Dyspeptic diseases of secretory origin are little understood. Their essential causes have been badly described, and their clinical symptoms are ill-recognised.
We cannot prove whether the forms said to be due in man to excess of hydrochloric acid and insufficiency of hydrochloric acid really occur or are well defined in domestic animals: nor are we better informed as to the exact part played by the organic acid of fermentation (lactic, butyric, acetic acid, etc.); but the most complete investigations which have yet been made justify our supposing there is some parallel.
Moussu described primary ulcerative gastritis in 1895; and as this form is almost certainly associated with excess of pepsin, the occurrence of an excess of hydrochloric acid also seems possible, the more so as the symptoms noted resemble the general symptoms of that condition—preservation of appetite and of the motor power of the rumen, accumulation of food in the rumen as a consequence of reflex intolerance of the abomasum, constipation, and vomiting.
In addition to these two morbid conditions, a third occurs with some frequency. It is characterised by chronic tympanites, alimentary diarrhœa (the food being badly digested), and progressive wasting. This condition seems due to an insufficiency of hydrochloric acid, brought about by chronic gastritis, the epithelial cells of the mucous membrane appearing incapable of producing sufficient hydrochloric acid for digestion.
Diagnosis. In the present state of our knowledge regarding digestion in ruminants the precise diagnosis of these pathological conditions must always remain difficult; but it is indisputable that with the above grouping of symptoms we are more likely to succeed than by confining ourselves to the diagnosis formerly common, viz., that of chronic tympanites or chronic indigestion.
The difference between primary and secondary dyspepsia should always be borne in mind, and careful examination will often reveal the special condition which has served as the point of departure for gastric disturbance. Thus generalised tuberculosis, or tuberculosis of the liver or mediastinum, should always be sought for, and the possible existence of such conditions of the liver as echinococcosis, cancer of the bile ducts, tumours, etc., and diseases of the kidneys should be borne in mind. The influence of gestation, which so frequently causes gastric disturbance complicated with albuminuria, should never be overlooked, and in these secondary forms of dyspepsia the determining cause, and not the objective symptoms should receive chief attention.
Prognosis. The prognosis of secondary forms of dyspepsia varies with the gravity of the primary disease. The prognosis of primary dyspeptic conditions varies greatly, and that state in which hydrochloric acid is too sparingly secreted is certainly the gravest.
Lesions. The lesions have not been carefully studied, but it is probable that in many cases they might afford a key to the symptoms noted. Like all mucous lesions, they are difficult to demonstrate histologically. Infiltration and thickening of the mucous corium and submucous layers have been described. Such lesions indicate nothing; but in some cases new growths have been found in the gastric compartments or contractions about the pyloric orifice, the essential importance of which cannot be doubted.
Treatment. If our knowledge is still insufficient to enable us precisely to diagnose what we have termed “gastric dyspepsia,” or what is still currently described as “chronic dyspepsia,” the difficulty is even greater when attempting to lay down lines of treatment, because of the lack of known facts and the want of a base for reasoning. Thus we find, without being able to explain why, that some prescribe tartar emetic, others rapid and energetic purgatives, others, again, laxatives; whilst German authors, apparently without any justification, recommend oil of turpentine. It seems to us, however, that one might do better than this and attempt to lay down some rational indications for treatment.
(a) In cases characterised only by chronic tympanites, without diarrhœa, without manifest constipation (motor dyspepsia), and without any other apparent organic disturbance, drugs calculated to stimulate peristalsis of the rumen seem indicated. The most promising comprise ipecacuanha in doses of 1 to 2 drams per day, tincture of nux vomica in similar doses, powdered nux vomica in doses of 45 to 75 grains, and laxatives like Carlsbad salts in doses of 8 to 10 drams.