THE TREATMENT 
OF 
SOME FORMS OF DYSPEPSIA 
(CHRONIC CATARRH OF THE STOMACH). 
BY 
WILLIAM B. NEFTEL, MJ). THE TREATMENT 
OF 
SOME FORMS OF DYSPEPSIA 
(CHRONIC CATARRH OF THE STOMACH). 
/ 
WM. B. NEFTEL, M.D., 
NEW YORK. 
Reprinted from The Medical Recoiid, June 8, 1878. 
NEW YORK: 
TROWS PRINTING & BOOKBINDING COMPANY, 
205-213 East 12th Street. 
1878. THE TREATMENT OF SOME FORMS OF 
DYSPEPSIA (CHRONIC CATARRH OF 
THE STOMACH). 
During the last ten years I have had the opportunity 
of observing a considerable number of patients af- 
fected with chronic catarrh of the stomach of long 
standing. They were referred to me principally on 
account of the accompanying intense gastralgic pains 
and the very unpleasant cerebral symptoms. In a 
number of cases these latter symptoms assumed so 
predominant a character in the history of the disease, 
that some doubt was entertained as to their true sig- 
nificance-whether it was not the brain symptoms 
which constituted the primary affection, and the dys- 
pepsia a secondary symptom, instead of vice versa. I 
could, however, almost always convince myself that 
the chronic gastric catarrh was the primary affection, 
that brought on the secondary cerebral symptoms, 
because it existed long (sometimes years) before the 
appearance of the cerebral symptoms, which latter 
commenced in a mild, scarcely noticeable form, and 
only gradually became more serious, and generally 
disappeared with the cure of the catarrh. 
In the majority of cases that have come under my 
observation, the disease was in an advanced stage, 
and the patients presented a high degree of anaemia 
and emaciation. They complained of general pros- 
tration and of inability to work intellectually, of loss- 4 
■of memory, sometimes of dimness of vision, without 
any objective cause, occasionally of tinnitus aurium 
and frequent faintness; more especially of vertigo, 
that rendered them timid in walking alone. They 
almost always felt chilly, and complained of a sensa- 
tion of fulness and a constant uneasy feeling in the 
epigastrium. This uneasiness increased to intense 
pain several times in the twenty-four hours, generally 
after meals, and especially during the night, thus in- 
terfering with sleep, which was sometimes interrupted 
by the pain at regular hours. They have had fre- 
•quent eructations, nausea, and sometimes vomiting, 
and complained of complete want of appetite, not- 
withstanding their extreme weakness and anaemia. 
The bowels were costive, the pulse small, the heart's 
action feeble, the respiration slow, the temperature 
not increased ; rather subnormal, the skin pale and 
dry, the abdomen tender and distended in the epi- 
gastrium. 
On examination of the contents of the stomach 
(ejected by vomiting, or removed with the stomach- 
pump), I found the reaction sometimes neutral, some- 
times even slightly alkaline; and when the reaction 
was acid, it was not owing so much to the presence 
of free hydrochloric acid as to that of lactic, butyric, 
acetic, and other volatile fatty acids. Under the mi- 
croscope I almost always found numerous sarcinae 
ventriculi and other microscopic fungi; the gas es- 
caping with the eructations was a mixture of hydro- 
gen, carbonic acid, and air. 
The gases, the acids, the fungi, etc., leave no doubt 
that the stomach of these patients is the seat of a 
morbid fermentation. The food, instead of under- 
going the normal digestion under the influence of 
the gastric juice (which in the normal condition con- 
tains free hydrochloric acid), is undergoing fermenta- 5 
tion, with evolution of gases and development of fatty 
acids, of which especially the butyric acid acts upon 
the stomach as an acute irritant. Hence the distention 
of the stomach, the gastralgic pains that increase 
during the height of the fermentation (some time after 
the introduction of food), and all the other local and 
general consequences which always accompany chronic 
gastric catarrh. The permanent dilatation of the 
stomach (gastrectasia) owes its origin to the paretic 
condition of its muscular coat, and this causes stag- 
nation of the food within the stomach, the relaxed 
walls of which are not able to forward the contents 
by their impaired contractions. On the other hand, 
this stagnation of the food promotes and perpetuates 
the fermentation, the vomiting, the constipation, etc. 
The general consequences produced by the gastric 
catarrh are chiefly due to the impaired nutrition of 
the whole system, and manifest themselves as general 
emaciation and anaemia, especially that of the brain. 
Generally the patients who came under my care 
' had tried before a great variety of therapeutic methods. 
As a rule, it was first attempted to control the gas- 
tralgic pains with alcoholic stimulants, spirits of 
camphor, etc., and which in the earliest stages of the 
disease would relieve them temporarily, but after a 
while lost entirely the power of producing the desired, 
effect. Anodynes were then resorted to, with a similar 
result. Of medicinal remedies, pepsine, bitters, nux 
vomica, strychnia, bismuth, alkalies, purgatives, etc., 
had their turn without avail, and of external applica- 
tions, different plasters, hydropathy, rubbing, elec- 
tricity in the form of electrical baths, general faradiza- 
tion, or central galvanization. In addition to all this, 
special kinds of movement and lift cures, and also 
different mineral waters and milk diet were vainly 
tried. 6 
Notwithstanding all these remedies and methods, 
the disease continued to make steady progress, the 
dilatation of the stomach increasing sometimes to an 
enormous extent, the gastralgic pains becoming in- 
cessant, with frequent exacerbations, depriving the 
patient of sleep, and the emaciation, anaemia, and 
general prostration reaching the highest degree. But, 
long before the disease advanced to that stage, the 
patients generally came to the conclusion that they 
must avoid some articles of food which in their ex- 
perience increased the eructations, pain, nausea, and 
vomiting, and therefore at first gave up eating those 
vegetables which produce flatulence, then a great 
many other articles, gradually reducing the variety of 
their diet, and living exclusively on Graham bread, oat 
meal, mutton-chops and beefsteak. Water was also 
avoided as much as possible, on the supposition that 
it dilutes the gastric juice, and hence increases the in- 
digestion. At last even this simple diet augmented 
their suffering and had to be changed for a diet 
amounting to slow starvation, viz.: rice-water, some- 
times rice boiled with milk, and the juice of meat. 
