BY E. O. ADAMS, M. D., PROFESSOR OF DISEASES OF THE DIGESTIVE OR- Mrs. H. History. Age, 33. Has been in poor Present Condition.-Somewhat emac- Mrs. M. History.-Age, 35. Has been in poor fever. Present Condition. - Fairly well nour- * Written expressly for the REPORTER. 198422 Physically there is considerable tenderness all over the abdomen, but a certain point three or four inches above the umbilicus, pressure causes greatest distress, and causes pain through to the back. Stomach dilated. No, growths cr thickenings can be found. Uterus enlarged, hard, fixed and tender. Laboratory Findings. In gastric juice the Hel is increased, ranging about 40. Total acidity, 72. Organic acids, absent. Products of digestion about normal. If she goes long enough without vomiting, lavage discloses that food is retained in the stomach considerably longer than normal. Above, briefly told by means of parallel comparisons, are the reports of two cases, which, as regards many important particulars, are quite similar, yet, they are totally different as regards the diagnosis, and the treatment required for their relief. The two points which were of chief importance in differentiation, were as follows: 1. The difference in the mentality. In Mrs. M., there was about her entire personality a sort of indefinable, yet easily recognized suggestion that she was a neurotic; her intense and variable. fears; her conversation which lacked continuity of thought; her imperious manner, which might be followed by sudden change to tears and despondency. Of course, such cases may develop severe organic disease, therefore it is necessary to look carefully for it, but here no evidence of such condition could be found. In Mrs. H. these features were entirely lacking, and there were only the indications of a long continued suffering. 2. The other point which had a bearing on the diagnosis, was the finding upon careful search in Mrs. H. of a small, circumscribed spot in the epigastrium, that seemed much more sore upon pressure, than any of the rest of the abdomen. With Mrs. M. no such spot could be found. Mrs. M. came under my care first, and upon arriving at the conclusion that her troubles were hysterical, I told her repeatedly, and with a manner of certainty, that in the past she might, or might not have had organic disease of the stomach. Possibly there had been an ulcer at the time she had vomited blood, or that might have been only a form of vicarious menstruation. But that if she had had such trouble then, it had entirely disappeared now, and that her present discomfort was entirely due to the alarm which arose in her mind when she did have such trouble as had not disappeared when the cause of it had been removed. That when such trouble existed, of course she felt worse at the menstrual period, and therefore she had gotten into the habit of expecting trouble at that time; had eaten with fear of resulting trouble; and of course it had come. I explained how nerves pass down to the stomach from the brain, and through them how it is possible for the mental influences of fear, or the expectation of any given phenomena, to powerfully affect the stomach and the process of digestion. I found on questioning that the vomiting always preceded the menorrhagia, and so told her what I believe was true, that the latter was entirely due to the effort of straining when she vomited; and that this also caused the soreness which she had in the abdomen and pelvis. By means of such statements, and by positively affirming that she had no organic heart disease, or stomach disease, or uterine disease, except those due to the straining of vomiting, and by various other statements and arguments, which I attempted to make appear reasonable to her, the treatment was instituted. As she was in bed, I allowed her to remain there for a few days, and hot fomentations were placed over the abdomen to help relieve the tenderness present. This all happened about two years ago, and she has not vomited more than half a dozen times since then. Occasionally she has a slight back-sliding, and needs a few repetitions of the psycho-therapeutic prescriptions. But as compared with her health of the preceding sixteen years, she has during the past two years been well. Menstruation is normal in amount, and practically painless. Appetite good and she has eaten freely. With but a very few, short exceptions, digestion has caused no distress. Cases such as this one. are the kind that Christian Scientists are apt to benefit, and gain honor thereby, but in my opinion we as physicians can do better |