and their mutual reaction has already partly taken place. I have already spoken of the necessity for and advantages of this union. It is better than cod-liver oil, because it carries the agent of its own solution along with it.

THE INDIGESTION OF WATER as a consequence of anæmia is cured by the administration of iron. Where it results from heart disease or emphysema, it indicates a mercurial purgative, and is temporarily relieved by its emptying the congested portal circulation. An observant patient of mine with emphysema tells me she finds it a good rule never to drink with her meals.

SECTION VI.

Treatment based on pathological condition.

It cannot but strike any one who reviews either the typical cases I have collated from my notes, or those (not essentially different, I am sure) which have occurred in his own practice, that a general deficiency of the vital powers is more notably exhibited in indigestion than in any other disease. And this is equally apparent in each form of indigestion from whatever cause arising. I always, therefore, look forward to giving tonics as the prime therapeutical aim in all cases. Sometimes that part of the treatment can be commenced forthwith, sometimes it will be necessary to relieve temporarily certain of the prominent symptoms first, but without tonics no cure is effected.

My favorite tonic is quinine, in two-grain doses in lemonjuice sufficient to dissolve it, and diluted with water to a convenient bulk. Its action seems to be principally on the mucous membrane of the mouth, œsophagus, and stomach, which it astringes and tones up to a healthy state, restraining the secretion of mucus, and making the special secretions more active.

To quinine I usually add from th to th of a grain of hydrochlorate of strychnia, unless there are some contra-indications to its use. It relieves flatulence, and that feeling of sinking when the stomach is empty, arising from a sluggish state of the involuntary muscular fibres; and in cases of constipation activates the expulsion of fæces. The principal contra

indication to its use is an over-sensitive state of the nervous system. I have been obliged to leave it off in several cases of hysterical women because of the neuralgia which followed it, and in two instances of men agitated by business I have had want of sleep and excitement of mind attributed with apparent justice to strychnine. In the doses quoted cramps never are produced, and the slight inconveniences I have named cease immediately the alkaloid is omitted.

In larger quantities strychnine may sometimes produce spasmodic action of the muscles. I have had this happen in hospital, when administering it for other complaints. But even then not the slightest harm accrues, if the amount is diminished. Some persons have a fear of its accumulating in the body, and the effect of successive doses being concentrated into one, which to me seems impossible in a soluble diffused salt. The fallacy has probably arisen thus-in cases of paralysis, for which strychnine was originally prescribed, the nervous system is usually so prostrate as not to respond to even considerable quantities: after a time the patient becomes more healthy and more sensitive, and then the dose of strychnine which had been given day after day without effect, acts perceptibly, and perhaps vigorously; it acts so, not because it has accumulated, but because the nerves have at last become well enough to be conscious of it. A soluble and diluted salt of strychnia seems to me one of the most manageable drugs we have in the Pharmacopoeia, because you can graduate the dose accurately to your requirements. The extract of nux vomica is dangerous, because you never know the exact strength of the preparation sold.

This treatment of indigestion does not interfere with remedies addressed to check pain, pyrosis, vomiting, or any of the other morbid phenomena, which will be discussed in future chapters. I have found it the most universally applicable, and therefore I do not mention others of less value.

CHAPTER III.

HABITS OF SOCIAL LIFE LEADING TO INDIGESTION.

SECTION 1.-Eating too little. SECTION 2.-Eating too much. SECTION 3.-Sedentary habits. SECTION 4.-Tight lacing. SECTION 5.-Sexual excesses. SECTION 6.-Compression of the epigastrium by shoemakers. SECTION 7.-Solitude. SECTION 8.- Intellectual exertion. SECTION 9.-Want of Employment. SECTION 10.- Abuse of purgatives. SECTION 11.-Abuse of alcohol. SECTION 12.-Tobacco. SECTION 13.-Tea. SECTION 14.-Opium.