The only temporary relief during the attacks they 
found in hot water taken in large quantities. These 
patients, therefore, had to resort to hot water and the 
starvation diet to make their life at all bearable. In 
this stage of the disease the condition of the patients 
seemed so alarming that doubts would arise as to the 
correctness of the diagnosis. Indeed, the cachectic 
appearance of the sufferers would warrant the suspi- 
cion that a cancerous affection of some abdominal 
organ, or cirrhosis of the liver existed, though neither 
a tumor nor any characteristic symptom of cirrhosis 
could be detected by the physical examination. 
As regards the etiology and diagnosis of dyspepsia, 
I shall limit myself to a few remarks. I can state 7 
from my own observation that all forms of dyspepsia 
are incomparably more frequent in this country than 
in Europe. The majority of all the patients who have 
come under my care in this country have had one or 
another form of chronic dyspepsia ; even children seem 
not to be entirely exempt from it, and often exhibit 
an apparently inherited disposition to the disease. 
To explain these facts it is only necessary to take into 
consideration the history of this country and the mode 
of living of the people. The early colonists had no 
means of regulating their diet or properly preparing 
their food, two circumstances which constitute the 
principal causes of dyspepsia. The immigrants of the 
present day, the pioneers settling in the far West, 
labor under the same disadvantages. As a general 
rule, the culinary art is not yet sufficiently cultivated 
here ; and we often find, even in some hotels, abun- 
dant and excellent provisions spoiled by bad cook- 
ing. In the cities, the busy life of all classes scarcely 
allows time for meals, so that people get into the habit 
of eating in a hurried way, and set the example to 
their children. Thus the food does not undergo the 
preliminary changes requisite for a prompt and thor- 
ough digestion, viz., mastication and intimate mix- 
ture with the saliva. The function of the latter must 
not be underrated, the diastatic property of ptyalin 
and the excitation by the alkaline saliva of an abun- 
dant secretion of healthy gastric juice being most 
favorable for the digestion. Moreover, some incor- 
rect notions are prevalent among the public at large, 
which formerly were entertained by the profession, 
but are now abandoned owing to our advanced know- 
ledge. Many people think that water ought not to 
be taken during digestion, because it dilutes the gas- 
tric juice ; and this rule is most religiously observed 
by nearly all dyspeptics. And yet, experiments with 8 
artificial gastric juice show that food is easily digested, 
provided there is free hydrochloric acid and plenty 
of water, a minimum quantity of pepsine being suffi- 
cient to digest large quantities of food. Another 
fallacy, fortunately now losing ground, is the opinion 
that alcoholic stimulants are useful for digestion, 
which in reality are exactly the reverse; they disturb, 
retard, and check digestion, and by irritating the 
stomach constitute one of the most frequent causes of 
gastric catarrh. Again, some think that it is very 
healthy to eat in small quantities, but often. In ex- 
ceptional cases, in persons with an impaired diges- 
tion, where only a small quantity can be digested at a 
time, we are obliged to give food often in order to 
support life. As a rule, however, sufficient time is 
requisite for the food to be thoroughly digested, and 
it is injurious to add perfectly undigested food to that 
which is in the process, perhaps in an advanced stage, 
of digestion. We know, from physiological re- 
searches, that by the gastric juice the albuminous sub- 
stances of the food are transformed into soluble modi- 
fications-peptones-which are readily absorbed. But, 
until the peptones are removed by dialysis (absorbed), 
no new albumen can be thoroughly peptonized, nor 
can the peptones be absorbed in the presence of un- 
modified albuminous substances. It is, therefore, 
much better to take the necessary quantity of food at 
long intervals (three or four times in 24 hours), and 
entirely to abstain from eating anything between the 
meals. 
The diagnosis of chronic catarrh of the stomach 
may offer some difficulty only in its advanced stages. 
One of the easiest means to ascertain the extent of 
dilatation of the stomach is to introduce into it effer- 
vescent substances (bicarbonate of soda and tartaric 
acid) ; the shape of the stomach is then made palpable 9 
and even visible. The next thing to find is whethei 
the dilatation depends on the gastric catarrh, or 
whether they are both symptoms of a stricture at the 
pyloric part of the stomach. This is sometimes ex- 
ceedingly difficult to demonstrate, and we mostly have 
to be guided by tlie previous history of the case (ulcer 
of the stomach, etc.), or by the presence of a tumor. 
The microscopic examination of the contents of the 
stomach, the palpation of the abdomen, the absence 
of ascites, diarrhoea, etc., must be taken into consider- 
ation when making the differential diagnosis of chronic 
gastric catarrh, cirrhosis of the liver, amyloid degen- 
eration of the bowels, etc. ( hronic gastric catarrh is 
frequently mistaken for cancer of the stomach. I 
know of a case where an elderly person was consid- 
ered by her physicians to be suffering from cancer, 
which, however, was not found at the post-mortem, 
though during life the patient exhibited all the symp- 
toms of carcinoma ventriculi, except the presence of a 
tumor. It must be borne in mind that the most prom- 
inent symptoms of ca 1 of the stomach depend on 
the accompanying gastric catarrh, and may not exist 
at all without the latter. 
