtration with decinormal soda solution, of 80, 100 or even higher, instead of 40 or 50, and on examination with alizarin and dimethal amido-azobenzol the increase is found to be clue entirely to HCl. Discs of egg albumen are rapidly digested and a blue or purple reaction is given with Lugol's solution (I. in K.I.) showing defective carbohydrate digestion.The symptoms consist of a dull pain in the epigastrium coming on an hour or an hour and a half after meals and rather more diffused than the pain of ulcer. Flatulence, nausea and vomiting may also be present with acid risings into the mouth. The epigastrium is somewhat tender but the tenderness is not localised as it is in ulcer, and there is no cutaneous hyperaesthesia, hyperaemia or exaggeration of the epigastric reflex. The symptoms come on early after a bulky meal of starchy food and late after a heavy proteid meal.The treatment consists firstly in eliminating the cause if possible and regulating the habits of the patient as regards diet, exercise, alcohol and tobacco. The teeth should be examined, all cavities treated and all deficiencies supplied by suitable dentures. It is quite common for people with no back teeth at all to assure one that there is nothing wrong with his teeth. Constipation also requires attending to—especially concealed constipation which is revealed by the indican test.With regard to drugs there is no question that pride of place must be given to belladonna. There are very few cases which are not benefited by belladonna—of course, belladonna will not cure a diseased appendix or a duodenal ulcer. Nor will it have much effect in those cases of hyperchlorhydria which occur along with gastroptosis in weakly individuals of bad family history, with long narrow thoraces and hopelessly neurotic tendencies. But where the condition is due, as it so frequently is, to evil habits of one kind and another if the habits are corrected, the diet regulated and belladonna in suitable doses is enhibited, then it is only in rare cases that marked improvement does not follow.The belladonna may be given in doses of 7 to 10 minims of the tincture after those meals that are usually followed by pain, after breakfast and lunch in some cases, after lunch and dinner in others. If the pain is chiefly nocturnal (although that usually indicates hypersecretion) a pill containing 1-100 gr. of atropin and ½gr. green extract of belladonna nay be given at bedtime.Symptoms of poisoning sometimes occur but the drug need not be discontinued for a slight rash of dryness of the fauces which can be relieved by the sucking of lozenges. If there is much irritability of the mucosa, gr. 5 or gr. 15 of bismuth subnitrate may be added. If the flatulence is very troublesome menthol dissolved in spirits of chloroform will give relief.Where the pain is very severe, chloral hydrate, tinct ferri perchlor, or tinct opii may be used. It is better to avoid the use of antacids altogether as the patient will always abuse them, and it is positively harmful to order the ordinary tonic drugs such as gentian, mix vomica, calisaya, etc., as they simply excite the further secretion of hyperacid juice.The diet is of course all important. In a bad case where there has been a good deal of pain and vomiting it is just as well to begin with a few days' rest in bed on very low-diet and to keep an ice bag on the epigastrium. In milder cases it is sufficient to order a simple dietary. Bulky carbohydrate foods should he avoided as they excite the gastric secretion without giving it any work to do. That is why cases of hyperchlorhydria do so badly on a milk pudding diet which is so frequently ordered for them.The diet should consist of a good proportion of proteid, but it should be light as easily digestible. All substances likely to irritate the mimosa should be avoided, such as pickles, hot sauces, condiments, mustard, curries, coarse vegetables, salads, raw fruits, seed jams, scones, pastry, soups, potatoes, coarse fibred meats, as beef or pork, and all twice cooked or highly seasoned meat dishes.The patient should live chiefly on fish, chicken, rabbit, tripe, sweetbread, underdone mutton, cauliflower, spinach, asparagus, cream, fat bacon, butter, well cooked rice, eggs, custards, stewed fruits, and dried bread (rather than toast), Veal and soft-boiled ham have a very high acid binding quality and are recommended by Riegal, but they should be used in moderation. There should be only three meals daily, dinner preferably in the middle. of the day and no supper. When the pain comes on the patient may take half a raw egg beaten with a. little sugar. Riegel and other German authorities recommend six meals daily