symptoms disappear when the pain ceases; and the patient rightly states, that as soon as the pain has subsided, a hearty meal can be taken, and well digested without any renewal of pain.

This condition then is due to the relation of nervous structures; the renal plexus of nerves is intimately connected with the semi-lunar ganglion, and branches of the pneumogastric nerve also pass directly to the kidney; the stomach also receives its nerve supply from both these sources, the pneumogastric nerve and the semi-lunar ganglion; these instances are not really dyspepsia at all, nor even disease of the stomach in any sense, although not a few instances have been brought under my notice as such.

The second form of gastro-renal disease is from organic disease of the kidney; the blood is imperfectly purified, urea is retained in it, and as a symptom of this uræmia, gastric disturbance is produced. From this bloodcontamination all the secretions become changed, and the gastric juice itself is altered from the presence of urea in it.

The symptoms of this disorder are loss of appetite, nausea coming on without any assignable cause, and vomiting of clear watery mucus; anything placed in the stomach is at once expelled, even the blandest diet is with difficulty digested; distension and pain are excited, and when the viscus has become composed, any indiscretion is sufficient to bring on a recurrence of the

irritability. These symptoms are often less severe, and we may find the urine highly albuminous, without any disorder of the stomach.

This dyspepsia is accompanied by other characteristic symptoms of renal disease, such as anæmia and anasarca, but in numerous instances this is not the case; the anæmia may not be remarkable, and the only evidence of anasarca may be an oedematous condition of the conjunctiva and of the eyelids. Pain in the head, and at the back of the neck, or an unusual disposition to sleep, may, however, be the indication of an uræmic

state.

These instances of disease are of a most serious kind, and great care is required lest the already diseased kidney almost cease in its action, and the case terminate fatally. In sudden suppression of urine, vomiting is sometimes as marked a symptom as in intestinal obstruction, as shewn many years ago by Dr. Barlow.

When vomiting is persistent in albuminuria, and especially when it is accompanied with purging, we regard it as a very unfavourable symptom. The whole mucous membrane of the alimentary canal becomes oedematous, and the serous discharge produces irritation, disturbs the ordinary functions, and exhausts the patient. With renal dyspepsia other cerebral symptoms are often conjoined, as occasional momentary loss of consciousness or epileptiform attacks; the senses are also affected, and amaurotic symptoms come on from degenerative change

of the retina; the hearing is perverted, and ringing or other noises are excited as subjective phenomena; these perverted sensations are followed by general diminished power of the sensory organ affected. It is a wise precaution in all cases where vomiting is a prominent symptom, carefully to examine the urine.

These varieties of disease are excited by the causes of acute or chronic renal affection; we have seen numerous instances in connection with the intemperate use of ardent spirits, in which a single glass will at once produce a return of the albuminuria; with other patients gouty diathesis is associated, and a very severe form of sympathetic disturbance of the stomach is observed when diabetes is co-existent with albuminuria. I have witnessed this complication in young children producing epileptiform convulsion and speedy death; and on the contrary in others, it had apparently lasted for many years.

In the treatment of renal dyspepsia, if the bowels are confined, they should be acted upon freely; the skin should be excited to increased action by diaphoretics, as by the acetate of ammonia, by hot air, or Turkish bath, and a cupping-glass should be applied to the loins. In chronic disease of the kidney a blister to the loins often proves of great service.

Sedatives, as effervescing medicines, hydrocyanic acid, bismuth, have very little effect in quieting the stomach; they may, however, be tried, and in some cases partial relief follows. It is of greater service to act upon the

kidney, and thus remove the cause of the gastric disturbance. Salines of potash and soda, the acetate of ammonia, and free doses of the compound jalap powder, effect greater benefit than remedies directly influencing the stomach itself. The compound jalap powder is often very efficacious at first, but afterwards it entirely fails. Elaterium should then be tried in doses of one-sixth to one-fourth of a grain, administered with the bitartrate of potash; but when thus given, it often acts as powerfully upon the mucous membrane of the stomach as upon that of the intestine, and violent vomiting takes place. This effect is partially obviated by giving the drug, in the form of a pill, with the extract of henbane; and very small doses of elaterium, as one-twentieth of a grain, repeated every two to four hours, are also, in some instances, found to distress the patient less, and to act very efficiently. The resin of podophyllum, I have found in some cases of chronic albuminuria, prove more serviceable, than either jalap powder or the elaterium, especially when the renal is associated with hepatic disease. The resin of jalap sometimes produces more certain result than the powder.

Again, I have had several cases of this kind under my care, in which erysipelas of the lower extremities and abdomen has been followed by marked relief to the renal and gastric symptoms. It is scarcely necessary to mention that ardent spirits should be avoided, and, if possible, every form of alcoholic stimulant.

CHAPTER XII.

MECHANICAL DYSPEPSIA.

IT is not sufficient for the completion of the digestive process that the mucous membrane alone should possess its functional activity and integrity; the muscular coat is essential, in order to execute the churning movements performed in the process, and then to propel the fluid mass onwards through the pyloric valve. Anything that interferes with these normal movements may become a cause of dyspepsia; and we may arrange these mechanical impediments into three groups: 1. Displacements of the stomach.

2. Pressure upon the stomach in its normal site.

3. Changes in the muscular fibre itself, fibroid disease of the pylorus, causing contraction, and atrophic distension.

It is more especially to the simple displacements that we refer, in speaking of the functional maladies of the stomach. The common causes of these displacements are external pressure, from stays or belts, or the pressure from leaning over a table or desk, or against instruments used in mechanical occupations; but a frequent