After having made the diagnosis of chronic catarrh, 
I employed formerly the treatment introduced by 
Kussmaul.* It consists in the methodical use of the 
stomach-pump, by means of which, at certain inter- 
vals, the stomach is entirely emptied of the stagnated 
food and the accumulated products of fermentation, 
and washed out with a weak alkaline solution (soda- 
water, Vichy). Tlie patients are then given nourish- 
ing and easily digestible food in gradually increasing 
quantities. They are much benefited by this method, 
and are often ultimately cured of the gastric catarrh; 
* Kussmaul: Heber die Behandlung der Magnerweiterung. Deutsch. 
Arch, fiir klin. Medicin. Bd. VI., p. 455. 10 
but it requires the constant and prolonged attendance 
of the physician, and is extremely tedious and un- 
pleasant to both. I have now adopted methods 
equally efficient, and in some respects much more 
so, and presenting none of the disadvantages men- 
tioned. 
In the earliest stages of dyspepsia the regulation of 
the diet alone is almost sufficient to arrest its further 
development. In the treatment of gastric catarrh, our 
special attention has to be directed to the circum- 
stance that such patients generally abstain from a 
great many wholesome and digestible articles of food, 
and are apt to resort to that form of dieting which, in 
reality, is slow starvation, and which, when prolonged, 
results in the impairment of nutrition of the most 
important organs. I therefore recommend to dyspep- 
tics a variety of articles of food (of course, excluding 
such as are indigestible), and prefer to correct the 
unpleasant symptoms they may call forth. It is far 
better to keep up the general strength of the patients, 
and treat the gastric symptoms, than in avoiding these 
latter to produce general anaemia and emaciation. 
It is not difficult to correct the gastric symptoms in 
the first stages of the disease; an occasional dose of 
magnesia or rhubarb, sometimes both together, or a 
wineglass of some bitter water (Friedrichshall, Hun- 
yadi, etc.), taken at bed-time, will often answer the 
purpose. Even pure water taken repeatedly, subdues 
the symptoms by washing, as it were, the stomach, 
and removing the accumulated products of the 
■catarrh. 
Experiments on animals with gastric fistula show 
that the introduction into the empty stomach of an 
alkali immediately excites an abundant secretion of 
gastric juice. I therefore advise dyspeptics to take 
Vichy water some time before their meals. About a 11 
tumbler before breakfast, and a much smaller quan- 
tity before lunch and dinner, and also to drink as 
much pure water as they like during and after the 
meals. 
It is advisable to rest awhile after meals, muscular 
or mental over-exertion being injurious, because the 
supply of blood is then diverted to the muscles or 
nervous centres, whereas during digestion the stomach 
ought to be in a state of congestion. Therefore, rest 
should be taken after the principal meals, even a little 
sleep, in order to afford the stomach the greatest 
amount of blood necessary for its increased activity. 
Infants and animals instinctively follow this rule. 
On the other hand, substances in a state of fermenta- 
tion, or which readily undergo fermentation, like 
beer, sweet things, etc., ought to be avoided, as also 
those substances which the stomach, affected by catarrh, 
is apt to produce itself-acetic, lactic, and butyric 
acids. Therefore, vinegar, bad milk, and especially 
rancid butter and fatty substances must necessarily be 
avoided. Unfortunately, such patients are sometimes 
even advised to take exactly the above-mentioned 
acids (vinegar bitters, lactic acid, etc.), in the suppo- 
sition that the gastric juice is acid and contains lactic 
acid. But the acid which in the free state is always 
present in the normal gastric juice is hydrochloric 
acid ; the lactic and other acids are produced by the 
chronic catarrh of the stomach, and rather interfere 
with the healthy digestion. One of the best remedies, 
and often quite indispensable in dyspepsia, is hydro- 
chloric acid, diluted in water, which I prescribe to be 
taken after meals. Physiological experiments have 
proved that one to four parts of free hydrochloric 
acid to one thousand parts of the gastric juice are 
most favorable for the digestion, while only a trace of 
pepsine is sufficient, and can be utilized over and over 12 
again in the process of digestion, provided the neces- 
sary quantity of hydrochloric acid and water be 
added. In the great majority of dyspeptics, if not in 
all, there is a deficiency of hydrochloric acid in the 
gastric juice, which must be considered as the princi- 
pal cause of the abnormal digestion. This is espe- 
cially the case with anaemic persons or during the 
febrile condition. Manassein * experimentally de- 
monstrated the deficiency of hydrochloric acid as 
being the cause of the deranged digestion during 
fever or anaemia. This acid, therefore, ought to be 
supplied to all patients affected with fevers, to 
anaemic persons, convalescents, and dyspeptics gener- 
ally. The experiments of Manassein made by him on 
anaemic and feverish animals have also showm that 
food mixed with their gastric juice easily undergoes 
putrefaction if no hydrochloric acid is added. I 
found that common salt or substances containing salt 
-like oysters, for instance-are useful in dyspepsia, 
because salt is an antifennentative, and the chlorine 
of the salt during digestion is transformed into 
hydrochloric acid. 
In the more advanced stages of the disease one of 
the principal indications is to check the morbid fermen- 
tation in the stomach. The experiments of Hoppe- 
Seyler on animalsf have shown that the healthy gastric 
juice is one of the best antifermentative remedies, as 
it prevents cane-sugar from fermenting even in the 
presence of fungi. In treating, therefore, the gastric 
catarrh, our efforts must chiefly be directed towards 
re-establishing the secretion of the normal gastric juice. 
