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accompanied with severe headache, with vertigo and disturbed vision, and it may be, with noises in the ears. The headache is often very severe in acute temporary disturbance of the stomach of this kind, and is experienced across the eye-brows, at the forehead, or at the back of the head; sometimes the whole head is felt to throb with each pulsation of the heart. The countenance is sallow and the mind depressed; sleep is greatly disturbed, and everything is seen mentally through a distorted medium; the physical strength is apparently lessened, and the patient complains of exhaustion, a weakness the result of impeded action, rather than of actual loss of power. The kidneys act imperfectly, and the urine is scanty and loaded with lithates; the bowels are often confined, but sometimes irregularly purged, with accompanying pain; the motions are mottled and clay-coloured, or of very dark and offensive character, and as an additional discomfort, hæmorrhoids distress the patient.

Another class of cases are those in which, without any gastric irritant whatever, bilious vomiting comes on, and is connected with extreme irritability of the stomach. Languor and headache often precede the attack, and tenderness at the scrobiculus cordis follows.

These symptoms closely resemble those of inflammatory dyspepsia. .

The condition thus described is an easily remediable one, but the first and essential means of relief is to

avoid perpetuating the disturbance by fresh excitement, by indigestible or rich viands, by fermented liquors or ardent spirits. The most manifest treatment is to allow the stomach to rest, having first removed irritating matters from it, if need be, by an emetic; and at the same time, it is well to unload the bowels and the portal system by a free purgative; thus the congestion of the liver is lessened, and the first step towards relief obtained. After a time, saline drinks, soda water, or more correctly carbonic acid water, with or without milk, may be taken. Soda water is very often resorted to, and its benefit is partly due to the sedative action of the carbonic acid, and to the diluent action of the water; in fact, free potions of cold water are a very serviceable remedy in this condition, it cleanses away offending excreta by acting on the bowels, on the kidneys, and in fact, on all the abdominal glands.

A free mercurial purge is often productive of great benefit; as four or five grains of calomel, blue pill or grey powder, followed by a saline purge.

If the stomach continue irritable, bismuth may be given, with magnesia or its carbonate.

Still the most bland nourishment only should be allowed: as arrowroot made with water, mutton broth, thin gruel, &c.

If the dyspepsia be of a chronic kind, and the secretions have been already acted upon, we have found great benefit from the use of the nitro-muriatic acid with

taraxacum; and as a purgative, small doses of the resin of podophyllum with rhubarb, capsicum, and henbane. If the secretion from the stomach be defective in quantity, ipecacuanha is an excellent addition. Another form of treatment is the combination of dried rhubarb with dried carbonate of soda, the bowels are thereby gently acted upon, and the tonic effect of the rhubarb strengthens, whilst the alkali diminishes the irritability of the membrane; these medicines in a fluid state, although less palatable, can be given in more effective doses.

Still, too often some fresh indiscretion renews the complaint, or the patient cannot be persuaded to discontinue ardent spirits, or wine in excess, or large draughts of malt liquors, and the physician is expected to remove the effect, whilst the cause is allowed to remain. The vigorous diet, and strict regime of the hydropathic establishments often prove of signal service in these cases ; for it is found to be easier to go from one extreme to another, than to observe rules of hygiene commensurate with the wants of the system and the healthy activity of its functions.

When the stomach has become weakened by attacks of this kind, extreme regularity as to the time of meals should be observed; sufficient time should be allowed for thorough mastication, and the articles of diet, although of a proper character, should not be unwisely mixed together.

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CHAPTER X.

RHEUMATIC AND GOUTY DYSPEPSIA.

It is not our intention to enter into a description of the symptoms of rheumatism and gout; these diseases have some symptoms in common, but they are not identical in their character; and it is a subject of grave doubt amongst many physicians whether they are ever combined, that is to say, whether there be any such condition as rheumatic gout. Their origin has been referred to defective secondary assimilation, a term comprehensive in its character, but one that is often used to veil our ignorance of the phenomena of the healthy organism ; after absorption has taken place into the blood, and the pabulum which is to supply the wants of the system has been brought into intimate relation with its several structures, growth is the result. This growth and manifestation of function involves chemical change and rearrangement of elementary composition; the glands grow, whilst they receive elements from the blood, and pour forth their pormal excretions, whether it be the liver, the kidney, the pancreas, or the mammary gland. Similar changes ensue in relation to the muscular system,

and to the substance of the brain itself. During functional activity there is the entrance of fresh material, and the discharge of effete product; these changes constitute the life of the part, and in their aggregate they are the life of the whole. The phenomena themselves present new manifestations of force, whether in the development of heat, the production of motion, the putting forth of nervous energy. The result of these changes is variously shewn; the presence of urea and of uric acid prove a readjustment of nitrogenous compounds, and may to some extent be taken as an estimate of the amount of that internal change which is going on in the system. If the eliminative processes of these substances be checked, the products may be retained in the blood, and induce other changes in the system; and as the result of one form of defective secondary assimilation and of elimination, gout takes place. Dr. Garrod has demonstrated that there is excess of uric acid in the blood in gout; this excess, however, does not constitute gout; that is essentially caused by some antecedent defect of which this excess of uric acid in the blood is only a sign. The primary changes which induce gout affect the whole system, and hence the production of other symptoms beside the paroxysm of gout. So also with reference to rheumatism, it has been referred on insufficient data to an excess of lactic acid in the system; but this, if correct, is an insufficient explanation of the disease; we should next have to enquire why such

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