but I am convinced that it is a mistake to excite the gastric secretion so frequently and further the overloading of the stomach tends to produce atony of the muscle.The best drink to take at meal times is water or, if flatulence is not a very prominent symptom, some alkaline mineral water. Tea and alcohol are best avoided altogether, but if one must defer to an acquired bad habit, a cup of weak China tea may be allowed in the afternoon and a little light wine or very weak whisky and soda with meals.An occasional pill of mercury and colocynth should be taken and some phosphate or sulphate of soda in the morning. Some exercise should be taken every day and worry and overwork avoided, as far as possible. These patients usually get rid of their symptoms altogether when they go away for a change, and so numerous short holidays should be taken. I do not wish to quote a long list of cases but I would like to mention one or two taken at random from my case books to show how the presence of hyperchlorhydria may be overlooked, and to show further the benefit of treatment.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

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Excerpt of an article that appeared in NZMJ May 1912;9(42):117-24. Continued from part 1 at http://journal.nzma.org.nz/journal/124-1338/4778/Acute hypersecretion and acute hyperchlorhydria call only for a passing reference, The attacks closely resemble those of acute gastritis with vomiting, pain and thirst, but the vomited matter turns bitmus red, and, unlike the vomit in gastritis which is free from acid, consists entirely of acid juice. Chronic hyperchlorhydria is diagnosed by an examination of the gastric contents, when, after a test breakfast, they are found to have a total acidity, on filtration with decinormal soda solution, of 80, 100 or even higher, instead of 40 or 50, and on examination with alizarin and dimethal amido-azobenzol the increase is found to be clue entirely to HCl. Discs of egg albumen are rapidly digested and a blue or purple reaction is given with Lugol's solution (I. in K.I.) showing defective carbohydrate digestion.The symptoms consist of a dull pain in the epigastrium coming on an hour or an hour and a half after meals and rather more diffused than the pain of ulcer. Flatulence, nausea and vomiting may also be present with acid risings into the mouth. The epigastrium is somewhat tender but the tenderness is not localised as it is in ulcer, and there is no cutaneous hyperaesthesia, hyperaemia or exaggeration of the epigastric reflex. The symptoms come on early after a bulky meal of starchy food and late after a heavy proteid meal.The treatment consists firstly in eliminating the cause if possible and regulating the habits of the patient as regards diet, exercise, alcohol and tobacco. The teeth should be examined, all cavities treated and all deficiencies supplied by suitable dentures. It is quite common for people with no back teeth at all to assure one that there is nothing wrong with his teeth. Constipation also requires attending to—especially concealed constipation which is revealed by the indican test.With regard to drugs there is no question that pride of place must be given to belladonna. There are very few cases which are not benefited by belladonna—of course, belladonna will not cure a diseased appendix or a duodenal ulcer. Nor will it have much effect in those cases of hyperchlorhydria which occur along with gastroptosis in weakly individuals of bad family history, with long narrow thoraces and hopelessly neurotic tendencies. But where the condition is due, as it so frequently is, to evil habits of one kind and another if the habits are corrected, the diet regulated and belladonna in suitable doses is enhibited, then it is only in rare cases that marked improvement does not follow.The belladonna may be given in doses of 7 to 10 minims of the tincture after those meals that are usually followed by pain, after breakfast and lunch in some cases, after lunch and dinner in others. If the pain is chiefly nocturnal (although that usually indicates hypersecretion) a pill containing 1-100 gr. of atropin and ½gr. green extract of belladonna nay be given at bedtime.Symptoms of poisoning sometimes occur but the drug need not be discontinued for a slight rash of dryness of the fauces which can be relieved by the sucking of lozenges. If there is much irritability of the mucosa, gr. 5 or gr. 15 of bismuth subnitrate may be added. If the flatulence is very troublesome menthol dissolved in spirits of chloroform will give relief.Where the pain is very severe, chloral hydrate, tinct ferri perchlor, or tinct opii may be used. It is