each of these forms of gastrodynia. I have found nothing of more general utility than the sulphate of iron, in doses of two grains, combined with one grain of aloes and five grains of aromatic powder, taken three times a-day. Oxide of bismuth combined with rhubarb in the same manner, is also frequently very useful; likewise lime-water, and small opiates. When the affection proves more obstinate, it must be treated by topical bleeding and blistering, with farinaceous diet.

4. Pain in the stomach takes place in a fourth form occurring at uncertain intervals, in most violent paroxysms; accompanied generally by a feeling of distention, much anxiety, and extreme restlessness; and, in females, it is frequently combined with hysterical symptoms. This form seems to depend upon over distention of the stomach, and is relieved by carminatives; but it is often very severe and untractable. I think the most effectual relief, in general, is obtained from exciting a brisk action of the bowels, by means of a strong injection. From the facility with which such affections often yield to this remedy, it is probable that the uneasiness is sometimes seated in the arch of the colon. External stimulants, such as sinapisms, and friction with strong spirits, often give great relief.

There seem to be some other modifications of pain in the region of the stomach, not referable to any of these classes. Among these may be reckoned a pain which affects persons of a gouty habit, and may occur either in the form of severe and sudden paroxysms, or as a more continued pain going on for many days together. It seems in general to be most relieved by stimulants, combined with alkalies and small opiates; but it requires to be carefully attended to, and to be treated by topical bleeding and blistering, if it do not soon give way. There is also a violent affection of the stomach, occurring chiefly in females of an

irritable habit, and assuming a spasmodic or neuralgic character. It seems in general to be relieved by opiates combined with absorbents or alkalies. All these affections of the stomach, however, should be watched with attention, for several remarkable examples have been given which show that they are often connected with chronic inflammation or ulceration, and that they may be very rapidly fatal, without having assumed any formidable character till the fatal attack.

In all these painful affections of the stomach, attention to regimen is, of course, of the utmost consequence. On this head it is impossible to lay down any general rules, as the diet must be regulated by attention to the nature and characters of the case. One rule is applicable to all of them, namely, that the food ought always to be in the smallest quantity. In regard to quality, there is great diversity. Some of the cases agree best with farinaceous diet and milk, while in others, the pain is aggravated by articles of this kind; and the patient goes on most comfortably upon animal food in small quantities, with bread, or a little rice. For a variety of interesting facts on this subject, I refer to a work by M. Barras, "Sur les Gastralgies et les Enteralgies." It is directed against the prevailing doctrine of the French school, by which all affections of this class are referred to the 'gastro-enterite chronique;' and shows in a satisfactory manner the evils which arise from the indiscriminate application of this system, and the practice founded upon it.

II. Chronic vomiting, occurring at various irregular intervals, and without suspicion of organic disease. This seems in general to be connected with a morbid irritability of the mucous membrane of the stomach, and sometimes

proves very untractable. It may occur at a short period after taking food, or at the distance of three or four hours. In the former case, the disease is probably seated in the stomach; in the latter, in the pylorus or the duodenum. The treatment is very uncertain; the oxide of bismuth is in some cases extremely useful, and in others lime water. In some forms of the affection, again, articles of a stimulating nature are beneficial; and I have known some very protracted cases yield to the use of a strong tincture of garlic; and others, to small doses of calomel. Much depends upon regimen, and some of the most severe and protracted cases have got well under a diet restricted entirely to milk. External applications are also frequently useful, as blistering and tartar emetic ointment. It is to be kept in mind, that habitual vomiting often depends upon diseases of other organs, affecting the stomach sympathetically, such as affections of the kidney, the liver, the spleen, the pancreas, and sometimes the brain.

Protracted cases of vomiting which have resisted much treatment, sometimes yield to the practice of keeping up a slight but continued action on the bowels, by very small doses of laxatives repeated at short intervals. An interesting example of this is mentioned by Dr. Parry, in which the vomiting was in such a degree, that every thing was rejected, even a tea spoonful of water. The case had gone on in this manner for several weeks, and the patient was reduced to the last degree of emaciation, when Dr. Parry ordered half a grain of aloes to be given every four hours, moistened only with a few drops of liquid. This was retained, and acted gently on the bowels, and in less than two days, the complaint entirely subsided. The bowels had been freely moved from time to time during the previous treatment, and other

remedies in great variety had been employed without any benefit.*

III. Obstinate and untractable pyrosis, often accompanied with discharge of quantities of thin acrid mucus by eructation, or with a feeling of constant and intense acidity, produced by articles which are not likely to become acid. These symptoms are probably connected with a diseased condition of the mucous membrane of the stomach. In some of the cases formerly described, we have seen them connected with actual ulceration; in others, the membrane appears thickened, pale, and spongy, with an increased and unhealthy secretion. A woman mentioned by Andral, vomited every day about four pints of white glairy mucus like the white of eggs; and she never vomited either food or drink. On dissection, no other morbid appearance could be discovered than a general thickened state of the mucous membrane of the stomach, which was of a brownish colour, and the follicles were remarkably developed. When the fluid discharged is tinged of a brown or chocolate colour, ulceration is to be suspected : in other cases, only a thickened state of the mucous membrane is met with, combined with an appearance of melanosis. The fluid in these cases has been found to contain a large proportion of albumen, and the colour appears to arise from the colouring matter of the blood. The affection is very untractable; it is often benefited by lime water, bismuth, the stimulants, as garlic and benzoin, and frequently by the acids, particularly the nitric; likewise by blistering and mild farinaceous diet.

IV. Hæmatemesis. This, which we have seen as the result of ulceration, also occurs without any such disease ;

• Collections from the unpublished writings of Dr. Parry. Vol. II.

and I have seen it fatal where no organic disease. could be discovered, and even the source of the hæmorrhage could not be detected. In other cases, a varicose state of the veins is observed in the mucous membrane of the stomach. The quantity of blood brought up is often immense, so that the patient is reduced to the last degree of exhaustion; and yet the disease is not often fatal. Some persons, especially women, are liable to frequent or almost periodical attacks of it, sometimes in connection with retention of the menses. When the patient is much exhausted, it is necessary to give small quantities of brandy at short intervals. For settling the stomach, and restraining the hæmorrhage, the acetate of lead is often very useful, and may be given in doses of one or two grains, repeated every three or four hours, for thirty-six or forty-eight hours, if necessary; also the acids, the muriated tincture of iron, bismuth, alum, and kino in powder or tincture. The blood is apt to pass into the bowels, from which it must be discharged by the mildest means, as injections repeated two or three times a-day. The patient must be supported by farinaceous nourishment in small quantities, or by milk, or fresh-made soft curd.

V. Sympathetic Affections of the Heart. These are often among the most troublesome symptoms that accompany affections of the stomach, and are always the most alarming to the patient. They appear under various forms, and frequently assume, in a very great degree, all the characters of fixed disease of the heart or large vessels. The slightest and perhaps the most common form consists of a momentary feeling of a rolling or tumbling motion of the heart, like that which is produced by a sudden surprise or fright, and it is accompanied by an intermission of the pulse. This feeling may be repeated only once or twice at a time, and