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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 3i. doses of pure nitrate given three times 2 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

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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 out namely, 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 -ngetable tonics, assist in effecting the latter ob

curial 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 con tain 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.

CHAPTER IX.

HEPATIC DYSPEPSIA.

The liver is frequently blamed for disturbance with which it has no connection; but, there can be no doubt, that in some forms of dyspepsia the liver shares in the disorder of the stomach, and that this unhealthy state perpetuates the gastric symptoms.

The veins of the stomach pass into the vena portæ, and thus directly to the liver; and any irritating ingredient or stimulant, after exciting the mucous membrane of the stomach, in an equally direct manner creates similar abnormal action in the liver. Thus ardent spirits exert their action at once upon the liver; and although the erythematous inflammation of the stomach thus produced very quickly subsides, less readily does that of the liver, for the secretion of the bile is changed, it is diminished in quantity, or of an unusually irritating character; the elements of bile are thereby retained in the blood, and thus the balance of the whole economy is upset. If the offending cause is only temporary, then the irritation it has excited soon diminishes, and the attack is what is so often

called a “bilious attack ;” but if, on the contrary, the irritation is renewed day by day, then the congestion of the stomach becomes persistent, its secretions are disordered, its mucous membrane thickened, its submucous coats infiltrated, and the liver still more seriously suffers. There is inflammatory effusion into Glisson's capsule, leading to enlargement and afterwards to contraction of the gland; the serous surface becomes thickened and inflamed, the secreting cells atrophied, and the bile ducts changed in their character. The depuration of the blood is hindered, effête materials are retained, engorgement of the portal system is consequent, and the disease thus leads to organic change in the liver and to dropsy. Hepatic dyspepsia is the first step in this most serious downward course of disease; and what are its symptoms ? Many of them are referred directly to the stomach, others to the liver. The former is irritated and irritable, and vomiting is a common symptom, sometimes only sufficient to empty the viscus, but more generally severe and leading to regurgitation of bile into the stomach. This also is rejected, and the patient regards it as proof of excess of biliary secretion. Still more severe is vomiting in some instances; and the stomach remains so irritable that for many days it will not bear the presence of any food, however bland its character. This irritability of the stomach is preceded by foul and furred tongue, by bitter or unpleasant taste in the mouth, and is often

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