War Surgery and Medicine
Dyspeptics were not treated as outpatients during the period of Riley's investigations, but were all admitted to hospital for thorough investigation for an average period of seven to ten days. Rest was enforced and a milk diet given.
A test meal was given with specimens withdrawn every half hour. The stools were examined for occult blood after four days, and then a full radiological examination was carried out for the whole intestinal tract, the chest being screened at the same time. A further barium meal was given in ten days in cases of doubt.
Cholecystography, sigmoidoscopy, warm stool examinations, and ENT and dental examinations were made when thought fit. Phenobarbitone thrice daily was given to those with evidence of neurosis.
Peptic Ulcers: A typical history was the first necessity before diagnosis of ulcer was considered. Burning pain in the epigastrium, heart-burn, and water-brash were the usual complaints. Localised tenderness was uncommon and hyperaesthesia noted only twice. Radiological examination was the most important procedure, but patience and caution were both needed. Pyloric ulcer was shown by page 626 persistent deformity. Duodenal ulcer was diagnosed if a deformity in the bulb was seen to be constant in appearance and was present on re-examination after seven to ten days' rest and milk diet. Twice only was a niche seen. No cases had a five-hour residue. Hyperchlorhydria was present in 4 per cent of ulcer cases. A therapeutic test of some value was the satisfactory response to rest and diet made by ulcer patients.
Organic Dyspepsia:Under this heading were included cases of ‘ulcer-like’ dyspepsia, including gastritis, duodenitis, achlor-hydric, or hyperchlorhydric, dyspepsia, with negative radiological findings. Symptoms were similar to the ulcer group. A few showed some radiological abnormality such as duodenal spasm or rapid emptying of the stomach; 16 per cent hyperchlorhydria, 13 per cent hypochlorhydria, and 8 per cent had achlorhydria. They responded well to treatment in most cases, and loss of appetite was less frequent than in the nervous group.
Nervous Dyspepsia: This group comprised patients suffering from obvious anxiety or hysteria, whose symptoms were not like those of a case of peptic ulcer. The history was generally confused and contradictory. Retching and vomiting was a common feature. A personal or family history of nervous disorder was usually obtained, and the patient's facial expression revealed his state of anxiety. Barium meals revealed no abnormality apart from rapid emptying of the stomach in a few cases. Fourteen per cent had hyperchlorhydria, 2 per cent had hypochlorhydria, and none achlorhydria. Appetite was capricious or absent, and response to rest and diet rare. Sedatives and occupational therapy were more effective than diet.
A diagnosis of ‘reflex dyspepsia’ was not made in any case.
The average duration of symptoms in the three groups was 7 years, 4 years, and 4¾ years respectively, the individual range being from 6 months to 18 years.