In the milder type of case the above may suffice, supplemented, if necessary, by some gentle aperient. Unfortunately in many instances the condition is apt to become complicated by fermentation with excessive formation of organic acids. It is to these that the “acid risings” are due, and not to excess of HCL. Indeed, the reverse is the case, viz., a deficiency of HCL. It is this that is responsible for the fermentation with the production of butyric, lactic, and acetic acids. Moreover, in middle-aged “gouty” subjects of sedentary habits there is often superadded motor defect, which may end in dilatation.
For treatment of this condition careful dieting alone may suffice. Indeed, attention to general health often succeeds where stomachic therapy alone conspicuously fails. The medicinal indications in these cases will vary according to the stage at which they are seen. In the milder forms we may stimulate the flow of gastric juice by alkalies and bitters before meals, or hydrochloric acid after food may be taken to replace the defect.
Now, theoretically speaking, this may sound very simple, but in practice it is often not so. Moreover, the less the attention paid to correction of diet and faulty habits, the more bewildering and disappointing the effect of drugs. Conversely, the more care expended on the selection of food and hygienic measures, the less need for drugs and the clearer the indications for such as may be helpful.
Thus simply under a revised diet the acid eructations may wholly disappear and the subject suffer only with languor, discomfort, or drowsiness after meals. Here dilute hydrochloric acid combined with strychnine and pepsine after food will be found useful.
On the other hand, many of these patients are impatient of dietetic control, yet nevertheless clamour for relief of their “acid” eructations. In such cases alkalies must be given an hour or so after meals to correct the excess of organic acids. The same may be combined with antiseptics—carbolic, B. naphthol, creosote, etc.—or some artificial digestive, such as papain, pancretin, or taka-diastase.
| ℞ | Bismuth carb. | gr. 15 |
| Calcii carb. | gr. 5 | |
| Acid. carbol. pur. | ♏︎ ½ | |
| Oleum cajeput | ♏︎ 2 | |
| Fiat cachet, 1 or 2 an hour or more after meals. | ||
The calcium and bismuth carbonates are best, inasmuch as, though they act slowly, they give rise to no secondary hypersecretion. Of digestive adjuvants in these cases, Luff speaks highly of taka-diastase (gr. 2½) immediately before meals in addition to bismuth and alkalies. The taka-diastase assists the digestion of carbohydrate foodstuffs, and so lessens or inhibits the formation of organic acids. But as a digestive adjuvant in these cases of “dyspepsia” with acid eructations papain is most useful, acting in acid, alkaline, or neutral media. This indifference on its part enables us to combine it with alkalies, and so attain the dual effect of reinforcing the digestive capacity and neutralising hyperacidity.
| ℞ | Mag. carb. pond. | gr. 15 |
| Sodii bicarb. | gr. 10 | |
| Papain | gr. 3 | |
| Oleum caryophylli | ♏︎ ½ | |
| Fiat cachet, 1 or 2 after meals when acidity is at its height. | ||
Our forefathers in such cases thought highly of rhubarb and magnesia, and certainly in hospital patients some such combination as the following is invaluable in so-called “gouty dyspepsia”:—
| ℞ | Mag. carb. | gr. 10 |
| Sodii bicarb. | gr. 15 | |
| Acid. carbol. pur. | ♏︎ 1 | |
| Tinct. rhei co. | ♏︎ 15 | |
| Spts. chloroformi | ♏︎ 15 | |
| Inf. caryophylli ad unciam, ter in die post in cibos. | ||