decomposing mucus, with changed epithelial products, or even with blood.

A morbid state of the urine is an exponent of secondary assimilation rather than of any primary defect in the digestive process; but still it is exceedingly important in gastric disease carefully to note the state of the renal secretion. Disorders of the stomach at once react upon the kidney and bladder, especially if there be any undue sensibility of these parts. Disturbed primary assimilation, the formation of a cruder chyle, and the absorption from the stomach of irritating products, are an additional tax on the excretory organs; it may be that an unusual quantity of lithates in the urine express the separation of effête material; but if there be organic disease of the kidney or calculus, if there be any tendency to chronic cystic disease, to stricture of the urethra from any cause, then the gastric disorder is severely felt. In gouty dyspepsia the urine contains an abnormal quantity of uric acid, and equally expressive are its indications in rheumatism, and in the imperfect digestion connected with hepatic and renal disease, with cardiac and pulmonary affections, with functional and organic disease of the brain, and diabetes.

During the earlier part of the digestive process, the urine has been shown by Dr. Bence Jones to undergo ⚫ remarkable change; it loses partially its acidity, and may even have an alkaline reaction. It is well also to

remember the interesting observations of Dr. Edward Smith, namely, that in children, in whom waste and oxidation are proportionately in excess, there is a larger quantity of urea present than in adults and in aged persons; and the same observer remarks, that in summer also the quantity of urea excreted is larger than during the winter months. Oxalic acid, with lime in the form of beautiful crystals, is often present in the urine of the dyspeptic, even when no article of diet containing that acid has been taken. In atonic dyspepsia we have an excess of phosphates, and the crystals of the ammoniomagnesian phosphate.

Other symptoms of gastric disease are connected with the vaso-motor or sympathetic nerve, or with the connection of that nerve with the cerebro-spinal system. Many of these we have alluded to in speaking of the sympathies of gastric disease: as the disturbance of the senses; the irritation of the extremities of the alimentary tract ; itching of the nose and mouth or of the anus; the irregular pains or perverted sensations of the extremities; the disturbance of the heart and of the respiration, producing in the one case irregularity of the pulse and distress, in the other dry and irritable cough; the irregular flushings of heat, and burning of the hands and feet; and, lastly, the disordered workings of the brain in its important functions, so that the dyspeptic becomes excitable and restless or depressed and melancholic, his days passed in wearisome inertia and his nights in restless dreams or in

continued watchfulness. These symptoms, the burden of the dyspeptic, we have already spoken of, and need not further dwell upon them than to remark, that in functional disease the severity of the symptoms and the distress of the patient are often out of all proportion to the magnitude of the affection.

CHAPTER IV.

ON THE GENERAL TREATMENT OF DISEASE OF THE STOMACH.

IN no class of diseases is it more important to regard the system in its entire character than in the maladies before us, and amongst these general considerations the state of the mind stands foremost, for as long as that is unsettled and disturbed, mere medicinal treatment will have very little effect in relieving the symptoms. Intense mental anxiety will cause such an irritability of the stomach that the meal is at once rejected, and the only effectual remedy is to calm the mind, and to remove the causes of anxiety. Mental repose has a wonderful effect in conducing to the healthy performance of digestion. Anxiety will destroy the appetite, so will pleasurable excitement or intense exercise of thought; but as soon as the stimulus ceases, it is followed by a sense of exhaustion. Amidst beautiful scenery there may be no sense of bodily fatigue, whilst the mind is entranced; hunger is not experienced, but when at length the excitement is lessened, the exhausted system may be unable to take the required refreshnent, or, if taken, there is the inability to digest it.

Sudden alarm, unexpected news, whether pleasurable or painful, take away the appetite, and may even induce rejection of food. In the treatment of these gastric maladies, perhaps more than in any other, the confidence of the patient in the skill and diagnosis of the practitioner is an essential element of success. Without that confidence, every suggestion will probably result in an aggravation of the symptoms, and with it the simplest placebo will sometimes suffice to relieve functional disease.

The effect of climate is very perceptible in stomachic disease. A damp relaxing atmosphere, a locality upon clay, where moisture is retained and preternatural humidity induced, have a marked influence in perpetuating the symptoms of gastric affection, especially where atony exists, where the powers are enfeebled, and where a strumous diathesis renders the functions generally more easily disturbed. A dry bracing air tends to invigorate and to strengthen, and to the dyspeptic accustomed to a damp, confined situation, it will often suffice effectually to ameliorate his symptoms. It is scarcely necessary to refer to the injurious influence of impure and miasmatic conditions of the atmosphere, as affecting the gastric in common with other functions of the body. The ideas handed down to us from past centuries as to the influence of the season upon the health, have been confirmed by the scientific observations of Dr. E. Smith, that there is the greatest amount of general vigour in