better to avoid the use of antacids altogether as the patient will always abuse them, and it is positively harmful to order the ordinary tonic drugs such as gentian, mix vomica, calisaya, etc., as they simply excite the further secretion of hyperacid juice.The diet is of course all important. In a bad case where there has been a good deal of pain and vomiting it is just as well to begin with a few days' rest in bed on very low-diet and to keep an ice bag on the epigastrium. In milder cases it is sufficient to order a simple dietary. Bulky carbohydrate foods should he avoided as they excite the gastric secretion without giving it any work to do. That is why cases of hyperchlorhydria do so badly on a milk pudding diet which is so frequently ordered for them.The diet should consist of a good proportion of proteid, but it should be light as easily digestible. All substances likely to irritate the mimosa should be avoided, such as pickles, hot sauces, condiments, mustard, curries, coarse vegetables, salads, raw fruits, seed jams, scones, pastry, soups, potatoes, coarse fibred meats, as beef or pork, and all twice cooked or highly seasoned meat dishes.The patient should live chiefly on fish, chicken, rabbit, tripe, sweetbread, underdone mutton, cauliflower, spinach, asparagus, cream, fat bacon, butter, well cooked rice, eggs, custards, stewed fruits, and dried bread (rather than toast), Veal and soft-boiled ham have a very high acid binding quality and are recommended by Riegal, but they should be used in moderation. There should be only three meals daily, dinner preferably in the middle. of the day and no supper. When the pain comes on the patient may take half a raw egg beaten with a. little sugar. Riegel and other German authorities recommend six meals daily but I am convinced that it is a mistake to excite the gastric secretion so frequently and further the overloading of the stomach tends to produce atony of the muscle.The best drink to take at meal times is water or, if flatulence is not a very prominent symptom, some alkaline mineral water. Tea and alcohol are best avoided altogether, but if one must defer to an acquired bad habit, a cup of weak China tea may be allowed in the afternoon and a little light wine or very weak whisky and soda with meals.An occasional pill of mercury and colocynth should be taken and some phosphate or sulphate of soda in the morning. Some exercise should be taken every day and worry and overwork avoided, as far as possible. These patients usually get rid of their symptoms altogether when they go away for a change, and so numerous short holidays should be taken. I do not wish to quote a long list of cases but I would like to mention one or two taken at random from my case books to show how the presence of hyperchlorhydria may be overlooked, and to show further the benefit of treatment.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Excerpt of an article that appeared in NZMJ May 1912;9(42):117-24. Continued from part 1 at http://journal.nzma.org.nz/journal/124-1338/4778/Acute hypersecretion and acute hyperchlorhydria call only for a passing reference, The attacks closely resemble those of acute gastritis with vomiting, pain and thirst, but the vomited matter turns bitmus red, and, unlike the vomit in gastritis which is free from acid, consists entirely of acid juice. Chronic hyperchlorhydria is diagnosed by an examination of the gastric contents, when, after a test breakfast, they are found to have a total acidity, on filtration with decinormal soda solution, of 80, 100 or even higher, instead of 40 or 50, and on examination with alizarin and dimethal amido-azobenzol the increase is found to be clue entirely to HCl. Discs of egg albumen are rapidly digested and a blue or purple reaction is given with Lugol's solution (I. in K.I.) showing defective carbohydrate digestion.The symptoms consist of a dull pain in the epigastrium coming on an hour or an hour and a half after meals and rather more diffused than the pain of ulcer. Flatulence, nausea and vomiting may also be present with acid risings into the mouth. The epigastrium is somewhat tender but the tenderness is not localised as it is in ulcer, and there is no cutaneous hyperaesthesia, hyperaemia or exaggeration of the epigastric reflex. The symptoms come on early after a bulky meal of starchy food and late after a heavy proteid meal.The treatment consists firstly in eliminating the cause if possible and regulating the habits of the patient as regards diet, exercise, alcohol and tobacco. The teeth should be examined, all cavities treated and all deficiencies supplied by suitable dentures. It is quite common for people with no back