Diagnosis

The presence of symptoms of general neurasthenia, and especially of those attributable to the digestive tract without the existence of a real organic trouble, will establish the diagnosis. The principal characteristic of this affection is the lack of proportion between the multiform complaints and the results objectively found in an examination of the digestive organs. Another point of value is the circumstance that different kinds of food, even indigestible substances, do not seem to aggravate the condition, nor does very light food ameliorate it, while changes of climate or surroundings or sometimes pleasant news and the like, may suddenly check all the unpleasant sensations for a considerable time.

Differential Diagnosis

Neurasthenia gastrica may occasionally be confounded with chronic gastric catarrh, ulcer of the stomach, or cancer, the more so as all these organic affections of the stomach are frequently associated with nervous symptoms. The following points will serve to differentiate between neurasthenia gastrica and the affections mentioned: in neurasthenia gastrica the nervous symptoms (referring to the stomach and to other distant organs) play the most important part. While the different complaints are connected more or less with the digestive tract, the quality and quantity of food do not seem to be of great importance. Sudden changes in the condition of the patient, who feels entirely well for a few days and then again utterly disabled, are characteristic of neurasthenia gastrica. Chronic gastric catarrh will be easily recognized by the constancy of the symptoms, which are aggravated by errors in diet, and by the condition of the gastric secretion (diminished acidity, large quantity of mucus, etc.). In ulcer of the stomach we shall always find some of the characteristic points (circumscribed painful spot, vomiting, haematemesis or melaena, pains after the ingestion of food, as a rule very intense). As is well known, however, an ulcer may exist without any of these characteristic symptoms, and it therefore becomes very difficult to exclude its presence, the more so as neurasthenia gastrica may complicate this affection To establish the differential diagnosis between neurasthenia gastrica and cancer of the stomach, it is often necessary to have the patient under observation for quite a period of time.

Whenever there is a tumor or other distinct symptoms of cancer, it is easy to recognize the cancerous affection. If, however, marked symptoms are absent (during the first period of the disease), the differential diagnosis is difficult. In cancer of the stomach there will also be some relation between the quality and quantity of the ingesta, and the existing disturbances. Moreover, in cancer of the stomach there is progressive aggravation of the trouble, while in neurasthenia gastrica the condition may remain stationary for a long period of time.

Treatment

Tn all cases in which some connection can be found between this affection and other existing ailments, the treatment must be directed against the latter. If neurasthenia gastrica exists alone, then therapeutic means must be resorted to which will strengthen the entire nervous system. Change of climate, outdoor life, entire relief from business cares, are of great importance, and sometimes sufficient to cure the patient. The diet should be ample, and it is of importance to impress upon the patient the necessity of taking plenty of food. As to the digestibility of different kinds of food in this affection, the patient's own judgment and experience are the best guides to follow. Condiments should be taken moderately and the use of wine, tea, coffee, and beer in small quantities is allowable. In patients who have greatly emaciated, Weir Mitchell's rest cure is often followed by the best results. The direct means which serve to strengthen the nervous system are the following: 1. Hydrotherapeutic measures of a mild nature (wet cold pack, lukewarm sitz bath). 2. Massage of the entire body, to which special massage of the abdomen may be added. 3. Electricity; general faradization of Beard and Rockwell;1 the patient sits barefooted on a large plate electrode, while the other electrode is passed by the physician over the chest, back, and extremities - electric bath. 4. Both sleep and rest should be accorded to the patient in a large degree.

While gymnastic exercises are beneficial, they should never be indulged in to such an extent as to tire out the patient.

With reference to the local treatment of the stom-ach, the gastric douche has been recommended by Malbranc1 and lately by Rosenheim.2 In a few cases I have applied the gastric spray with similar good results. As regards medicaments, the bromides are of the greatest importance.

1 Beard and Rockwell: l. c.

℞ Amnionii bromidi,

Sodii bromidi,.......aa 1.0

M. f. pulv. D. in chart. No. SO. S. One powder twice daily in milk or in water.

The use of the different tonics (iron, arsenic) is frequently indicated. Levico or Roncegno water (one-half to one tablespoonful three times daily), ferratin, Gude's peptomangan, Dietrich's peptonate of iron are also in place. In cases in which the anorexia plays a dominant part, tincture of nux vomica (ten drops three times daily) or orexinum basicum (2 dgm. in wafers, three times daily) should be administered. Insomnia will often have to be remedied by the use of either chloral hydrate, sulphonal (1 1/2 to 2 gm.), or trional (1 to 2 gm.).

The bowels should be regulated according to the rules given in the chapter on chronic gastric catarrh. A sojourn in the mountains or in some watering-place having mild ferruginous springs, such as Elster, Franzenshad, and Pyrmont, or salines such as Ems, Wiesbaden, and Kissingen, may be recommended, while the purgative waters of Carlsbad and Marien bad should be avoided.

1 Malbrane: l. c.

2Th. Rosenbeim: Therap. Monatehefte, 1892, p. 882.