the nervous system already mentioned, we find perverted special sensibility, as indicated by double vision, muscæ volitantes, noises in the ears; and the nerves of general sense are also affected, as manifested by numbness, formication, &c.

In strumous subjects, there is a special tendency in the mucous membrane of the stomach to become very irritable. The gums become spongy, the mouth and pharynx aphthous and painful; vomiting is occasionally a troublesome symptom, and also diarrhoea. The pain at the stomach is increased by every kind of food. This form of disease is of a very obstinate character, and may persist month after month; and although we have no evidence of actual ulceration and destruction of the mucous membrane, still there is probably chronic inflammatory change. It must be distinguished from the sympathetic irritation of the stomach produced in the early stage of disease of the lung and of the brain; but it closely resembles that condition of exhaustion with irritability, which we find towards the close of phthisis, of cirrhosis, of strumous peritonitis, &c. The latter state is associated with hectic symptoms, and generally with peculiar fretfulness and irritability of temper.

The symptoms of inflammatory dyspepsia from excess may pass into delirium tremens, or may lead to chronic disease of the liver; and in reference to the stomach itself, the subsequent effects will be scarcely less dis

astrous.

It

It may be that the state of chronic engorgement of the vessels is suddenly relieved by the rupturing of its capillaries; hæmorrhage takes place into the stomach, and the blood is either vomited in a dark clotted state, or passed downwards in a semi-digested condition, constituting black alvine discharges. We have seen cases where this natural relief has mitigated the former symptoms, although it may have completely blanched the patient, and for a time placed his life in apparent jeopardy; or superficial ulceration may supervene, followed by hæmorrhage of a more severe and dangerous character; or chronic ulcer may be set up, with all its attendant misery, and with symptoms only to be subdued by the most careful treatment, and by attention to strict hygienic rules.

In reference to the prognosis, this form of dyspepsia will generally be relieved, and patients may entirely recover, if they will be controlled in their diet and adopt other suitable measures.

The principles of treatment consist in diminishing the irritation and in relieving the congestion; and these objects are effected by removing anything from the stomach which perpetuates disturbance, by allowing rest as far as possible to the viscus, and by medicines, if any be given, which directly soothe the inflamed surface.

If undigested substances remain in the stomach, an emetic of ipecacuanha or of sulphate of zinc is the most effectual remedy.

The most bland forms of diet are desirable, and those articles which tax all the energies of the stomach to dissolve them should be avoided, as solid animal food; animal soups, and even beef-tea, are often injurious, whilst farinaceous substances are well borne.

Stimulants, especially ardent spirits, malt liquors, and generally wine also, should be abandoned; whilst cold drinks and ice are often extremely grateful to the patient, as well as curative in their effects.

As remedies, those which act upon the bowels, as saline purgatives, especially magnesia and the salts of soda, are of service. These not only unload the congestion of the gastric capillaries, but they act upon the whole portal system. Mercurial purgatives and alteratives act in a similar manner, and afford speedy relief to many of the distressing symptoms. Unfortunately this has led to their too general adoption.

Mucilaginous drinks sheathe the irritable membrane; lime water is often of great service as an alkali in diminishing the extreme sensibility of the stomach ; but we have still greater confidence in bismuth when combined with salines and mucilage; the dose of it may, however, be much larger than that usually given. I generally begin with doses of 10 grains, but I have known i. doses of pure nitrate given three times a day, with relief to the symptoms, and without any injurious consequences. Schacht's solution of bismuth I have often used with advantage, and a very elegant

and useful preparation is the effervescing citrate of bismuth, prepared by Savory and Moore. Carbonic and hydrocyanic acids act as sedatives to the disturbed parts.

In acute forms of inflammatory dyspepsia of adults, leeches to the scrobiculus cordis and counter-irritants have often afforded great relief; and in them, but especially in infants, the bicarbonate of potash alone, or combined with the chlorate, tends to mitigate the distressing sensibility of the stomach by diminishing the acidity of the secretions. I have found few remedies of greater value when oftentimes repeated, and given in some bland mucilaginous fluid. In the gastroenterite of children, the thing of greatest importance is to adapt the diet to the condition of the mucous membrane, and to the requirements of the system. It is often necessary, in children thus affected, to avoid milk altogether, and to give cream with water, or only rice water, and to some, ass's milk; and by adults, milk may sometimes be agreeably taken with soda water.

In chronic inflammatory dyspepsia, the same principles of treatment must, if possible, be carried outnamely, to prevent fresh sources of irritation from improper diet, to unload the congested structures, to clear away effête materials from the system, and to restore healthy action.

Saline aperients, with vegetable tonics, assist in effecting the latter objects. Mercurial alteratives, when

cautiously administered, stimulate the lacking energies of the glandular system, and small doses of ipecacuanha tend to promote healthy secretion from the mucous membrane, whilst they diminish capillary stasis. The beneficial effects of the saline mineral waters are often in these cases very evident, especially those which contain sulphates of soda and of magnesia. In our own country we may especially mention Cheltenham, Leamington, Purton Spa, Epsom, Scarborough, Harrowgate; and on the Continent, Carlsbad, Franzensbad, Seidlitz, Marienbad; but the attendant circumstances, the change of scene, the rest, both physical and mental, the attention to hygienic rules, the rigid exaction of abstinence in diet, with regularity, conduce most effectively to restore health and vigour.