The Coated Tongue - Its Cause And Meaning Part Four

As to the cause of the acidity in heartburn Fothergill says that it is generally caused by the decomposition of some fat in the stomach, of which there is an excess in the food, with the formation of a fatty acid like butyric acid. In the escape of gas from the stomach, the esophagus being very sensitive, the acrid fatty acid sets up a condition known as heartburn or cardialgia. Of old a favorite cure was sour buttermilk. Such an acid as lactic (butter-milk) or of citric (lemon and orange), which kills the feebler irritant fatty acid, is better for heartburn than an alkali like soda, which forms with butyric acid a butyrate of soda, scarcely less irritant than free acid?. (An additional fact is that where there is a deficiency of hydrochloric acid in the gastric juice, which is frequently the case, soda is contraindicated, as neutralizing the little acid there is.)

How regurgitation can be caused is made plain by Bernheim who says that during a treatment of a woman for floating kidney, nervousness and general debility he administered enemas of cottonseed oil. About five hours after the injection the patient vomited cotton seed oil. These enemas were administered for over two weeks and this was the only time when there was a backflow of oil to the stomach. Bernheim afterwards experimented with another human subject and found that four minute particles of tin foil used in an enema were recovered from the stomach by the instrumentality of a stomach tube. Altogether he made 7 experiments on a man, 7 on a dog and 6 on a woman patient, a total of 20. Of these, 3 made with oil and 10 made with a table salt solution proved successful; 4 with the latter solution proved negative as far as the stomach was concerned, while 3 made with distilled water were also negative, (13 successful 7 negative).

Biliousness, according to Alvarez, derives its name probably from the fact that patients note bile in the regurgitated or vomited material. As presence of bile in the stomach is normal, any excess need not indicate liver trouble so much as an increase in the normal backflow from the `duodenum (upper end of the small intestine). The relief these people derive from purgation, particularly by calomel, is due not to any action on the liver (for all pharmacologists are agreed there is no such action) but probably to a restoration of the downward cur-rent. The relief comes so promptly that Alvarez is sure it cannot be due to the removal of a source of toxins.

In the matter of reverse peristalsis (reversal of the ordinary downward movement of the intestine) Alvarez cites a homely incident that has such universal application that we summarized it. Two boys ate heartily of blackberries at dinner. The next morning A had diarrhea but B seemed all right. Early in the afternoon B began to complain of dizziness, a queer feeling of pressure in pharynx (a part of the swallowing apparatus) and re-current waves of nausea, which came every 20 or 30 minutes). Once or twice he retched unsuccessfully. At supper he made several attempts to eat but each time said the food would not go down. He then felt like defecating and with the help of an enema passed a hard plug. Following this he had a large soft movement containing the remains of the blackberries, and immediately after he asked for food. This child appeared to have had a series of reverse waves which arose in a colon distended by irritant material. These waves took the form of surges of nausea and dizziness with a tension in the throat and an inability to take more food. If the lower bowel had not been emptied when it was B would probably have vomited large amounts of intestinal fluid the next day and a few days later the material might have be-come fecal in character.

Alvarez says he has talked with a number of intelligent persons who objected to nourishment by means of nutrient enemas because they did not like its bitter taste afterwards. He credits Dr. Emge, of San Francisco, with the statement that after severe pelvic operations (in the lower abdomen) it is his practice to give enemas of coffee which can later be detected in vomited material. At first he thought it was dark blood but chemical examination disclosed that it was coffee.