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Oil of turpentine, in doses of mxx, has been much recommended, and has been followed by beneficial results. It is exceedingly important, that the patient should avoid those habits or excesses which have led to the disease; but advice on this subject is generally disregarded.

In vicarious menstruation, our efforts should be directed to establish the proper and natural discharge, rather than immediately to check that from the stomach, unless it be excessive. Hip baths, steel, aloes and myrrh, change of air, exercise, the avoidance of all tight lacing or unnatural excitement, will probably restore the health. This form of hæmatemesis may, however, continue for a considerable period.

Purpura hæmorrhagica is generally best relieved by preparations of steel with acids, as the tincture of the sesquichloride of iron or the sulphate of iron, with sulphuric acid; and I have more confidence in these than in gallic acid or the oil of turpentine. The latter sometimes produces vomiting, and patients complain of its offensive character. Ruspini's styptic has in the hands of some been found most efficacious.

Distension of the Stomach and Eructation.-Amongst the symptoms of gastric disease flatulent distension and eructation are very distressing. There is usually some gaseous fluid present in the stomach even when in a quiescent state; but in abnormal conditions this becomes

enormously increased. Several sources of gaseous

formation have been described :—

1. That the gas is swallowed.

2. That it is produced by the decomposition of food in the stomach.

3. By the decomposition of the gastric mucus.

4. That it is evolved from the blood.

5. That it passes from the duodenum or colon or some communicating abscess.

6. It may be produced by sloughing growth in the

stomach.

Ordinary food contains some atmospheric air incorporated with it, and in the act of deglutition some air is also passed downwards with the food, or even with the saliva that is from time to time swallowed. If effervescent drinks are taken, then the exhaled carbonic acid must necessarily distend the stomach. But these causes are quite insufficient to explain the cases of distension of the stomach which are frequently met with in practice. The second source of gaseous repletion we have mentioned, namely, the decomposition of food in the stomach itself, is doubtless frequently present in dyspepsia. It has justly been compared to fermentation; and according to the changes induced we have carbonic acid evolved from a form of alcoholic fermentation. This may be accompanied with the formation of sarcina ventriculi of Goodsir; and with the development of vegetable growth lactic or butyric acid may also be produced. This kind of fermentation with sarcina we frequently find in cancerous disease affecting the pyloric

extremity, in chronic ulcer and in spasmodic contraction of the pylorus. It may be well, however, to remark, that the presence of sarcina is not an invariable sign of organic disease of the stomach; and sarcina have been detected in other animal products, in the urine, in the fœces, in pus, in pulmonary abscess, and even on the healthy mucous membrane. Again, sulphuretted hydrogen gas is formed in the stomach by putrefactive decomposition of the food, and is generally accompanied by eructation of offensive gas.

Distension of a distressing kind takes place, however, from evolved gas in the stomach even although no food has been taken; and the fact of chemical decomposition does not suffice to explain all these cases. It will frequently be found in those of enfeebled digestive power, that the very absence of food induces flatulent distension of the stomach. To pass for an hour or two beyond the accustomed period of refreshment is with some, certainly followed by this symptom of fulness, if not of severe pain. Again, fermentation does not explain those instances in which from nervous excitement or hysteria great and sudden distension takes place quite unconnected with food. An explanation of these cases has been sought in the decomposition of mucus in the stomach, whilst others refer it to an evolution of gas from the blood itself.

The quantity of mucus in the stomach in an ordinary state of the viscus is comparatively small, still

it is quickly secreted, and a large quantity of saliva is swallowed; these secretions very readily undergo change. Still there is nothing incompatible with the structure of the walls of the gastric vessels, that in some abnormal conditions probably connected with exhausted function of the vaso-motor nerve, an action should take place somewhat similar to that which is the usual functional action of the capillaries in the lungs; and this view of the subject, a gaseous exosmosis from the blood, is confirmed by the character of the gas itself, as consisting especially of nitrogen and carbonic acid gases, which are always present in venous blood.

An occasional source of gas in the stomach consists in its regurgitation from the duodenum, or its passage through some fistulous communication with the colon. Gas of this kind contains a large quantity of sulphuretted hydrogen gas, and it has a focal odour; such instances are exceptional, and do not require further comment here. So also in instances we have known where an abscess communicated with the stomach, and the presence of offensive gas was explained by decomposing pus. And lastly, we may mention that when sloughing takes place in the stomach gaseous evolution necessarily follows.

Prominence of the epigastric region, however, does not always arise from distension of the stomach; the fulness may be deceptive, and proceed from curvature of the spine, or the parietes of the abdomen may be

weakened by constant artificial support, so that on its removal, especially if there have been firm bands around the lower part of the abdomen, distension is observed, which simulates gastric fulness. Again, enlargement of the colon is frequently mistaken for that of the stomach, and lastly, when there are effusions within the chest the depression of the diaphragm leads to greater fulness than normal in the epigastrium.

When the stomach thus becomes distended, the sensation produced is 'one of fulness and tightness, and if excessive, severe pain is the result; if spasmodic contraction of the pyloric fibres is induced, the pain which is known familiarly as "spasm" at the stomach takes place.

This painful symptom is relieved by gaseous eructation, and the discharge of flatus is promoted by stimulating antispasmodic and aromatic medicines; the relief is generally speedy, but in conditions of great exhaustion we have known the stomach to become apparently paralysed, and the distension so to increase that the viscus nearly filled the whole abdominal cavity, and the impediment to the circulation become the immediate cause of death.

In close connection with the symptom just mentioned, is an offensive state of the breath; and the remark is often incidentally made, that in consequence of this condition the stomach "must" be disordered. It is frequently the result of the gaseous effusion or trans

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