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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, thè 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 elateriuin, 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 digestire 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

source of displacement is internal, and consists in abnormal intestinal adhesions. The stomach is naturally placed almost horizontally, the pyloric being only a small distance below the cardiac extremity; and from its greater curvature, the omentum extends to the transverse colon and spreads over the small intestine.

When the lower ribs are firmly compressed, especially during active growth and development, the stomach assumes an almost vertical position; the pylorus is then pressed downwards to the umbilicus, and the natural churning movements of the stomach, as well as the passage of the food along the lesser curvature, and backwards towards the cardia by the greater curvature, are interfered with ; the semi-formed chyme gravitates unnaturally towards the pyloric valve, and portions pass into the duodenum before they have undergone complete solution. In this semi-dissolved state of the ingesta irritation of the intestine is set up, and pain produced. Borborygmi and flatulent eructations distress the patient, and a fertile source of hysterical complaint arises. When direct pressure is made upon the scrobiculus cordis, the movements of the stomach are differently modified; the firm pressure whilst digestion goes on, not only interferes with free movement, but excites irritation.

Again, cases are far from unfrequent where the omentum, attached as we have just said to the greater curvature of the stomach, becomes adherent at the lower part of the abdomen, or is fixed by hernial attachment. The free distension that accompanies normal diges. tion is prevented, for the stomach is tied down; we find that pain in the side is produced of a fixed character, and this distress is increased by anything that distends the viscus, therefore especially by digestion; and the pain recurs after nearly every meal. Another form of dyspepsia of a mechanical kind is that arising from pressure upon the stomach by dropsical and other effusions. As the effusion accumulates in the peritoneal cavity, an uniform pressure is exerted upon the stomach, and no inconvenience may be felt as long as the stomach is not distended; but directly it is required to perform its normal work, and necessary movements, with which are also generally associated some increase in the volume of the stomach, either from food or gaseous evolution, pain is produced, and is frequently followed by the rejection of the contents of the stomach. And although the primary disease—the cause of the dropsy, whether it be chronic disease of the liver, of the kidney, or of any structure--may itself produce dyspepsia as one of its symptoms, still this mechanical pressure greatly aggravates the gastric disturbance. The patient becomes physically unable to take food; pain, eructation, and a sense of almost insufferable distension are produced. When the fluid or the pressure is lessened, the symptoms subside ; and we have very frequently noticed that the stomach has suddenly regained its power after paracentesis abdominis had been

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