In order to arrest the fermentation, I prescribe, accord- 
* Manassein : Centralbl. f. med. Wis. 1871. p. 853. 
+ Hoppe-Seyler : TJeber den Einfluss des Znckers auf die Verdauung 
und Ernahrung. Virch. Archiv. Bd. X., p. 144. 13 
ing to Botkin's recommendation, chlorine water * 
{freshly prepared according to the German pharmaco- 
poeia), to be taken several times a day, sometimes even 
every hour. It not only checks the fermentation, but, 
being ultimately transformed into hydrochloric acid 
-a natural constituent part of the gastric juice-it 
promotes digestion. After the disappearance of the 
morbid fermentation in the stomach, the chlorine may 
be substituted with advantage by the hydrochloric 
acid. Of late I have tried with good results to arrest 
fermentation by very small doses of thymol, but 
further observations are requisite to corroborate my 
first impressions. Quite recently I have used in one 
-case, to be mentioned hereafter, salicylic acid, with a 
most excellent result. In some exceptional cases, 
when the food stagnates unusually long in the stomach, 
owing to an excessive dilation and loss of con- 
tractility of the stomach, or to a strictured condition 
of the pyloric portion, it may occasionally become 
necessary to use the stomach-pump, or give Carlsbad 
salt one or two drachms in a large quantity of warm 
water, administering it before breakfast in two or three 
doses, at intervals of ten or fifteen minutes. Instead of 
Carlsbad salt, a mixture of sulphate of soda eighty-five 
per cent., common salt twelve or fourteen per cent., and 
•two or three per cent, of carbonate of soda, can be used 
with the same, and sometimes even with better effect. 
A solution of these salts stimulates the contractions of 
the stomach and the peristaltic motions of the bowels, 
causing several free passages, besides washing out the 
stomach and exciting the secretion of normal gastric 
juice, and thus promoting the digestion of the food 
now to be introduced. I need scarcely add that, 
until the disappearance of the gastric catarrh and the 
* Botkin : Ein Fall von Stenosis pylori, etc. Berl. kl. Woch. No. 38. 14 
cessation of pain, some palliative may occasionally be 
administered-for instance, small doses of morphine, 
alone or in combination, with bismuth, etc. 
One of the most important indications in the treat- 
ment of gastric catarrh is to reduce the dilatation of the 
stomach. Although with the abolition of the catarrh 
the stomach has a tendency to assume its normal 
dimensions, yet, owing to the atrophy of the muscular 
coat and its paretic condition, the diminution of the 
size of the stomach progresses very slowly, and the 
peristaltic contractions remain for a long time imper- 
fect, thus causing the stagnation of food. Hence the 
great persistency of all the morbid symptoms, and 
the excessively protracted treatment, notwithstanding 
the employment of the most rational and efficient 
methods. As gastrectasia, in some degree, is always 
present in gastric catarrh (and also in hysterical gas- 
tralgia), I have introduced a special treatment of the 
dilated stomach.* It consists in producing contrac- 
tions of the stomach by means of induced currents in 
the following manner: Both electrodes, in the shape 
of broad plates, are applied transversely (stabil) to the 
remotest portions of the dilated stomach. The current 
is gradually increased from minimum intensity to its 
maximum, and after several seconds' duration again 
diminished to its minimum. This is repeated fifteen 
to twenty times in succession, with a pause of several 
seconds between. Then the electrodes are applied to- 
two other distant portions of the dilated stomach in 
a vertical or diagonal direction, and the current again 
alternately increased and diminished in the above 
described manner. In addition to these "fluctuat- 
ing induction currents," I employ another method 
* Neftel: Die Behandlung der Magenectasien beim chronischen. 
Magencatarrh. Centralb. fur die med. Wissensch. 1876. No. 21. 15 
of "tetanizing induction currents" in the following 
manner: while the broad electrode is kept steadily 
at one portion of the dilated stomach (the current 
being of maximum intensity), the smaller electrode is 
suddenly pressed against the opposite portion during 
several seconds, then suddenly removed, and after a 
short interval again suddenly applied and removed, 
repeating this alternate applying and removal about 
fifteen or twenty times in succession. The electric 
treatment by means of one of these methods, or of 
both combined, is daily resorted to until the disap- 
pearance of all the morbid symptoms. The contrac- 
tion of the stomach produced by this treatment can 
be ascertained by percussion, and by the immediate 
relief it affords, although this effect is not lasting 
from the first, and the stomach assumes its previous 
size; but the tone of the muscular coat soon improves 
from the repeated applications of the current, and the 
size of the stomach becomes ultimately reduced. Un- 
der the electric treatment the costiveness invariably 
disappears, thus indicating the increased tone and 
peristaltic motion of the stomach and bowrels. 
After the disappearance of the gastric catarrh, there 
remains for some time a torpid state of the digestion, 
caused very probably by insufficient secretion of the 
gastric juice. We know from the earliest observations 
made by Beaumont * and others, that in fever, for in- 
stance, no gastric juice is secreted, not even by the 
excitation of the introduced food. The consequence 
is that the food remains unchanged in the stomach 
during twenty-four or forty-eight hours. Something 
similar takes place in torpidity of digestion, as can 
be ascertained w'ith the stomach-pump. (Leube in 
* Beaumont: Experiments and Observations on the Gastric Juice. 
