alvine discharges. In some cases of protracted indigestion, great fulness is observable in the situation of the cœcum, and in the course of the colon, particularly the sigmoid flexure, owing to inattention to the state of the bowels and habitual costiveness. The dyspeptic complaint may be considered in some respects as a consequence of this torpid condition of the large intestines, although it is more frequently a cause; but, however originating, there can be no question but that this state of the colon aggravates the disorder of the stomach, and should be removed as soon as possible. For this purpose, few better medicines can be prescribed than the combination of blue-pill and aloes, given at bed-time, and the bitter aperient draught taken in the morning. The effects of these remedies will be advantageously promoted by the use of the soap injection, or of the common gruel enema, in which some common salt may be dissolved, and a little assafoetida rubbed down.

Amongst other symptoms which require removal, those of acidity are the most troublesome. When these depend upon the quantity, richness, and irritating nature of the food, then the means of removing them are obvious. But they do not always proceed from this cause they frequently seem to arise from a state of inflammatory irritation of the mucous coat of the stomach, and a deficient secretion of the gastric juice and mucus. The consequence of these conditions is, that the aliment is not converted into healthy chyme, but undergoes those changes to which its chemical affinities and the temperature of the body dispose it to enter into. These combinations being of an acid and irritating nature, the nervous sensibility of the organ is excited, and thus heartburn and pain in the stomach are produced. It is usual, in this variety of disorder, to prescribe antacids, which merely neutralise the acid which is formed, but which often increase that state of functional disorder upon which the acidity depends. Antacids are, notwithstanding, useful in such cases; but not as the chief agents-they are merely subsidiary means. They should be combined with aperients, and with such remedies as are best calculated to promote the healthy function of the liver and bowels. As an antacid, the carbonate of ammonia is perhaps the best, especially when given with the liq. ammon. acet. in any mild aromatic water, or in the simple decoction of sarsaparilla, or compound barley decoction. In all such cases, the state of the bowels should be attended to, and the operation of the gentler and more tonic aperients, which are here best adapted to the func tions of the stomach, may be promoted by the occasional use of enemas, composed of ingredients similar to those already specified,

or of the decoction of camomile flowers, with some aperient extract dissolved in it.

Flatulence is another symptom which often occasions considerable distress, and even acute pain, in the advanced stages of dyspepsia. It will, however, be generally removed by the means already pointed out, more especially by a regularly open state of the bowels, and by the combination of aromatic and antispasmodic remedies with aperients and antacids. Where flatulence is frequently present to a great degree, we should always suspect the existence of a torpid state of function of the liver, with inactivity of the cœcum and colon; and we should therefore extend our remedial agents to these viscera, as well as to the stomach itself. The use of injections is here necessary, in order to unload the colon, and prevent the accumulation of fæces or morbid secretions in its cells.

Having relieved the more urgent symptoms, our next endeavour should be to impart strength to the digestive organs, and, through them, to the frame in general. The means already particularised will be productive of this result to a certain extent, particularly those which unload the alimentary canal of the offending materials which have accumulated in it, and impaired its energies. Until these be removed, it will be in vain that we shall attempt to give strength to the digestive organs; for whatever means we employ, if they accomplish not this effect, will frequently disorder the system, and be productive of general febrile irritation. In some cases, however, particularly in those who are much debilitated, tonics may be advantageously combined with aperients. The tonics employed should be of the mildest kind, and the least calculated to heat the system. Stimulating and heating tonics when prescribed before the strength of the digestive organs is in some degree restored, are generally hurtful, productive of thirst and fever, and often lead to the supervention of inflammatory disorder of the liver. Weak infusions of columba root, gentian, or camomile flowers, are at first the most suitable of this class of remedies to debilitated subjects; but as the strength returns, the cinchona, or cascarilla, with soda, may be prescribed with advantage. The sulphate of quinine may likewise be given in small doses; but, unless for the purpose of arresting the progress of intermittents, it is generally detrimental when taken in large doses, or when the use of it has been long persisted in. Even small doses, when prescribed for those who are liable to disorders of the liver and bowels, create considerable heat of skin and accelerated pulse. Its astringent effects are also such as

require the exhibition of aperient medicines. In all cases of dyspepsia, whatever be the symptoms or complications attending upon it, tonics even of the mildest description should be combined with gentle aperients; and when the functions of the liver and bowels are torpid, and still more especially if their secretions be morbid, suitable purgative remedies should be exhibited, at the same time that the strength of the digestive organs is promoted.

The Gentiana Chirayita of Roxburgh, or wormseed plant, is one of the best tonics generally used in India, and is well suited to the dyspepsia of weak persons, on account of its bitter and tonic properties, and the absence of any heating or irritating qualities. It may, as well as the common gentian, be used advantageously in combination with senna, for infusions, and, either with or without this latter, it forms, when thus prepared, an excellent vehicle for other tonics, or for aperient remedies, in the stomach and bowel complaints of warm climates.

