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as in animals chewing the cud. Sometimes, however, it is the reverse, and the patient suffers very violent pain at the stomach, which is only relieved upon her bringing up in the same manner a pint or more of limpid and perhaps tasteless fluid; this may happen three or four times in the day. By an observation of Andral's, the complaint appears to arise from a low degree of inflammation of the glands of the stomach, which become slightly swollen, and pour out a more or less altered mucus, which is the waterbrash. It is a sort of relaxed inflammation, and accordingly is cured by astringents. The following formulæ are appropriate: ten grains of kino, with a third of a grain of opium, taken in water three times a day; or three grains of alum and five of kino so taken; if the fluid thrown up is acid, an alkali should be combined with the astringent.

Pain of the Stomach.-One kind of pain of the stomach has been already described. When undigested food is retained in the stomach, it is liable to cause settled pain and uneasiness,-a symptom so far useful, that it leads to the expulsion of the offending substance. The stomach sometimes marks in this manner that a particular kind of food is temporarily unacceptable to it. A gentleman, who is in the general habit of drinking porter at his dinner, for some days before a severe and alarming attack of vertigo from indigestion, expe

rienced a dull ache in the stomach after drinking porter, which would last for an hour, and subside very slowly; he had every reason to believe that the attack of illness which followed, arose from pressing this then unwholesome liquid upon the reluctant stomach. One sort of stomach-ache thus arises from the presence, in a healthy stomach, of less digestible food.

Another kind of pain of the stomach results from habitual indigestion, and supervenes from one hour to five or six after a meal. The meal is eaten with more or less appetite: after a period, the solvent secretion not being poured out in sufficient quantity, pain more or less severe supervenes; this is accompanied with, and partly caused by distension from flatulence, sometimes by heartburn; sometimes it depends upon the mere presence of the unchanged food, and there is little distension and no acidity. This occurrence is well exemplified in a case above narrated, page 33; I have met with it in several other instances in the same degree of aggravation. At the worst, the patient has no repose or cessation of pain till he has mechanically excited vomiting and thrown the food off his stomach, which often is returned unchanged, although eight or nine hours have elapsed since the meal. In lighter seizures, after two or three hours of suffering, the stomach beats the meal; the pain wears off, enough gastric juice

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having gradually been poured out to dissolve the food.

The treatment of such a case must vary with its features. If there is tenderness of the epigastrum, leeches, and hot fomentations should be applied ; and if the patient has not an irritable skin, a blister afterwards, over the stomach. By these means, what inflammatory character the indisposition may bear admits of being removed. The same object is promoted by the use of aperient medicine, and by regulating the diet to that which is plain in kind, and extremely moderate in quantity; above all things, if the patient has at all studied his own case, by attending to the suggestions of his appetite. If there is acidity present, as a temporary expedient, an alkaline draught gives great relief; and the best form is the effervescent one, a draught, for instance, consisting of thirty grains of carbonate of potass in a wine-glass of spring water, with twenty grains of tartaric acid stirred into it. Liquids containing carbonic acid are very salutary to the stomach; whether they act on any chemical principle is not known. There is generally some flatulent distension along with the state of indigestion which I am now describing; the effervescent saline, instead of leaving the stomach loaded with more wind, promotes its immediate expulsion. One of the principal means, however, for allaying this painful indigestion, con

sists in lowering the sensibility of the stomach by opium. This, in general, should be combined with a purgative;—the dose may consist of half a grain opium, three of compound extract of colocynth, one of soap; this pill to be taken two or three hours after the meal, the digestion of which is most painful. The aperient is given to obviate the constipating effect of the opium. Opium, however, requires to be used with caution in such cases, lest it disguise some progressive mischief of an inflammatory or ulcerative character in the organ. Opium may be given during the paroxysm of indigestive pain; Batley's liquor opii sedativus is then probably the best form; ten to fifteen drops may be administered in an effervescing saline. Opium applied externally is sometimes beneficial, either in the form of the emplastrum opii, or upon hot flannel smeared with equal parts of laudanum and camphor liniment.

Sometimes the stomach has a morbid sensibility which causes pain the moment anything is introduced into it, the pain continuing till digestion is completed. This form of disorder generally appears not to depend upon inflammatory action, or, at all events, it does not yield to the means which should be efficient against inflammation; so leeches and blisters, and aperient medicine, are commonly of no avail. The remedies which are to be tried,

and which are sometimes efficient, must be viewed as purely empirical; not that they are to be undervalued on that account, but rather the more studied, as calculated by their operation to throw light upon the nature of the disorder which they relieve.

The remedies which are likely to be beneficial, are the oxide of bismuth, given in a pill ;to begin with, two grains of oxide of bismuth combined with two grains of extract of chamomile or kreosote, given one drop as a dose in an ounce and a-half of water three times a-day. Or prussic acid, a drop of which to two drops in a wine-glass of water, has again allayed morbid sensibility of the stomach.

A symptom the opposite of the last, is pain when the stomach is empty, often attended with craving for food, and relieved by taking it; so three hours after breakfast, as soon as the stomach has got rid of its contents, pain will supervene, that is not relieved till another meal. A patient with a pulsating tumour in the belly, and suffering habitually from indigestion and pain of the present description, was used to relieve that pain, by having recourse to another meal as soon as it recurred; taking thus between eleven and twelve bread and cheese and ale, as a corrector of the craving pain following the complete digestion of his breakfast. His tongue

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