Edinburgh. 1838. p. 99. 16 
Ziemssen's Cyclopedia.) Physiological researches offer 
different means of exciting immediate and abundant 
secretion of the gastric juice, the most powerful 
stimulus being saliva; ether, cold water, alkalies, 
etc., belong to this category. But, in order to 
promote the secretion of a healthy gastric juice in 
a more permanent way, we possess other remedies, 
like bitters, nux vomica, and especially small doses of 
rhubarb. One- or two-grain doses of rhubarb, taken 
several times daily during several weeks, materially 
improve the digestion of such patients by exciting 
the secretion of a normal gastric juice. Large doses 
of rhubarb act more on the liver and bowels, and there- 
fore do not answer the purpose. 
With the disappearance of the gastric catarrh, and 
possibility of taking in sufficient quantities a variety 
of food, the general health becomes finally restored to 
its normal condition. 
The chronic gastric catarrh, if not entirely cured, 
invariably results in anosmia, which may continue as 
an independent disease and be the origin of some 
grave and fatal affection: pernicious progressive an- 
aemia, fatty degeneration of the heart, marastic throm- 
bosis, etc. The anaemic condition can be successfully 
treated with preparations of iron, which I generally 
prescribe to be taken with the meals (from two to five 
grains of iron by hydrogen, two or three times a day, 
with the principal meals). The iron is then readily 
assimilated with the food, and the patient increases 
in weight and assumes a healthy appearance, in a re- 
markably shorter time than when given in the usual 
way. I continue during several months the use of 
iron in smaller doses (two or three grains), without 
causing the slightest inconvenience to the digestion. 
The foregoing remarks contain the general princi- 
ples which I follow in the treatment of dyspepsia, 17 
modifying them according to the peculiarities and re- 
quirements of the individual cases. From a large 
number of cases I offer here only a few illustrations. 
Mr. B., of New York, 64 years old, was suffering 
from an aggravated form of dyspepsia during many 
years. Previous to the appearance of dyspeptic symp- 
toms he enjoyed excellent health, and was very active. 
He worked hard as a builder, and, owing to his great 
energy and perseverance, accumulated a large fortune. 
With the rapid increase of means he could accord- 
ingly augment the amount and variety of food, with- 
out, however, allowing the stomach the necessary time 
for digestion, continuing to speculate in real estate 
and to work with enhanced energy and excitement. 
The result was dyspepsia, appearing first in a mild 
form, and in the course of years gradually assuming a 
most distressing character. He was treated by emi- 
nent physicians here and in Paris, receiving but slight 
and temporary relief. I examined him for the first 
time, July 12, 1873. He is of middle size, very well 
built, intelligent-looking, but exceedingly pale and 
emaciated. He complained of pain in the epigas- 
trium, increasing after meals, and more especially at 
night, depriving him of sleep. He could take but 
a few articles of food, and in the smallest quan- 
tities, as even the simplest things in larger quan- 
tities invariably aggravated the suffering. He had 
constant eructations, and often vomiting, which some- 
what relieved the pain, though for a short time. The 
bowels were costive, and moved only by taking ca- 
thartic pills. He felt very weak and chilly, the ex- 
tremities were cold, he had dimness of vision, and 
occasionally tinnitus aurium. He often had attacks of 
vertigo, at times so severe and prolonged, and accom- 
panied with such a sensation of faintness, that he was 
obliged to sit down, in order to avoid falling. On 18 
account of this vertigo and loss of memory, he had 
generally to be accompanied by his son, especially 
when transacting business, which at last he was on the 
point of giving up altogether. The epigastric and 
hypochondria regions were bulging out, the stomach 
much distended with gases, and its slow peristaltic 
motion could be plainly observed ; the skin pale and 
cool; the temperature in the axilla 36° C. ; the pulse 
weak, 46; respiration slow, 10in a minute. Nothing 
abnormal could be detected in the thoracic and ab- 
dominal organs, except the dilatation of the stomach; 
no tumor. The urine scanty, slightly alkaline, con- 
tained no albumen or sugar, but a large amount of 
indican (tested with muriatic acid and calcium chlo- 
ride). The sediment consisted chiefly of crystals of 
magnesium ammonium-phosphate. The vomited mass- 
es had an acid reaction and rancid odor. When left 
for some time in the test-tube, presented two, or rather 
three layers, the upper of a grayish color and frothy, 
containing, besides gas-bubbles, debris of food (fat- 
drops, muscular fibres, etc.), and becoming more 
voluminous after standing. The lower layers were 
brownish and darker at the bottom, where, besides 
some residua of food (amylaceous bodies), a large 
quantity of sarcina and other fungi were found under 
the microscope. In making the patient pass the gases 
evolved, by eructation, through a tube, they could be 
made to burn with a pale flame (hydrogen). A piece 
of coagulated albumen, after remaining for three 
hours in a test-tube filled with the vomited mass, was 
found almost unchanged (the edges slightly rounded). 
The vomited masses scarcely contained a trace of 
hydrochloric acid (tested with argentic nitrate), but 
a considerable amount of butyric acid (the distillate 
gave with baric hydrate the characteristic crystals), 
and of lactic acid (by Hoppe's method). There was 19 
no alcohol in the vomited masses, which continued to 
ferment in the test-tubes, as indicated by the in- 
creased volume of the upper frothy layer. By adding 
different antifermentative substances (permanganate 
of potash, borax, camphor) to separate portions of the 
vomited masses, it could be observed that hydrochlo- 
ric acid, and still better, chlorine, decidedly checked 
the fermentation, and pieces of coagulated albumen 
would become entirely dissolved. It was evident 
from the chemical and microscopical examinations 
that the dilated stomach of the patient was the seat of 
fermentation; moreover, by the presence of butyric 
acid, hydrogen, and the absence of alcohol, it could be 
specified as butyric acid fermentation. 
