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 work of the digestive organs; for when the portions of

aliment are thoroughly divided they are more easily dissolved by the gastric secretions; and when left in large crude masses, they remain in the stomach even for many days, irritating and producing severe spasmodic pain. The action of the saliva upon the starchy portions of farinaceous food is also facilitated when sufficient time is allowed for the food to be thoroughly mixed.

Again, the diet may be so changed by the modes of preparation as to be hard and indigestible, or be so acted upon by heat and admixture with other substances that secondary chemical action is very soon induced, and indigestion is the result, or if it have already existed, the malady is greatly aggravated. It might seem strange, that if the diet be in itself of a suitable character it is still important that there should be variety; nevertheless change is needful for several reasons. The requirements of the system may demand for a short time the avoidance of animal and even of vegetable food, but if there be a too long continuance of farinaceous substances, the palate may become wearied till the stomach refuses to digest them; and so with the ordinary diet, it may be well adapted for the system, but be quite unpalatable. This needful variety in diet is often overlooked in laying down rules especially for the dyspeptic; and some of those things that may be in themselves less suitable may be found really more easy of digestion, because more agreeable to the palate.

If active exercise be taken soon after a meal, unless

digestion be rapid and in thorough integrity, flatulence is very likely to be induced, and sometimes severe colic is the result. Semi-digested portions are more easily extruded through the pylorus, fermentative changes are caused in the small intestine, and pain distresses the patient. The constant repetition of these practices— namely, hurried meals and active exercise immediately afterwards — induce oftentimes persistent dyspepsia. Not only should every meal be partaken of slowly, but a short time should elapse before active exertion is made. This is one among other reasons why the confirmed dyspeptic is greatly benefited, and able to pass his usual bounds, when on the Continent, and away from his usual avocations. He will sit down at the table d'hôte, occupying perhaps more than an hour at his repast, instead of the usual twenty minutes or quarter of an hour. But one or two hours afterwards, moderate exercise promotes the digestive process; those portions of food which have undergone solution have probably passed the pylorus, and the stomach is less distended than when digestion is at its commencement. During the performance of any function in its full energy, more blood is sent to that part; thus, whilst digestion is going on the pulse beats more quickly, but if at the same time the brain is actively at work, and demanding its full supply of nutrient material, there would seem to be a hindrance to the stomach's work and digestion is less perfectly executed, and still more if the

nervous system be so engrossed that the action of the vaso-motor and pneumogastric are interfered with; the process is then rendered slow or almost checked. It is notorious that any sudden intelligence of an exciting character, whether pleasing or distressing, completely destroys the appetite, and food can scarcely be taken; and if the senses be engrossed, the mind absorbed, and the attention wholly directed to any subject, the sense of hunger is forgotten or not experienced, so that even faintness may after a time be induced. An overwhelming sorrow appears to act not only upon the mental, but upon the physical state; and if food be placed in the stomach after persuasion, it will remain as if unacted upon for a prolonged period.

How essential, therefore, that the mind should rest, and that a calmness should if possible be attained during the performance of ordinary digestion!

2. A second class of remedies in gastric disorders are those which increase the digestive power by the addition of some of those principles which are naturally in operation during the digestive process.

As we have before stated, digestion can scarcely be limited to the stomach alone, for the action of the pancreas and of the liver are important secondary agents. Inspissated bile has long been used, and more recently a pancreatic emulsion. Among these remedies, then, we place pepsine, hydrochloric acid, lactic acid and lactates, inspissated bile, pancreatine.

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