stomach, that can possibly be avoided, even by the mildest articles. The patient should abstain in a great measure from bodily exertions, and hence the importance of endeavouring to distinguish the disease from mere dyspepsia, as the regimen and exercise which are proper and necessary in a dyspeptic case, would in this case be highly injurious.

In the early stages, little probably is gained by medicine given internally, beyond what is required for the regulation of the bowels. In the more advanced stages, or when there is reason to suspect that the disease has passed into ulceration, the same observations will apply in regard to external applications and regimen; and benefit may now be obtained by some internal remedies, such as the oxide of bismuth, lime water and nitric acid; and, in some cases, small quantities of mercury appear to be useful. Small opiates, combined with articles of a mucilaginous nature, appear frequently to be beneficial,-likewise articles of an astringent nature, such as kino, alum, and the Rhatany root. The arsenical solution has also been recommended, and small doses of the nitrate of silver; and in several instances in which I suspected this disease to be going on, I have found remarkable benefit from the sulphate of iron. Dr. Malden recommends borax, in doses of from ten grains to half a dram, taken in solution three or four times a-day, as of great efficacy in cases of this class: he sometimes combines with each dose, one or two drops of laudanum.* Whether the disease can be cured, after it has advanced to ulceration, must indeed remain in some degree a matter of doubt; because, in a case which has terminated favourably, we have no means of ascertaining with certainty that ulceration had existed. In some of the cases, however, which have been described, we have seen every reason to

*Midland Medical and Surgical Reporter, May 1829.

believe that some of the ulcers had cicatrized, though the disease had afterwards gone on to a fatal termination; and from what we observe in the intestinal canal, we can have little doubt that simple ulceration of the mucous membrane may cicatrize. I am satisfied that I have seen the cicatrices of such ulcers when the patient has died of another disease, after having been for a considerable time free from any symptom in the bowels.

I insert here the following case, without deciding whether it is referable to the affection which has been the subject of the preceding observations. In a practical point of view it is of some importance.

CASE XIII.—A lady, aged about 30, came to Edinburgh from a distant part of the kingdom in summer 1818. She was affected with violent pain in the stomach, which seized her every day immediately after dinner, continued with great violence through the whole evening, and gradually subsided about midnight; it sometimes occurred after breakfast, but more rarely. The complaint was of two years' standing, during which time a great variety of practice and every variety of diet had been tried, but with very slight and transient benefit. The paroxysms occurred with perfect regularity; she was considerably reduced in flesh and strength, and had a sallow unhealthy look; and her whole appearance gave strong grounds for suspecting organic disease. In the epigastric region no hardness could be discovered, but there was considerable tenderness on pressure at a particular spot. Various remedies were employed during the summer with little advantage; at last, however, she appeared to derive some benefit from lime water, and returned home in the autumn rather better. But the affection soon recurred, and she returned to Edin

burgh in 1819 as bad as ever. After another trial of various remedies, this severe and intractable affection subsided entirely under the use of the very simple remedy to which I have above referred. She took two grains of the sulphate of iron three times a day, combined with five grains of the aromatic powder and one grain of aloes, which was found sufficient to regulate the bowels. Under the use of this remedy she was soon free from complaint, and has continued to enjoy good health.

In every form and every stage of the affection, the utmost attention to diet, both as to quality and quantity, is of essential and indispensable importance. The farinaceous articles and milk are those which seem in general to agree best; and some cases have been found to make most satisfactory recoveries under the use of a diet restricted entirely to small quantities of milk or soft fresh-made curd, after they had exhibited for a length of time every character of most formidable or nearly hopeless disease. The following interesting case of this kind has been communicated to me by Dr. Barlow of Bath.

CASE XIV. A female, whose age is not mentioned, had for a considerable time laboured under symptoms which were supposed to indicate scirrhus of the pylorus, and her case had been regarded as entirely hopeless. She suffered severe pain in the stomach when the smallest quantity of food was taken in, with great tenderness upon pressure, and constant vomiting, which occurred regularly about the same period after eating, at which it usually takes place in affections of the pylorus. A variety of treatment had been employed without benefit, when Dr. Barlow determined upon trusting entirely to regimen, by restricting her to a diet consisting wholly of fresh-made uncompressed curd,

of which she was to take but a table-spoonful at a time, and to repeat it as often as she found it advisable. On this article she subsisted for several months, and recovered perfect health.

An inflammatory affection of the mucous membrane of the stomach of a peculiar kind, is frequently met with in practice, in conjunction with a general inflammatory condition of the whole course of the mucous membrane from the pharynx downwards. I think it sometimes occurs as an idiopathic disease, but I have generally observed it taking place at an advanced period of other diseases,-as simple fever, or any of the inflammatory affections, as pneumonia. There is a peculiar rawness and tenderness of the whole mouth and throat; often with a dry and glazed appearance of the tongue, a deep redness of the pharynx, interspersed with aphthous crusts; and, in some cases, the whole pharynx presents one continued dense crust of an aphthous character. There is generally tenderness on pressure in the epigastric region, with uneasiness in swallowing along the whole course of the oesophagus, and great uneasiness in the stomach, excited by the mildest articles of food or drink. In some cases, this is immediately communicated to the bowels, and the articles speedily pass off by a rapid diarrhoea. In other cases, vomiting takes place, and in others, both vomiting and diarrhoea. I have not seen the affection fatal, when the original disease had been removed; but I have seen it assume a very alarming character, with a very rapid pulse, and extreme exhaustion. The remedy which I have generally found most useful is lime water, or equal parts of it and a strong decoction of quassia. Small opiates are required, with very mild articles of food; and, when there is much sinking, wine or brandy, mixed with

arrow root. The following case will illustrate the affection.

CASE XV.-A woman, aged 30, and previously healthy, after some continuance of a febrile disorder, with very mild symptoms, became affected with pain and tenderness in the epigastric region, extending over the abdomen. The mildest articles of food produced great pain; there was diarrhoea, with much griping, and frequent vomiting. The affection was accompanied by a feeble rapid pulse, great debility, and collapse of the features; and there was a peculiar rawness and tenderness of the mouth, tongue, and throat. After various remedies had been employed without benefit, the symptoms subsided speedily under the use of lime water.

The aphthous affection of the mouth and throat, which is sometimes fatal to infants, seems to be allied to this diseased condition of the mucous membranes; and it is often found to be connected with minute ulcers of the mucous membrane of the intestine. A similar condition occurs in advanced stages of phthisis, and is often the prelude to the colliquative diarrhoea. It is likewise found affecting the mouth and throat, accompanied by tenderness along the œsophagus and in the stomach, when there is no affection in the bowels.

Another modification of disease in the mucous membrane of these parts, is that to which the French have given the name of Diphtherite. It does not appear to be a common affection in this country; but I have had opportunities of seeing it at various times, particularly in summer 1826, when it was frequent and fatal in Edinburgh. It is an epidemic chiefly affecting children. The