It remained yet to decide whether the fermentation 
was caused simply by gastric catarrh, or whether this 
latter, together with the fermentation, was called forth 
by stenosis of the pylorus; and if so, whether the 
stenosis was the result of a cicatrix or of a tumor 
within the walls of the stomach or in some adjacent 
organ, and merely pressing upon the pylorus. The 
previous history of the patient, who at no time had 
any symptoms of ulcer of the stomach, excluded the 
cicatricial stenosis, and the long duration of the dis- 
ease made the existence of a malignant tumor improb- 
able. Accordingly, I began treating the patient as 
if affected with simple gastric catarrh, reserving the 
prognosis on account of the indican in the urine. At 
that time I had the opportunity of observing a num- 
ber of cases with cancerous deposits in the liver and 
other viscera, who all had a large amount of indican 
in the urine.* The recent researches of Jaffe f and Sena- 
* Neftel: Die electrolyt. Behandl. bosart. Geschwulste. Virchow's 
Arch., Bd. 57, p. 242. 
+ Jaffe: Ueber die Ausscheidung des Indicans, etc. Virchow's 
Arch., Bd. 70, p. 72. 20 
tor * have shown that indican may be present also in 
various other diseased conditions. I prescribed the 
solution of Carlsbad salt in divided doses, to be taken 
before breakfast (on the first day only), and strong, 
freshly-prepared chlorine-water every hour. I also 
advised him to drink pure water with and between 
the meals, and treated him with induced currents. 
Besides applying the electrodes to the stomach in the 
way above described, I applied them also to the hypo- 
gastric region, in order to stimulate the activity of the 
bowels. The electric treatment was continued daily, 
and so was the chlorine (every two hours). The pains, 
eructations, vomiting, became less intense and less fi e- 
quent, and soon entirely ceased. The appetite im- 
proved from the very beginning of the treatment, 
though under my advice he had to increase very grad- 
ually and cautiously the amount and variety of food. 
With the abolition of pain he slept soundly, and his 
general health steadily improved. After the disap- 
pearance of the symptoms of fermentation the chlorine 
was left off, and hydrochloric acid prescribed, to be 
taken with water after each meal. A mixed diet was 
then allowed, with the exception of salads, sardines, 
fatty and other indigestible substances, and at the end 
of the month the patient considered himself almost 
well. There remained, however, a considerable de- 
gree of anaemia, general debility, and a slight weak- 
ness of digestion, occasionally calling forth some pain, 
and a tenderness and swelling in the epigastric region. 
I ordered one-grain doses of rhubarb four times a day, 
and continued the treatment with induced currents- 
at first daily, and then every other day. After two 
months' treatment, the general health of the patient 
was in an excellent condition. He felt strong, could 
* Senator : Ueber Indican und Kalk Ausscheidung, etc. Berl. klin. 
Woch., 1877, No. 40. 21 
walk long distances, and the sleep, digestion, and 
bowels became quite normal. Together with this 
treatment, and on account of the marked cerebral 
symptoms, I employed galvanization of the brain, 
according to my method described in the Archivfur 
^xychiatrie und Nervenkrankheiten. Bd. VIII., p. 409. 
The patient still continues in excellent health, and 
never complains of either dyspeptic or any cerebral 
symptoms. 
I will now give an instance in which the cerebral 
symptoms were the principal object for treatment, 
while the dyspepsia to which they were due was con- 
sidered of secondary importance. 
Mrs. R., fifty years old, a cultivated lady of high 
standing in society, complained principally of a sensa- 
tion of faintness, as if the head were swimming. This 
sensation recurred quite frequently, and at times lasted 
so long that she was obliged to sit down to prevent 
falling. After evacuation of the bowels, which almost 
always had to be produced artificially, she invariably 
felt quite faint and had to remain in a recumbent 
position for an hour or more, though there was no 
local pain in the rectum, and neither a fissure nor 
piles. She suffered besides from general debility, 
being unable to take food in sufficient quantities, be- 
cause it produced pain and swelling in the epigas- 
trium, and frequent and loud eructations. She had 
to exclude a great many articles of diet, as they always 
increased the distressing symptoms. She was there- 
fore reduced to the simplest food in insufficient quan- 
tities. Owing to the judicious advice of her physi- 
cian, and the great care the intelligent lady observed 
in her diet, the dyspepsia was kept in check during a 
great many years, her principal complaint being 
vertigo, headache, fainting fits, and other cerebral 
symptoms. 22 
On examination, Nov. 17, 1873, I found consider- 
able emaciation and anaemia, the stomach moderately 
dilated. I prescribed a full dose of calcined magne- 
sia at bed-time, and the chlorine to be taken every two 
hours, and commenced the electrical treatment of the 
dilated stomach and torpid bowels, and the galvani- 
zation of the head. At the same time I advised her 
to eat a variety of articles of food in considerable 
quantities, and should this diet produce indigestion, 
to correct it by a dose of calcined magnesia. In 
about a fortnight I substituted hydrochloric acid for 
chlorine, and, as an after-treatment, prescribed small 
doses of rhubarb, and finally iron. The result of this 
treatment was entirely successful; the dyspepsia and 
cerebral symptoms vanished, the patient gained flesh, 
and her general health became excellent in every re- 
spect. 
I shall briefly relate the following case, to show 
the beneficial effect derived from the use of salicylic 
acid as an antifermentative in chronic catarrh of the 
stomach. 
