of ammonia; its primary action is as a stimulant to the mucous membrane and to the vaso-motor nerve, and in this way it serves a doubly beneficial purpose. Condiments with food have a direct stimulant action on the stomach, and one can understand that the old remedy of mustard-seed was of service; pepper, cayenne, curries, &c., act in a similar manner.

It will be found that a more beneficial stimulant effect may be induced by small doses of the preparations of iron, as the tincture of iron with chloric ether and tincture of calumba, or a dinner pill containing a small quantity of steel pill with cayenne and rhubarb, or if needful a small admixture of the aloetic pill. Dilute hydrochloric acid with vegetable bitters may be tried, and as a natural constituent of the gastric juice, the acid promotes solution of food; but in these instances, it is in vain to expect benefit from the preparations of pepsine.

It is less, however, by any direct medicinal treatment that we can relieve the atonic dyspepsia of advanced life, than by careful attention to those rules of health and diet by which declining strength may be spared. Special symptoms and causes of disturbance will require special attention, and are amenable to right treatment; but medicine is not the chief means at the disposal of the physician in these cases.

A second cause of atonic dyspepsia will be found in exhaustion of the cerebro-spinal nervous system. Mental

distress and excitement, great anxiety and physical fatigue, constitute this most frequent cause of dyspepsia.

After much anxiety of mind, close intellectual application or research, whether the result of literary pursuit pr the competition of commercial enterprise, the impress of the mental state is stamped upon the whole physical organism. The lineaments of the countenance portray the operations of the mind, the sunken eye, the contracted pupil, the careworn expression, the restlessness of manner, all shew that the mind has been taxed beyond the power of the body. In a subject of this kind, there is pallor or sallowness of the countenance, sleep is very transient, easily broken, and often disturbed by dreams; there is headache or giddiness, the tongue is slightly injected in its papillæ, and has a whitish fur, sometimes large, indented, and clean; the pulse is sharp, compressible, and irritable; palpitation of the heart, throbbing sensations, and often pain in the head are produced; there is sometimes nausea, or actual vomiting; the bowels are constipated or irregular; the appetite is diminished, or entirely absent, and if food be taken, it is felt to remain as an undigested mass, producing weight and pain at the scrobiculus cordis; sometimes it is followed by a throbbing sensation in the abdomen, and almost over the whole body, with languor or drowsiness; at other times there is faintness after food; and when undigested portions pass into the pylorus and duodenum, violent cramp or spasmodic pain is produced.

Ingesta may be retained in the stomach for many hours, and in some cases even for days, in a crude state; the secretion is not sufficient to dissolve what is placed in the viscus; the irritation produced by the retained food aggravates the ailment, and fermentation or decom position is set up, with flatulence, pain, heartburn, or severe gastralgia. This imperfect solution, however, may arise from excess of food, rather than from diminished solvent power of the gastric juice.

After any sudden mental shock, this state of comparative cessation of the digestive powers is painfully shewn, the smallest quantities of food exciting pain, headache, and distress; the heart, already feeble in its action, is still more disturbed by attempted digestion, and actual syncope may be the result, or distressing colic and vomiting; the bowels are in this state generally confined, but they sometimes become irritable.

It may be, that in this condition of nervous exhaustion the stomach receives an insufficient supply of blood, and that the mucous membrane is in an anomic state; but, there can be very little doubt, that the intimate connection of the vaso-motor or sympathetic nerve of the stomach with the cerebro-spinal centres determines this marked effect upon the digestive function. Numerous instances of this effect of the mind upon the physical organism might be adduced; it is familiar to every one how bad news will destroy the appetite, and that the sight of disagreeable and offensive objects disturb the stomach;

but graver and more persistent symptoms arise when the mind is overdone by the sudden removal of some beloved relative, or when it is agitated by great alarm and sudden fright, or overwhelmed by unexpected reverse of fortune. It will often be found that, whilst others may have forgotten some event which for the time produced universal sympathy, the effects are long seen by the physician, upon those immediately concerned; years may elapse, and the effect on the physical organism may still persist, and it is frequently found that a functional disturbance of the stomach thus produced, is followed by organic change; this dyspepsia at first may be only functional, but it slowly gives place to the signs of cancerous disease of the stomach or liver; thus it was with the great Napoleon at St. Helena, and thus it has been with very many who have come under our own observation.

The same connection of nerve supply explains the loss of appetite, and the inability to digest food after great physical fatigue; how often is it found that strength is so reduced that a person cannot partake of nourishment! A strong and vigorous young man may be so exhausted by the fatigue of a mountain climb as to be utterly unable for a time to take that which the system so urgently requires; and in a less degree the same state is continually observed.

The large nerve ganglia of the abdomen may, however, not only be affected secondarily by the state of

the mind, and by the centres of ordinary sensation and motion, but they may become directly involved, and this leads us to a third source of atonic dyspepsia, namely, exhaustion of the nerve of organic life. A certain amount of nervous energy is required for the digestive process, in order that gastric juice in sufficient quantity, and of a healthy kind, may be poured out, that the necessary muscular movements may be performed, and that the temperature best fitted for the solution of food may be maintained.

In chronic disease, as the powers of life gradually wane, there is inability to take or to assimilate the nourishment the system so much requires; and it is often in vain that we afterwards search in the stomach itself for the cause of this feebleness, although sometimes we find the mucous membrane affected with fatty degeneration, or the minute capillaries of the surface are involved in lardaceous disease.

This form of atonic dyspepsia is of very common occurrence amongst those who are in circumstances of poverty and want; hard labour and corroding care, insufficient rest and pining hunger, induce a condition that is very familiar to those who have seen much of hospital and dispensary practice, or who have seen disease amongst the poor. The spare appearance, the dejected and careworn countenance, the complexion partially bronzed, irregularly sallow, the eyes sunken, the tongue clean, or irregularly furred and injected a