tigation to decide, whether the disease is really wholly abdominal in its character, and whether the brain disease is not secondary rather than primary.

In another class of cases, the patient is more advanced in life, it may be in early manhood, when severe pain in the head, and vomiting without any real gastric disturbance, usher in most serious and fatal disease.

The same sympathetic connection is witnessed after concussion of the brain; as the patient begins to rally from the first effects of the blow, vomiting is a frequent result; and, if local inflammation of the membranes of the brain takes place, the irritability of the stomach is sometimes excessive, especially if the disease extend to the origin of the pneumogastric nerves.

These cases are often set down as "bilious attacks," which is the most serious mistake that could be made, for the sole attention is then directed to the stomach and the liver; the nature of the malady is overlooked, and the treatment misdirected. In the diagnosis of these cases, where irritation of the brain is the cause, the head is hot, the pupils generally small, the tongue clean, the abdomen contracted, and the bowels confined.

Another cause of sympathetic disturbance of the stomach is disease of the spinal cord; but although irritability of the stomach is sometimes to be traced to this source, more frequently the pain at the scrobiculus cordis, and flatulent distension of the stomach and

abdomen, are really signs, the one of irritation at the peripheral extremity of the spinal nerves, the other of paralysis, which prevents the muscles forming the abdominal parietes, and the involuntary muscular fibre of the intestine from contracting in their normal manner.

In disease of the lungs, especially of a tubercular kind, the implication of peripheral branches of the pneumogastric nerves in the morbid action sets up reflex disturbance of the stomach; we find delicate strumous subjects thus affected with such extreme sensibility of the stomach, that food of almost every kind is at once rejected; no cough may be present, but on examining carefully the apices of the lungs, some difference in the resonance on percussion will be found, and the respiratory murmur will be heard more feeble than natural, or irregular, or the expiratory murmur coarse and prolonged, even if more advanced indications of organic change do not exist. This state of sympathetic gastric disturbance sometimes subsides as the phthisical condition becomes fully developed, or it may continue to harass the patient throughout the whole course of the complaint.

It may be argued by some, that the gastric altogether precedes the pulmonary mischief, and that in the weakness from the impaired power of digestion we have the cause of the low organised deposit in the cell structure of the lungs. If such were the case, the gastric disease would continue at least pari passû with

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that in the lung, and be detected after death; whereas we never find tubercular deposit or strumous ulceration in the stomach, and the utmost that can be noticed is the fatty degeneration or atrophy occasionally found in phthisical patients, although not exclusively in them. Too often have we found that most important time has been lost during early phthisis by this error of supposing that the disease is "all stomach."

In this state of functional disturbance of the stomach, preceding or accompanying phthisis, there is unusual irritability of the mucous membrane. As Dr. Theophilus Thompson has shewn, the state of the gums is peculiar, a red injected line of congested mucous membrane being observable along the margins of the teeth; nausea, loss of appetite, disrelish for fatty substances, pain at the scrobiculus cordis may also co-exist; severe vomiting may be followed by cough, and after a time by hæmoptysis, and the general signs of tubercular disease of the lung.

It is during this early stage of phthisical disease that remedial measures are of inestimable value. Far better is it at this period to seek to invigorate and strengthen the system by change of climate and generous diet, than to wait until disease has become firmly established; for too often patients are removed from the comforts of home when the strength is entirely exhausted, and they are sent away to die among strangers, and in foreign lands.

We more frequently have sympathetic disturbance of the heart from functional disease of the stomach than the converse, namely, stomach irritability from heart affection, except that consequent on passive venous congestion.

In the disease of the supra renal capsules, which received so much attention from Dr. Addison, and which is generally associated with discoloration of the skin, irritability of the stomach is one of the characteristic symptoms; and although in some of these instances, we have found superficial ulceration of the stomach, and a condition of the mucous membrane indicative of more than mere functional change, namely, arborescent vascularity; still, we are led to regard the very intimate connection of the stomach by means of large nervous filaments with the semi-lunar ganglion, and the same ganglion with the supra renal capsules by still larger branches, as an important fact in explaining the irritability of the stomach in the observed cases of disease of the supra renal capsules.

In the sympathetic disturbance of the stomach from disease of the kidney, we do not refer to instances of Bright's disease and albuminuria, in which the changed character of the gastric secretion leads to vomiting and other signs of stomach disturbance; but we would notice cases of calculus in the kidney, in which vomiting is a constant and characteristic symptom, though evidently not connected with simple disorder of the

stomach, for patients often state, that when the pain has subsided, they can digest a hearty meal, as we have before said, and we have had cases brought before us of this kind mistaken for ordinary abdominal colic.

That diseases of the uterus and of the urino-genital organs set up vomiting, is a fact familiarly known. Many persons, during the whole period of utero-gestation, suffer severely by this sympathetic disturbance, and a greater number are affected during the earlier months.

Any abnormal congestion and inflammation about the ovaries, may lead to similar gastric distress; and in men, disease of the bladder, prostate and testicles, induce almost corresponding symptoms.

In the treatment of these forms of sympathetic disease, correct diagnosis is of the utmost importance, for it is worse than useless to direct the whole attention to the stomach, when it is only secondarily involved. Our chief concern then must be with the cause of the complaint; thus, in disease of the brain, if we can diminish the cerebral mischief, the gastric will soon subside. Still, although the stomach is not primarily implicated, and its structure is not changed, it is in an unfit state to digest an ordinary meal, and great care should be used to lessen the quantity of the diet, and to tax the energy of the organ, only by bland and unirritating diet.

Medicine may also assist in quieting also assist in quieting even this secondary irritation, and in enabling the stomach to tolerate