Mr. M., an elderly gentleman with a good constitu- 
tion, but for many years a prey to gastric catarrh, con- 
sulted me Oct. 31, 1875. The dilatation of the stom- 
ach was moderate, though the gastralgic pains were 
often intense. Being a resident of Massachusetts, he 
could only occasionally be treated for a short time, 
and therefore could receive but temporary relief. 
Two years previously he had an attack of inflamma- 
tory rheumatism, which kept him in bed for nearly 
two months, and since then was several times threat- 
ened with a return of the disease. I prescribed for 
him salicylic acid, to use in case of another attack. 
Last year he became ill with inflammatory rheumatism 
accompanied with high fever, and after suffering in- 
tense pains in the inflamed and swollen articulations- 23 
during twenty-four hours, he decided to try tlie sali- 
cylic acid according to my prescription. He took 
eight-grain doses every hour, beginning in the morn- 
ing, and towards evening the pains, swelling, redness 
and fever almost entirely disappeared. During sev- 
eral days he took salicylic acid three times a day, and 
found to his great amazement that with the disappear- 
ance of the inflammatory rheumatism the dyspeptic 
symptoms had also subsided, so that he was able to 
eat larger quantities and a variety of food, and gained 
flesh. He still continues to be in remarkable good 
health. 
The two following varieties of acute gastric catarrh 
present a peculiar interest-the one often leading to 
the chronic form, and the other being of great diag- 
nostic importance. 
The first appears in a most acute form, and is ac- 
companied with intense gastralgic pain. It attacks, 
sometimes, persons who were previously in good 
health, or had but very slight dyspeptic symptoms. 
After prolonged excesses in diet, especially when 
coupled with a liberal use of alcoholic liquors, the 
patients are attacked with nausea, vomiting, and vio- 
lent pains in the stomach, which increase in the night 
and prevent them from sleeping ; there is a complete 
loss of appetite, costiveness, vertigo, and headache. 
This condition may continue for days and weeks, and 
finally pass into the chronic form of gastric catarrh, 
if the acute attack is not radically cured. The accom- 
panying headache and vertigo often arouse suspicion 
of a brain affection, wTere it not for the acute gastric 
symptoms,[which are ascribed to inflammation of the 
stomach. 
Gen. , a strong and formerly very healthy gen- 
tleman, during the last five or six years indulged 
greatly in eating and drinking. Being very popular, 24 
he was often called upon to attend dinners, where, be- 
sides the abundant courses, wine was partaken of in 
profusion, and cigars smoked. After one of such gas- 
tronomic dinners he was attacked with nausea and 
vomiting, followed by intense pains, which kept him 
awake all night. Notwithstanding the remedies em- 
ployed (mostly homoeopathic), the gastralgic pain, nau- 
sea, vomiting, and want of sleep continued during four 
weeks. I saw him for the first time, Aug. 14, 1873. Be- 
sides the above-mentioned symptoms, he complained 
of headache, vertigo, eructations, and costiveness. The 
tongue was red, the abdomen tender in the epigas- 
tric and right hypochondric regions, the stomach was 
distended, the liver enlarged. I prescribed Carlsbad 
water (Sprudel), to which was added Carlsbad salt, 
to be taken before breakfast, and the chlorine every 
hour, besides the treatment with induced currents of 
the stomach and bowels. All the morbid symptoms, 
including costiveness, disappeared in a few days, so 
that he could resume his business, continuing for some 
time the electrical treatment, the diluted hydrochloric 
acid, and finally only the small doses of rhubarb. A 
year later, owing to excesses in diet, he had a new 
acute attack, but was promptly relieved by the same 
treatment. Last year a similar attack befell him in 
the country, where he suffered intensely during several 
weeks, and recovered only after coming to New York 
and resuming the treatment. 
I would call the attention of the profession to 
similar acute gastric attacks which appear periodically 
in persons suffering from locomotor ataxia and other 
affections of the spinal cord. Of late, Charcot * has 
described them in his admirable work under the name 
* Charcot: Le<?ons sur les maladies du systeme nerveux. Part I., 
p. 32, and Part II., p. 26G. 25 
o f crises gastriques or gastralgiques; but I believe 
that these attacks are still very little known, and not 
even mentioned in many text-books on diseases of the 
stomach, thus giving cause for great diagnostic errors. 
The case I here relate is not only of a theoretical in- 
terest, but of great practical importance. It teaches 
for the first time, so far as I know, that the periodical 
acute gastric attacks may exist for years before the 
appearance of any other symptom of locomotor ataxia. 
These attacks are therefore of the greatest value as an 
early premonitory symptom of most dangerous affec- 
tions, the development of which may thus be pre- 
vented by an appropriate treatment. 
Mr. C., 46 years old, came under my care February 
9, 1877, affected with locomotor ataxia in a very ad- 
vanced stage. He has a good constitution and is of 
healthy parentage, married twelve years, has three 
healthy children, and was formerly in good health. 
