1 7 2 D O C U M E N T 1 7 4 D E C E M B E R 1 9 2 3
stomach to examine its motility and chemistry is disagreeable and can be avoided
due to subjective complaints and the findings by other methods of examination;
likewise the now-modern method of gastroscopy introducing an illumination appa-
ratus and mirror into the stomach.—I just consider the stool examination really
necessary; if blood is found, you are scarcely going to be able to circumvent the
application of the other methods for an analysis of the type of stomach ailment; if—
upon repeated examination!—none is found, one can with great probability regard
the overacidity as transitory, that is, mostly of a nervous nature and not due to or-
ganic changes.—
In any event, I do want to ask you please not to tolerate this stomach pain fatal-
istically but rather get to the bottom of its cause. The success of treatment is no ir-
refutable proof of the correctness of the diagnosis because the complaints, and of-
ten enough also an individual objective symptom (sometimes even the entire
complex of symptoms), are ambiguous.— You will detect at least subjective im-
provement from abiding by the following prescriptions: avoidance of all foods that
irritate the stomach wall particularly strongly and induce secretion of gastric acid
or raise the acidity of the content of the stomach. To these belong: sour and sweet
foods and drinks (owing to the raising of the degree of acidity), fats that are hard to
digest (these are all fats, except butter or cream) for the same reason, scalding hot
meals as well as insufficiently chopped (chewed) ones, which irritate thermally or
mechanically, as well as those that specifically stimulate the peptic glands to se-
crete (spices, coffee, concentrated broth, so-called zesty sauces). It will agree with
you, if you (1) take frequent small meals and avoid overstraining your stomach by
infrequent ingestions of larger quantities; (2) eat cooked meat, eggs, butter, cream,
stale bread, cheese, boiled fish, furthermore potatoes and vegetables, only in
puréed form. (3) Have you taken up the habit of smoking
again?[2]
Immoderateness
would be harmful. (4) Provided there are no organic alterations to the gastric mu-
cous membrane, merely nervous circulatory disruptions, exercise is an excellent
cure, which I then couldn’t recommend to you enough in any form. (5) Bowel
movements must function well; constipation increases the flow of gastric acid. (6)
Do take 1 teaspoonful of the powder indicated on the enclosed prescription slip, 2–
3 times daily, ½ an hour before meals. Otherwise, you can take as much soda as
you like for indigestion, heartburn, stomach ache: always 1 teaspoonful with ½ a
glass of water. You are too caustic (naturally only meant chemically) and must be
neutralized by alkali. As the alkali consumed with food (particularly in vegetables)
are apparently insufficient for that, antacids in the form of soda, magnesia [alba],
or the like must be taken.— Concentrated intellectual exertion increases the excre-
tion of phosphorous in the urine (in the form of salts of phosphoric acid); these al-
kali are probably needed to neutralize not just phosphoric acid but other—