Having removed the more urgent symptoms present during the advanced states of indigestion, and having restored the energy of the stomach, and regulated the functions of those viscera which are subsidiary to this organ, the last indication proposed is, to prevent the return of the disorder, by adopting that diet and regimen which the circumstances of the case seem to require. Persons who have once suffered from derangements of the digestive organs are extremely liable to a return of them, even after they have been completely removed by medical treatment, upon the least error in diet, and after any indulgence at table beyond the ordinary habits of the individual. On this account, the patient's prudence should never forsake him. His diet ought to be simple, consisting of few articles, plainly dressed, and easy of digestion. Animal food may be taken once a day in moderation; and if active exercise be indulged in, it may be partaken of twice, provided that the appetite desire it. Exercise, in order to be beneficial to those who have a weak digestion, should be regular, moderate, and resorted to at suitable hours of the day. Exposure to the sun ought to be avoided, and the exercise should always be short of fatigue.

CHAPTER II.

ON INFLAMMATION AND ORGANIC LESIONS OF THE STOMACH.

SIMPLE and uncomplicated inflammation of the stomach is an extremely rare disease, both in warm and temperate countries. Among many thousand cases, reported at length, I find but very few in which phlegmonous or acute inflammation of the substance of this organ was present in an uncomplicated form. It must not, however, be inferred from this, that the stomach is rarely inflamed. As respects the European residenters in India, this is far from being the case; for this viscus very frequently becomes the seat of inflammation, particularly as regards its mucous coat, owing to the extension of morbid vascular action from adjoining parts. It is only as a primary, an acute, and an uncomplicated disease, that gastritis is rarely met with. As it occurs within the tropics, it is generally complicated with disease of the liver, spleen, or small intestines, these organs having been the primary seat of inflammation, and the vascular disorder having extended itself to the stomach, owing to the operation of those predisposing and exciting causes whence gastritis usually proceeds. Inflammation of the stomach, however, may originate primarily in this organ, and even in a few cases be productive of disorder of the adjoining viscera. But this is seldom the case in the very acute or phlegmonous form of the disorder. In that form of gastritis which has its seat in the mucous coat of the stomach, and which is more insidious and more chronic in its progress, the extension of disease to other viscera is a much more frequent occurrence.

SECT. I.-On the Symptoms and Causes of Inflammation of the Stomach, with the Appearances upon Dissection.

When inflammation commences in the mucous tunic of this organ, and is confined to this texture, its symptoms and progress are very different from those which characterise inflammation of the substance of the stomach. The former variety of the disease,

M

which has usually been denominated the erythematous or erysipelatous, is often insidious and indistinct until very serious organic lesion has supervened. The latter is, on the other hand, most alarming in its aspect, and quick in its progress; and tends generally to a fatal termination, if not arrested by judicious means. The one is slow, and often obscure; the latter most acute and well marked.

The chronic or erythematic form of gastritis is generally confined to the mucous coat of the stomach, and, in its slighter grades, is a much more frequent form of disease in warm climates than is usually supposed. It supervenes to a greater or less extent, in the advanced stages of dyspepsia,-many of the more urgent symptoms of this disease being the result of an inflammatory state of the mucous coat of the stomach. It is also present in many cases of bilious inflammatory fever; and in these it may be considered as being generally induced by the flow of acrid and irritating bile into the stomach.

The symptoms generally indicating the existence of this form of disorder are, heartburn, pain in the region of the stomach, particularly after eating, accompanied with a sense of constriction always denoting obstruction in the gall ducts. There are present slight fever and thirst,-a red state of the fauces and edges of the tongue, whilst its surface is covered with a whitish or yellowish coating. At first, the desire for food is not much diminished; but the digestion is slow and painful, and accompanied with acrid, acid, and rancid eructations, and occasionally with vomiting. As the disease advances, the appetite disappears; there is frequent vomiting, with periods of comparative comfort, when food is entirely avoided, or taken in small quantity, and of mild quality. Attending this there is also much thirst, and a sense of heat about the præcordia and pit of the stomach. The functions of the bowels are often not much disturbed; they are sometimes, however, slower than natural, and occasionally diarrhoea is present. As the disease advances to ulceration, the pain, heat, and vomiting become more urgent. Cardialgia and constriction at the pit of the stomach are more frequently present; the patient becomes emaciated, and the fever assumes more of the hectic character. The matters ejected by vomiting early in the disease consist at first only of the substances taken into the stomach; subsequently they are mucous and glairy; and sometimes small whitish flocculi may be noticed in them. Soon after ulceration has supervened, which commences in the mucous follicles with which the villous tunic is studded, the matters thrown