Before his marriage he was much addicted to drink 
and excessive venery, and even the first year after 
his marriage he continued to use alcoholic liquors 
until about eleven years ago, when he gave them up 
after an attack of intense gastralgic pains and inces- 
sant vomiting, lasting for about a week. Five weeks 
after his recovery he had another attack, and since 
then the gastric attacks appeared periodically, at first 
every five weeks, and afterwards oftener. During the 
attacks he remains for several days prostrated with 
intense gastralgic pain and incessant vomiting, takes 
no food at all, and passes sleepless nights. These very 
acute symptoms gradually subside in the course of a 
week or ten days, when his digestion becomes again 
normal, and remains so until the appearance of another 
attack. These gastric attacks were for a long time 
ascribed to inflammation of the stomach, and treated 
accordingly, but afterwards they were considered as a 26 
simple gastralgia, and therefore more successfully 
managed. Several years later, in addition to the gas- 
tralgic attacks, he commenced to suffer intense neu- 
ralgic pains in the lower extremities, and after awhile 
also in the upper ones. They always alternated with 
the gastralgic pains, so that with the appearance of 
the gastric attack the excruciating pains in the ex- 
tremities subsided. These latter were considered as 
rheumatism, and, after numerous remedies were tried 
in vain, the patient was sent to hot springs, where he 
remained during a summer and winter. There his 
locomotor co-ordination, his sight and hearing became 
very much impaired, and lie returned home in a 
greatly aggravated condition. He then consulted 
different specialists, who all declared the disease to be 
a well-marked case of locomotor ataxia, though the 
gastric attacks were still considered as a simple gas- 
tralgia, and in no connection with the sclerosis of the 
cord. He is now treated by me with the galvanic cur- 
rent, under the influence of which the sight, hearing, 
and locomotion have greatly improved, the neuralgic 
pains have disappeared, and the gastric crises occur 
but seldom (once in several months), and in a very 
mild form. 
The so-called crises gastriques may accompany not 
only locomotor ataxia, but also other diseases of the 
spinal cord, like central myelitis and multiple sclerosis 
in their earliest stages-therefore, at a time when these 
diseases can yet be more successfully treated. The last 
case proves that these gastralgic attacks may even pre- 
cede the development of the spinal disease, and thus 
become a most valuable premonitory symptom of the 
approaching danger. It is evident, therefore, that the 
early recognition of their true nature is of the greatest 
practical importance. Unfortunately, they are scarcely 
ever recognized, and thus give rise to great diagnostic 27 
errors. And yet these gastric attacks present some 
characteristic peculiarities which always make the diag- 
nosis possible and often easy. Thus, the attacks appear 
periodically, during the intervals of which the digestion 
is quite normal or nearly so; they are accompanied or 
followed by the neuralgic pains of the extremities pecu- 
liar to tabetics (douleurs fulgur antes). During the 
attacks the pulse is accelerated, but the temperature 
remains normal. Later there is incipient impairment 
of sensibility, vision, and locomotor co-ordination, etc. 
In some exceptional cases the gastralgic attacks and 
a slight impairment of vision (or merely a tendency 
to fall -when the eyes are closed) are the only symp- 
toms of locomotor ataxia, the real nature of which 
may thus remain unrevealed for a long period of time. 
Before dismissing the subject, I wish to make one 
more remark concerning the electrical treatment above 
described. Being employed in conjunction with other 
remedies, it is not evident how much of the result of 
the treatment has to be ascribed to its influence. 
The following case seems to prove that the electrical 
treatment is an important factor in reducing the gas- 
trectasia, and removing the atonic condition of the 
bowels. 
Mrs. W., set. 43, wife of a physician in Montgomery, 
Ala., placed herself under my care in September, 1874, 
for the treatment of habitual constipation of twenty 
years' standing. The dyspeptic symptoms were kept 
in check by the judicious treatment of her husband ; 
the dilatation of the stomach was moderate, but the 
costiveness baffled every treatment, and the bowels 
could not be moved without a cathartic. Her husband 
sent her to New York solely for the electrical treatment, 
having satisfied himself that internal remedies, of 
which she had already taken great quantities, did 
not modify the habitual costiveness. I was therefore 28 
enabled to observe in this case the effect of the elec- 
trical treatment alone, applied in the above described 
manner. The result was a permanent cure of the cos- 
tiveness and of the dilatation of the stomach. The 
anaemic condition was subsequently treated with iron. 
In conclusion, I will sum up the foregoing in a few 
propositions. 
The local effects of the chronic gastric catarrh are: 
1. Fermentation in the stomach (butyric acid), 'with 
•evolution of gases (inflammable) and formation of 
fatty acids (butyric, lactic, acetic). 
2. Dilatation of the stomach (gastrectasia) and im- 
pairment of its peristaltic movements. 
3. Stagnation of the food in the stomach and atonic 
condition of the bowels. 
4. Gastralgic pains and vomiting. 
The general effects of the gastric catarrh are emacia- 
tion and general anaemia from the defective nutrition 
of the system, especially anaemia of the brain, causing 
vertigo and other cerebral symptoms. 
The diet of those affected with chronic gastric 
■catarrh, though simple and easily digestible, must not 
be too uniform, and pure water can be used ad libi- 
tum. 
The principal indications in treating chronic gastric 
catarrh are: 
1. To arrest the fermentation (by antifermentatives 
-chlorine, thymol, salicylic acid, hydrochloric acid, 
etc.). 
2. To treat the gastrectasia and the atonic condition 
of the bowels with induced currents. 
3. To excite the secretion of a healthy gastric juice 
by the use of alkaline waters, small doses of rhubarb, 
bitter remedies, etc. 
4. To improve the digestive properties of the gas- 
tric juice by the administration of hydrochloric acid, not only in dyspeptics, but also in anaemic persons gen- 
erally, and in those affected with fevers, and in conva- 
lescents. 
It is of the utmost importance to diagnosticate 
early the gastralgic pains (crises qastriques), which 
sometimes accompany, or even precede, the develop- 
ment of locomotor ataxia and other diseases of the 
spinal cord. 
On the early diagnosis depends the possibility of 
preventing or curing these organic affections of the 
spinal cord. 
William B. Neftel, M.D. 
16 East 48th St., New York. 
29