the tip and edges, irritable cough, the pulse sharp and compressible, pain at the scrobiculus cordis, and flatulence after food, mark this state; very frequently the stomach becomes so sensitive that the food taken is quickly rejected, the bowels are easily disturbed, so that diarrhoea supervenes. It might be thought that in dyspepsia from exhaustion the appetite would be craving, and that a generous diet would at once be digested. This is, however, not the case: the appetite is lessened; and the solvent power of the stomach is so diminished that solids cannot be dissolved, and if swallowed they produce headache, vomiting, and pain.

In early manhood, especially if growth has been rapid, a state of general weakness is often induced, and atony is the result; inactivity of body, headache, dilated pupil, compressible pulse, and feebleness of digestion follow. There is a sense of apparent exhaustion, the mind often becomes dejected and melancholy, the more so if these symptoms be associated with any other cause of undue loss of strength. Trashy publications and advertisements tend to increase the mental depression, and the practice of the impostor is to magnify the symptoms to increase his own gain. This state is still more 'marked in young women, in whom the system undergoes even greater change at the period of commencing menstruation; and without great care, the stomach, at first irritable, induces painful digestion; the supplies are gradually lessened, and disease becomes.

confirmed; animal food is left off, and, simply tea or dainties, are preferred; exercise in the open air is avoided if possible, from the consequent fatigue and exhaustion; this still more increases the atony, and at length marked chlorosis results; then, we have a waxen countenance, dilated pupil, severe headache, nervous depression and excitement, throbbing of the heart, pain under the breast, pain at the stomach after food, sickness, flatulence, constipation or irregular bowels, as the symptoms. In this state of exhaustion, tubercular deposit may take place in the brain, lungs, mesenteric glands, ovaries, &c., and one or other form of phthisis be induced. I have had patients under my care, who had gradually reduced their scale of diet, till one article after another had been left off, and the dietary consisted only of small quantities of bread with tea; the countenance becomes as pale as white paper, and the physical strength is gone. With right treatment and perseverance in it, such atonic dyspepsia is entirely removed. This state is closely connected with that form of sympathetic dyspepsia, especially observable in young women, to which the term of "regurgitative disease" has been applied by Sir Henry Marsh, of which the prominent symptom is excessive irritation of the stomach; but, to this further reference will be made. After childbearing, and especially when that is followed by prolonged lactation, the whole power of the nutritive system becomes well nigh exhausted, and atonic dys

pepsia is a common symptom. The face, and especially the forehead, often become irregularly bronzed in patches, the headache is severe, either at the vertex or at the temple; ringing noises in the ears are experienced; the eyes are intolerant of strong light, the pulse is compressible, the stomach and bowels are irritable, causing either diarrhoea or vomiting, or both; the appetite is poor, and faintness is often felt, or there is a sensation of abdominal exhaustion and emptiness. The same condition is observed in the exhaustion from other causes; from severe hæmorrhages, from excessive menstruation and leucorrhoea, and in the convalescence from acute diseases. Mercurial medicines, if continued so as to affect the system, cause general depression, exhaust the nervous energy, and relax the mucous membrane, and thus induce dyspepsia of this form. Tobacco is a powerful depressant, and although, after its moderate use, it has a soothing effect on the nervous system, and it renders the intellectual power more vigorous, we often witness that in habitual smokers, the heart is enfeebled, the mucous membrane relaxed, the appetite is lessened, and a form of atonic dyspepsia results. This is still more apparent in great snuff-takers, especially if smoking bẹ combined. The state of the nervous supply to the mucous membrane of the stomach and its glands, is the probable cause of these symptoms. Large branches are sent from the semi-lunar ganglia upon the coronary arteries to every part of the stomach, and it is by their

influence that the gastric juice is poured out at its proper time, and in its proper quantity. The mere presence of food in the stomach will not induce further gastric secretion, if nervous energy be wanting. The enfeebled state of the nerve power is not, however, limited to the stomach, but the heart and its cardiac plexus are in a like state, and the supply of blood to the stomach is thus rendered insufficient. The attacks of faintness may be explained in the same way, namely, that a larger supply of blood being sent to the stomach, less is conveyed to the brain, causing a temporary failure of power. I have observed actual syncope, as the result of the slight disturbance to the circulation from urging exhausted patients to take solid food. In persons who are inordinately stout, we find feebleness of digestion, and this is in part due to the state of the vaso-motor nerve. The symptoms arise from the feeble condition of the heart and circulation, and are increased by an inactive state of the liver. A greater amount of food may be taken than can either be digested, or is needed for the system, and it consequently induces a sense of weight and exhaustion. Although the appetite is often small in stout persons, it is not always so, it may be both fastidious and one that has been pampered with highly-seasoned and indigestible diet; the hydrocarbons are stored up, instead of being removed in the ordinary changes of respiration, &c.; but the mischief is still further increased when the heart is irregular

from an excess of fat about it, or when the feeble circulation of the brain manifests itself in vertigo and disordered sensations. Much relief is afforded by occasional alteratives, by aloes, rhubarb, and taraxacum, or by nitro-hydrochloric acid with bitter infusions; stimulants should be cautiously given, and outdoor exercise gradually increased. To such patients horse-exercise is often most serviceable. Although in some of these cases of atonic dyspepsia superficial ulceration may take place, and from the want of power the other coats of the stomach be perforated, as we shall afterwards have to describe, it will generally be found that, with proper treatment and care, the symptoms slowly subside.

The object of the treatment is to rouse vital energy, at the same time that a diet, as sustaining as possible, is administered. The following are some of the medicinal agents at our disposal: the carbonates of ammonia induce a direct stimulant effect, and aromatics, with mild vegetable infusions, act in a similar manner. If the tongue be large and flaccid, and the food remains as a weight at the stomach, mineral acids are of great service, and assist digestion.

At a later period steel and quinine may be used, but care is required both as to the form of administration, and the mode of combination. It is well always to give ferruginous preparations directly after a meal; the medicine thus becomes incorporated and absorbed, without any excitement or pain being produced. The