the presence of food. Effervescent medicines, carbonic acid, &c., appear to act directly upon the nerve filaments of the stomach, and to diminish sensibility. Hydrocyanic acid, with alkalies, acts also as a sedative, and lessens irritability, so also bismuth.

In renal calculus, alkalies with rest are the most likely measures to afford relief, after having quieted the pain by chloroform, ether, or opium. Sometimes the inhalation of chloroform may be advantageously used, especially if the improved method be employed, namely, of mixing the chloroform with atmospheric vapour, in definite proportions, before the inhalation; the object to be sought for is, by so diluting the chloroform as to allow of its very gradual absorption, and in this way pain may be removed without narcotising the patient; or a free dose of Battley's sedative solution of opium may be combined with tincture of henbane and chloric ether. Belladonna may also be tried. The hypodermic method of employing morphia is a valuable means of quickly subduing the intense pain. In utero-gestation, on the contrary, mineral acids, with chloric ether, are perhaps the most effectual means of relieving vomiting, although too often ineffective whilst the cause remains.

In these instances of gastric irritation from uterine activity, the bowels should be gently acted upon, and the effervescing citrate of magnesia constitutes both a grateful and effective remedy. Much may be done, however, by careful regulation of the diet, the dis

turbance is sometimes quieted by the repeated administration of small quantities of food; and in all cases large meals should be withheld, and all external pressure upon the stomach itself taken away.

In young persons, especially those affected with hysterical susceptibility, with dysmenorrhoea or leucorrhoea, a state of extreme irritability of the stomach is sometimes induced. The contact of any substance with the mucous membrane is followed by its instant rejection, and this may take place without previous nausea or pain; and what is still more remarkable, there may be very little emaciation, although this condition have existed for many weeks or months. Sometimes pain at the scrobiculus cordis exists, but more frequently the pain is of a neuralgic kind, and is situated beneath the left breast; the pulse is irritable, the tongue has generally more or less injection of its papillæ, and the bowels are confined. It is to this state that Sir Henry Marsh has applied the term of "regurgitative disease;" because the food is rather regurgitated than vomited. These cases require careful watching and treatment; they nearly all after a time completely recover. cases may, however, be associated with gastric ulcer, when the pain and more persistent symptoms of that state will be also present.

These

The first question is as to the food, which must be of a bland and easily digestible kind, as soup, muttonbroth, soda water with milk, farinaceous food. If these

be rejected, then the quantity must be diminished, and only a very small portion given, as a few tea-spoonfuls of milk, with soda water or with lime water every quarter or half hour, and if the pulse be failing a small quantity of brandy may be added. If the regurgitation still continue, then it is well to allow the stomach to rest entirely, and to administer by enemata, nutrient fluids three or four times a day, as a cup-full of strong meat soup, thickened with flour, and with the addition of five to ten drops of laudanum, and a table-spoonful of brandy. We have known many obstinate cases entirely cured in this way. In one patient the injections were continued for a fortnight, and only a few tea-spoonfuls of cold water were given to relieve the thirst. The bowels should be gently acted upon by aloetic pill, alone or with steel, with henbane, or with the extract of nux vomica.

I have often found the nitrate of bismuth, with carbonate of soda and chloric ether in mucilage mixture, very useful; so also the black oxide of manganese in dose of gr. x. to xx., as recommended by Dr. Leared. The salts of cerium are praised by some, but I have found other remedies more efficacious.

When the extreme irritability has lessened, there must be a gradual return to more strengthening diet, and the milder preparations of iron are very serviceable, as the ammonio-citrate of iron with carbonate of ammonia, the phosphate and hypophosphite of iron with dilute phosphoric or hydrochloric acids; sometimes

also the sulphate of iron, in half-grain doses, with sulphate of quinine and extract of henbane is useful.

Other remedies, with uncertain effect, are tried, as hydrocyanic acid, alkalies, magnesia or its carbonate creasote, chloroform and chloric ether, opium. Opium does not act so well in these cases, as in ulcer of the stomach. If the pain be severe, a small quantity of morphia may be used hypodermically. Belladonna is

better than opium. Small blisters applied to the scrobiculus cordis, or to the spine sometimes alleviate the symptoms.

Calomel has been used as a sedative to the mucous membrane of the stomach in some of these cases of extreme sympathetic irritability. This condition is, however, so frequently associated with an anæmic, chlorotic, or hysterical state, that the administration of mercurials, except as occasional aperients, is better avoided. Still we have witnessed instances, where one grain of calomel, given several times during the day, has been followed by cessation of the symptoms.

There are several other conditions of dyspepsia which are atonic in their character, but appear at the same time to be sympathetic, and connected with the state of the cerebro-spinal system. In some men we observe a state closely resembling hysteria, as shewn by flatulence, loss of appetite, sensibility of the surface of the abdomen, sensations almost amounting to globus hystericus, disturbed cerebral function, depression,

anæsthesia, incapacity for exertion, &c. In this condition, which is often combined with distended colon, I have found marked benefit result from the use of aloes combined with steel; fresh air and vigorous exercise are important remedial agents, when they can be obtained.

In other cases, the head is badly formed, and the forehead narrow, shewing that the brain is likely to be easily disturbed, or there is hereditary tendency to mental disease, mania, and melancholia. The body is well nourished, but the patient complains of pain at the scrobiculus cordis and in the back, or in various parts of the body; the mind is depressed, and the appetite irregular. Although muscular, a man may be quite incapacitated for exertion; the tongue may be clean, the bowels regular, the evacuations normal or pale, the pulse tolerably full or depressed and irregular. would seem that dyspepsia has arisen from ordinary causes, but the sympathetic nerve reacts upon the cerebro-spinal centres, and these being easily disturbed from their healthy balance, again react upon the sympathetic nerve, perpetuating and aggravating the original and slighter malady.

It

In young children the susceptibility of the nervous system during first dentition is universally acknowledged, although frequently too much is attributed to this cause; and every disturbance of the brain or of the digestive system is attributed to this circumstance;