teeth at all to assure one that there is nothing wrong with his teeth. Constipation also requires attending to—especially concealed constipation which is revealed by the indican test.With regard to drugs there is no question that pride of place must be given to belladonna. There are very few cases which are not benefited by belladonna—of course, belladonna will not cure a diseased appendix or a duodenal ulcer. Nor will it have much effect in those cases of hyperchlorhydria which occur along with gastroptosis in weakly individuals of bad family history, with long narrow thoraces and hopelessly neurotic tendencies. But where the condition is due, as it so frequently is, to evil habits of one kind and another if the habits are corrected, the diet regulated and belladonna in suitable doses is enhibited, then it is only in rare cases that marked improvement does not follow.The belladonna may be given in doses of 7 to 10 minims of the tincture after those meals that are usually followed by pain, after breakfast and lunch in some cases, after lunch and dinner in others. If the pain is chiefly nocturnal (although that usually indicates hypersecretion) a pill containing 1-100 gr. of atropin and ½gr. green extract of belladonna nay be given at bedtime.Symptoms of poisoning sometimes occur but the drug need not be discontinued for a slight rash of dryness of the fauces which can be relieved by the sucking of lozenges. If there is much irritability of the mucosa, gr. 5 or gr. 15 of bismuth subnitrate may be added. If the flatulence is very troublesome menthol dissolved in spirits of chloroform will give relief.Where the pain is very severe, chloral hydrate, tinct ferri perchlor, or tinct opii may be used. It is better to avoid the use of antacids altogether as the patient will always abuse them, and it is positively harmful to order the ordinary tonic drugs such as gentian, mix vomica, calisaya, etc., as they simply excite the further secretion of hyperacid juice.The diet is of course all important. In a bad case where there has been a good deal of pain and vomiting it is just as well to begin with a few days' rest in bed on very low-diet and to keep an ice bag on the epigastrium. In milder cases it is sufficient to order a simple dietary. Bulky carbohydrate foods should he avoided as they excite the gastric secretion without giving it any work to do. That is why cases of hyperchlorhydria do so badly on a milk pudding diet which is so frequently ordered for them.The diet should consist of a good proportion of proteid, but it should be light as easily digestible. All substances likely to irritate the mimosa should be avoided, such as pickles, hot sauces, condiments, mustard, curries, coarse vegetables, salads, raw fruits, seed jams, scones, pastry, soups, potatoes, coarse fibred meats, as beef or pork, and all twice cooked or highly seasoned meat dishes.The patient should live chiefly on fish, chicken, rabbit, tripe, sweetbread, underdone mutton, cauliflower, spinach, asparagus, cream, fat bacon, butter, well cooked rice, eggs, custards, stewed fruits, and dried bread (rather than toast), Veal and soft-boiled ham have a very high acid binding quality and are recommended by Riegal, but they should be used in moderation. There should be only three meals daily, dinner preferably in the middle. of the day and no supper. When the pain comes on the patient may take half a raw egg beaten with a. little sugar. Riegel and other German authorities recommend six meals daily but I am convinced that it is a mistake to excite the gastric secretion so frequently and further the overloading of the stomach tends to produce atony of the muscle.The best drink to take at meal times is water or, if flatulence is not a very prominent symptom, some alkaline mineral water. Tea and alcohol are best avoided altogether, but if one must defer to an acquired bad habit, a cup of weak China tea may be allowed in the afternoon and a little light wine or very weak whisky and soda with meals.An occasional pill of mercury and colocynth should be taken and some phosphate or sulphate of soda in the morning. Some exercise should be taken every day and worry and overwork avoided, as far as possible. These patients usually get rid of their symptoms altogether when they go away for a change, and so numerous short holidays should be taken. I do not wish to quote a long list of cases but I would like to mention one or two taken at random from my case books to show how the presence of hyperchlorhydria may be overlooked, and to show further the benefit of treatment.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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