b. Cases with Hyperacidity of the Gastric Juice

In the beginning we employed saline waters with considerable hesitancy when treating cases of hyperacidity of the gastric juice, because it had been variously stated by different writers on the subject that such patients did not stand saline waters very well. To judge from our experience in this class of cases, the disagreeable effects of saline waters have been greatly exaggerated; in fact, we feel justified in stating most positively that numerous cases of hyperacidity are rapidly and permanently benefited by the use of saline mineral waters. We have records to-day of over a hundred cases in which the most favorable results imaginable were obtained. We report a few cases that were observed some years ago, and also give a tabulated summary of the cases observed within the last few years. Twenty-five cases that were carefully observed have in addition been reported by one of us (Dapper) before the Congress of Internal Medicine in Carlsbad, in 1899.

1. Mr. J. K., aged twenty-three years; nervous dyspepsia with hyperacidity and hypersecretion. Gastricatony.

A very nervous young man with a neuropathic disposition. A sufferer from habitual constipation; hyperaesthesia of the stomach; much acid belching after eating, and within the last few months considerable emaciation.

Physical examination revealed impaired motility of the stomach; hypersecretion and hyperacidity of the gastric juice. After a test breakfast, consisting of a quarter of a liter of tea and one roll, about 400 c. c. of fluid of an acidity of 0.03 per cent. (calculated for hydrochloric acid), were aspirated from the stomach. No dilatation of the stomach.

The treatment consisted in the administration of Kissingen Rakoczy water, in doses of 300 to 400 c. c.; in addition, frequent lavage of the stomach. The diet consisted of large amounts of food, containing much fat finely distributed. At times extract of belladonna was also administered.

At the expiration of two months the patient had gained ten pounds; after four months twenty pounds. At the end of the fourth week the subjective symptoms were essentially relieved. An after-cure in Kissingen, lasting about four weeks, did away with the last remnant of the patient's distress and restored him to complete and permanent health.

The analyses of the stomach contents gave the following results:

February 2, 1895. Total acidity, 0.03 per cent. Hydrochloric acid reaction very strong ; no lactic acid.

From this time on Kissingen Rakoczy water was given. On the days on which the gastric contents was aspirated no Rakoczy was given, or it was given after the lavage had been performed.

The use of Kissingen water was stopped. March 12, 1895. Total acidity, 0.16 per cent.

2. Mr. R., assessor, aged thirty-two years. Nervous dyspepsia with hyperacidity.

Patient had weak nerves as a child. He led a very strenuous intellectual life, and had been very nervous since his fifth year. Usually constipated. Complains of much heartburn. Is emaciated.

The physical examination shows that the gastric contents is propelled onward within the normal time limit. Hyperacidity of the gastric juice. After a test breakfast, total acidity, 0.34 per cent. (May 30, 1895); strong acid reaction. The patient receives 300 to 500 c. c. of Kissingen Rakoczy water, a very copious diet, and carbonated mud baths.

At the end of two weeks considerable improvement At the end of four weeks and a half no more subjective symptoms. According to a written communication transmitted by the patient, the recovery was permanent. Patient gained fourteen pounds.

The examination of the stomach contents gave the following results :

3. Mr. C. H., aged forty years; hyperacid dyspepsia.

Patient is a nervous man who is overworked in his business. He travels very much, and takes his food very irregularly. Smokes a great deal (ten to twelve cigars). For about three months patient has been complaining of much belching, occasional vomiting, heartburn, and constipation. The stomach is not dilated. On May 16, 1895, aspiration of the stomach contents after a test breakfast. Total acidity, 0.28 per cent.; no lactic acid. The patient is ordered to take 200 c. c. of Homburg Elizabeth water in the morning. Tobacco is interdicted; the patient is instructed to eat at regular intervals; the stomach is frequently washer! nut.

The use of Homburg water was gradually stopped. All the symptoms had disappeared by the beginning of July.

4. Mr. St., aged thirty-two years; nervous dyspepsia with hyperacidity; atony of the intestinal tract.

A nervous individual; very actively engaged on the stock exchange. Irregularity in eating; has been suffering for two years from gastric disturbance, with much heartburn and occasional vomiting, the vomiting being preceded by pain in the stomach; constipation; emaciation.

Examination revealed impaired motility of the stomach wall; hyperacidity of the gastric juice (June 2, 1895) ; no dilatation of the stomach.

Treatment: 300 to 500 c. c. of Kissingen Rakoczy and abundant diet containing much fat, and given at frequent intervals throughout the day. Carbonated mud baths; faradic current.

Examination of the stomach contents after a test meal gave the following results :

At the end of two weeks the symptoms had disappeared; the bowel action was regular. (Patient gained fourteen pounds and was permanently restored to health.)