fusion into the stomach, and small quantities are silently discharged, as opposed to more sudden eructation. There are several fallacies, which have only to be enumerated to put the practitioner on his guard :1. Caries of the teeth.

2. Local disease of the nose or ear.

3. Disease of the tonsil; and sometimes the secretion from these glands is quite sufficient to produce the symptom referred to in a very marked degree.

4. Ulceration of the throat or oesophagus.

5. Diseases of the lungs and bronchi; cases of offensive breath from pulmonic disease are not confined to instances of empyema and asthenic or sloughing pneumonia, but are found in chronic bronchitis; purulent decomposition takes place from the retention of mucus and pus in the more dependent bronchi, and sulphuretted hydrogen is abundantly produced.

6. Purpura. Not only in severe purpura hæmorrhagica, with bleeding from the gums, but in less degrees of purpura in connection with albuminuria and chronic hepatic disease, the breath becomes very offensive from decomposing blood, the odour is peculiar and very characteristic, and at once recognised from that dependent on gastric disease. It must, however, be borne in mind, that during some forms of indigestion, the saliva loses its natural alkaline reaction, the ptyalin more readily undergoes decomposition, and thus communicates a perceptible odour to the breath.

Sweetness of the breath is a condition very often observed in connection with gastric disturbance, when hepatic disease is also co-existent. It is very frequently, we might say almost constantly the case, that in gastrohepatic disturbance of young children the breath has a sweet smell. But it is not confined to them alone, and is observed in older persons similarly affected. It may be that this symptom is to be attributed to those chemical changes connected with saccharine products that the researches of modern physiologists have detected.

There is still another condition of the breath to which we must refer. It is very commonly found, that in renal disease the stomach is easily disordered, and in some of these instances the breath has a peculiar odour; some have said that it has an urinous smell, due to the abnormal presence of urea in the gastric and other secretions. Still it is not in every case of gastric irritation with Bright's disease that this can be detected, but in some chronic diseases and in acute uræmic poisoning.

The condition of the gustatory sense is often some guide to the state of the digestive function. We do not refer to the state of the appetite, although loss of appetite is a common sign of indigestion and disordered stomach; and it is well that in acute irritation of the stomach, the appetite should be stayed, for time is thus allowed for the disturbed organ to recover, but this is not always

an advantageous symptom, for in atonic dyspepsia the inability to relish food is a circumstance which greatly retards recovery. The sense of taste is, however, perverted, so that dyspeptic patients complain of a sour or bitter taste, or it may be acid or saline, nauseous or sweet, arising from the conditions to which we have just referred.

The condition of the tongue is an indication of the state of the digestive organs, and is an important guide in estimating the changing condition of the mucous membrane. It is the epithelium upon the mucous membrane, and upon the papilla of the tongue, which constitutes the characteristic "fur;" and since local changes are connected with the general state of the system, so these epithelial modifications indicate not only the condition of the mucous membrane, but of the whole organism.

But since the tongue receives a large vascular supply, the state of its capillary vessels point to the condition of the circulatory system, not only of the mucous membrane, but also generally; and again, the tongue, as a muscular organ, has also a general as well as a special import. We shall not attempt to describe all the morbid conditions of the tongue, and the respective diagnostic value of each, but we may allude to several general conditions: first, as to the "fur;" in febrile states nutrition is hindered, and the tongue has a whitish fur; if the secretions be disordered, the fur is

thicker and more distinct; if the strength be impaired, and the epithelial covering readily undergoes degenerative changes, the fur becomes browner in colour, and in great prostration it becomes even black, as in typhoid conditions of the system. Secondly, as to the injection of the tongue, if the mucous membrane be in an irritable and congested state, the papilla of the tongue become congested, and often stand out distinctly from a whitish fur, the substance of the tongue is also rather less than normal. If more severe, the sides and tip of the tongue are redder than usual, and are preternaturally congested. In more chronic forms of irritation and ulceration, especially when the small intestine is affected, this congestion of the tongue is very marked; sometimes, it is merely the centre, which presents a clear reddened stripe, or there are reddened patches, or the whole tongue has a red beefy appearance; this state is often well marked in typhoid ulceration of the small intestine, and in strumous peritoneal disease. Thirdly, in reference to the substance of the tongue itself, in irritable conditions the muscle is contracted as we have just mentioned, but in atonic dyspepsia, in feebleness of the system generally, as we find in anœmia with loaded colon, the tongue appears large, and is indented by the teeth.

The appearance of the tongue is, however, modified by the state of the mouth. A decayed tooth will produce a fur upon that side of the tongue, and an irregu

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larity of the tooth may cause local redness or ulceration; nor must we lose sight of local disease of the

tongue itself. In cynanche tonsillaris the whole

mucous membrane of the mouth is involved. In some diseases of the nose the buccal mucous membrane becomes chronically red and congested. Again we find that in mercurial poisoning the salivary mucous membrane and its glands are inordinately affected. In syphilis and cancerous disease also, local disease of a peculiar and distinctive kind is often present.

In some irritable conditions of the stomach, we find that aphthous ulceration takes place in the mouth; and this state is sometimes present with general disorder of the digestive organs.

The next symptom of gastric disease, or rather of indigestion in its various forms, is a disordered condition of the bowels. Sometimes we are told that the bowels act with great regularity, and that the evacuations are of a healthy kind, but more frequently we find that constipation exists; that there is difficulty in obtaining ordinary relief without some foreign help; and when, as is often the case, there is more general disturbance of the chylo-poietic viscera, and the liver and pancreas are also disordered, the evacuations become irregular, sometimes loose and changed in appearance, pale or deeper in colour than natural; and when intestinal affection also exists, the discharges are light or frothy, mixed with