deep inspiration. The attack generally continues from 15 minutes to half an hour, and then passes off in an instant, with a feeling of some obstruction suddenly giving way; every uneasy sensation is then instantly removed, and the pulse becomes full, soft, regular, and of the natural frequency. This affection was originally brought on by intense anxiety of mind nearly 30 years ago; it has continued to recur since that time, but at very uncertain intervals, often of weeks or months, and has never produced any injurious effects upon his general health.

It is unnecessary to enter into any general detail of the various sympathetic affections, which, in connection with disorders of the stomach, appear in other organs, particularly in the head, as these are familiar to every practical man; but I shall conclude this part of the subject with a short account of the following affection, which seems to be one of very rare occurrence.

A gentleman, aged about 50, liable to delicate health and impaired digestion, about five years ago began to be affected in the following manner :-At various times of the day, and without any warning, he was suddenly seized with an uneasy feeling in the epigastric region, accompanied by a violent and very loud sound, as from the belching of wind. At the instant when this sound took place, he was seized with a violent pain in some part of the lower extremities, generally on the inside of the thigh, a little above the knee. This was accompanied by a convulsive start of the limb, and the pain for the time was so acute, that he generally at the instant of the seizure, grasped the part with both his hands by a kind of involuntary or convulsive effort. The whole was the work of a moment, and passed off as suddenly, leaving only a kind of soreness

about the knee, which was relieved by friction. These paroxysms occurred many times in the day, and, in the night he had frequent starting of his limbs. His digestion was bad; the bowels were confined, and the motions were dark and unhealthy. At one time during the continuance of the complaint, his limbs became considerably weakened, so as to assume the appearance of a slight degree of paraplegia ; but nothing could be discovered about the spine, and the limbs after sometime recovered their strength. The affection has continued to recur from time to time, though it is very much diminished, both in frequency and in violence. The only treatment that appeared to have any influence over it was regular moderate purging, alternated with opiates.

The imperfect outline which has now been given of affections of the stomach, will serve to show the extent and importance of the subject, and the necessity which there is for constantly attempting a more correct diagnosis of this class of diseases. Some of them appear to be merely functional, or what may properly be called dyspeptic; while others are connected with most important and defined diseases of the mucous membrane, or the other coats of the stomach; and it appears that many of these cases, though of a very formidable nature, may be treated with success, if their characters are ascertained, and the necessary means adopted, at an early period of the disease. Other cases will be afterwards mentioned, which are connected with corresponding diseases of the mucous membrane of the bowels, or with affections of the neighbouring organs. It appears to me that some late writers have confounded a variety of these diseases under the vague and undefined use of the term dyspepsia, supposed to exist in different forms and differ

ent degrees; and, in this manner, have introduced much ambiguity into the inquiry. Thus, when we find these writers talking of a stage of dyspepsia in which it terminates by ulceration, or various organic affections of the parts concerned, I cannot avoid considering them as using a phraseology which is at variance with the principles of sound investigation, and calculated to obscure a subject of the utmost practical importance.

APPENDIX

TO THE

PATHOLOGY OF THE STOMACH.

In this appendix I mean to introduce a few observations on the following subjects, closely allied to the pathology of the stomach, though not connected with disease of that organ itself.

1. Derangement of the functions of the stomach by tumours attached to it externally, without disease of its

coats.

2. Outline of the pathology of the œsophagus. 3. Outline of the pathology of the duodenum.

SECTION I.

DERANGEMENT OF THE FUNCTIONS OF THE STOMACH BY TUMOURS ATTACHED TO IT EXTERNALLY, WITHOUT DISEASES OF ITS COATS.

Or the singular phenomena connected with some of the affections of this class, I shall only give the following example:

CASE XXIII.-A lady, aged about 70, had been affected for more than thirty years with periodical vomiting, which occurred so regularly a few hours after meals, that during the whole of this period she had vomited a part of almost every meal. It was brought up without nausea, or any unpleasant effort, and the affection had never injured her general health. I was in the habit of seeing her for several years, during which time she continued to enjoy good health, till she began to fall off rather suddenly, and died after a short illness with diarrhoea and rapid failure of strength.

Inspection. The only morbid appearance that could be discovered, was a tumour the size of a hazel nut or a very small walnut, and resembling an enlarged gland. It lay in contact with the outside of the stomach, near the pylorus, and slightly attached to its outer coat, but without any appearance of disease in the stomach itself.

In a similar case by Morgagni, in which the symptoms, had gone on for 24 years, the only morbid appearance was a slight induration of the pancreas. I have seen one case which was fatal in about a year, with constant vomiting, in which the only morbid appearance was a scirrhous hardness of the pancreas, without enlargement; and I have seen several in which the pancreas was enlarged and diseased in various ways. Similar symptoms may also arise from diseases of the other neighbouring parts, as the liver, the spleen, and the omentum. Many years ago, I examined the body of a woman who died gradually exhausted by daily vomiting, which had continued more than a year, and I could discover no morbid appearance except the gall bladder distended by a large number of biliary calculi, which completely filled it. In the Philadelphia Journal of Medical Science, a case is mentioned in which symptoms