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small sleeping apartment. The strength becomes impaired, and a relief to the sense of exhaustion is often attempted by the use of alcoholic stimulants, which still further interfere with sound digestion.

Having made these brief remarks as to the general treatment, we pass on to those measures which directly affect the stomach.



It would almost seem that during the last few years there is a mania for new remedies, and that the charm of novelty casts into disrepute those means which had previously been found of an efficacious character.

The remedies we possess are more than sufficient if we knew how rightly to use them; and we are able to effect more by regulating the physiological conditions of digestion, than by confining ourselves to the mere administration of medicines.

The remedies of diseases of the stomach may be divided into four classes.

1. Those which regulate the work the stomach has to perform.

2. Those which increase the digestive power by the addition of some of those agents, chemical or otherwise, which are naturally in operation during the digestive process.

3. Those remedies which remove the impediments of digestion.

4. Those general remedies which only act upon the

stomach in a secondary manner; but to this latter class we have already referred in the last chapter.

In the first class of remedies for gastric diseasenamely, those which regulate the work the stomach has to perform--we find agents more powerful than any other in counteracting diseased action and functional irregularities. The numerous questions suggested by the requirements of the system as to diet and exercise become doubly important during functional disturbance, but there are several facts to be borne in mind which it may be well to notice en passant. Digestion must be regarded as not confined merely to the stomach, for it really commences in the mouth, and extends beyond the stomach. Starchy substances begin to undergo chemical change as soon as they are incorporated with the saliva ; and although it is said that this change continues in the stomach itself, in that viscus it is rather nitrogenous food that undergoes solution. It seems probable also that the gastric juice is especially secreted under the stimulus of food, or from the intermitting action of the vaso-motor nerve. The experiments and observations made on Alexis St. Martin are most interesting on this subject, in whom an accidental perforation through the parieties of the stomach enabled Dr. Beaumont to watch these otherwise hidden processes, and a table was the result of his research, showing the length of time each substance required for its solution; but this knowledge is a very imperfect guide in the treatment of the forms of indigestion. Other considerations are of paramount importance. Thus we have to consider :

The proper intervals of food and the importance of regularity.

Its right quantity.
Its thorough mastication.
The quality of the food and the changes by cooking.
The necessity of variety.
The effect of exercise on digestion.
The interference produced by mental excitement.

1. The proper intervals of food might be considered in reference to health and disease, and in relation to the age and habit of the patient. In early life it is necessary that supplies of nourishment be administered very frequently. At first every two hours; the interval is gradually increased to three and then four hours. At first by night as well as by day; but the nightly repetitions are gradually lessened till they cease altogether. Again, in very advanced life, the intervals of the meals must be again lessened, and food taken even during the night. This is very important in the feebleness of advanced life; the stomach is unable to bear very ample meals, and exhaustion is the result of long-continued abstinence.

The majority of persons in ordinary health take three substantial meals during the day, at intervals of from four to five hours, but some regard two meals as ample for the necessities of the system, and by


habit this arrangement can be borne without any discomfort.

During disease, however, the stomach is unable to bear the rules of ordinary life, and the system may require other methods. In states of great exhaustion it is necessary that food be given very frequently, varying from every two hours to every quarter of an hour; and we have known many instances of otherwise fatal exhaustion in serious disease averted by the assiduous attention to this repeated administration. In irritable conditions of the stomach, where ingesta produce pain and cause their rejection, small quantities of bland nutriment are capable of being borne, whilst solids in the ordinary quantities are quite inadmissible. But it is not sufficient to allow of proper intervals between the meals; regularity as to the hours are needed, especially in the dyspeptic; to dine at every hour of the day, from noon till late at night, is an effectual method of producing and of perpetuating dyspepsia.

It has often been said that a larger quantity of food is taken than is absolutely needed ; and this is very apt to be the case when the meals are hurried, and when the appetite is tempted by a great variety of dishes. We have already referred to the absolute quantity of food required by the system; but in this respect there is a great difference in health and in disease. Imperfect mastication greatly increases the ork of the digestive organs; for when the portions of

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