In the cases cited in the last chapter the causes of the indigestion were, as a rule, out of the power of the patient to modify. Nobody for their own pleasure falls into poverty, catches cholera, is ruined in trade, lives upon potatoes, is worried by clients, nurses the dying, &c.; or at all events they do it with the hope of reward here or hereafter, and it is useless telling them not. The complaint cannot be cured by removing the cause: either it is past and gone; or it is as incapable of being removed, as much out of our control, as the changeable weather which in some cases brought on the complaint.

In this chapter I purpose discussing some of the habits of social life which are in a great measure voluntary, which do not promise any sufficient reward, which are persisted in by reasonable persons principally from ignorance, and which therefore we can require our patients to give up, as the principal step towards their cure. "Sublatá causa tollitur effectus" is a very practical motto when the cause is not too heavy for us to lift.

SECTION I.

Eating too little.

Too little to eat is a cause of dyspepsia familiar to medical men who have practised, and few of us have not so practised, among the lower classes. Eating too little is not exactly a synonym, for it is found, and by no means rarely, among those with whom it is not involuntary.

CASE L.-Miss H. W—, January 28, 1860. The patient is a very thin, nervous-faced girl of twenty-three, who complains of a weight at the pit of the stomach, brought on by swallowing any solid. This first began eighteen months ago at a catamenial period, and she immediately persuaded the family doctor to interdict all solid food, and she has taken none ever since. She has lost 21 lb. in weight, though never stout previously, and has become dreadfully flatulent and hysterical. The heart has become weak and irregular in strength, and sometimes intermittent.

She was a long time in recovering even under an improved dietary, so that I find noted in April, 1861, that though her muscles had become firm and the general health good, yet there was still some pain at the epigastrium after dinner, which I attributed to tight-lacing.

Let it not be supposed that such a mistaken view of what conduces to health is confined to the female sex or to youthful ignorance.

CASE LI.-The Rev. J. S-, aged 48, in February, 1866, tells me that when reading hard for his degree at the University he first became sensible of pain after eating. His theory was that he ought to eat less; and so he did, less and less; and, with the hope of working a cure all at once, actually lived a whole year on bread and water only. In consequence he is troubled with flatulence, debility, and frequent attacks of palpitation of the heart. The pulse is uneven, and occasionally intermits. As far as I can ascertain by questioning, he feels more pain now after eating than he used to when he began this ascetic life nearly a quarter of a century ago.

A generous animalised diet, taken frequently, with wine, quinine, and strychnine, while at the same time the oversensitive nerves were deadened by opium and hydrocyanic acid, enabled me to allow him to

return home in ten days; but it is of course not likely that he will ever be the man he would have been naturally under a rational dietary.

On July 17th he tells me he is able to eat more and more without pain week by week. His pulse is regular, and he has no flatulence. He has left off all medicine except a quarter of a grain of opium every night. He is more robust than ever I expected to see him.

I used the word "ascetic" in the last observation. Perhaps it was hardly right to do so; for though in familiar conversation applied to abstinence from pleasure with whatever intention, such is not its proper meaning, and it ought strictly to be confined to those self-restraints where the motive is nobler than the mere bodily health, where the abstinence is an active devotional exercise, a mode of honouring God.

Where this form of devotion is part of the established worship of any religious community, it is usually made the subject of minute regulations, designed with a view of securing practical results without injury to sanitary condition. The principles of these regulations seem to be that it should not be excessive, and above all not continuous. Moreover, the spiritual patient is never to prescribe for himself.

In the Church of England abstinence certainly does not constitute any portion of the regular religious services demanded of its members. Truly in the homily "On Fasting" a low diet on certain days is urged; but the preacher destroys the force of his advice by inserting the weakening argument that its general adoption would be a great encouragement to our fisheries. The method of asceticism being thus left to individual management, its intention is often mistaken, and its practice abused. Instead of looking upon it as an exercise, as a sacrificial service, in its essence intermittent, occasional, and departing from its essence if not intermittent and occasional, they treat it as a means of destroying the instinctive desires.

CASE LII. This last winter an Anglican rector, aged 32, consulted me on account of increasing inability to perform the duties of his ministry. Fits of mental depression more and more frequently came over him, accompanied by a feeling of loss of volition over the limbs.