was furred, his complexion loaded, the action of the bowels irregular. By reducing his diet, and prescribing the regular use of aperient medicine, his health greatly improved: at the same time, the early luncheon was forbidden, and a draught of half a drachm of tincture of henbane, seven grains of soda, and ten drops of sal-volatile, in water, taken on the recurrence of the pain of the stomach, was sufficient to remove it.

The same remedies which I have enumerated for the preceding case, have equally been tried in this, but with uncertain success. Another, that has been of use, is the nitrate of silver, beginning with a grain at a dose in a pill made with crumb of bread.

There are attacks of pain in the stomach, which are commonly described as spasms. They come on suddenly, are of the most acute description, and seldom last long; they are described as suggesting the idea of a knife stuck through the side. Women are more subject to these seizures than men. I suppose that they entirely result from distension with wind; they are allayed at once, by taking a wine-glassful either of very hot water alone, or hot water with twenty drops of sal-volatile, or with a dessert-spoonful of brandy in it; at the same time, and in which the relief seems to consist, wind breaks off the stomach. Sometimes a few drops of laudanum in hot water

form the best remedy for these seizures; but it is better to try other remedies first*.

Generally speaking, pain in the stomach rarely denotes serious disease: it is the result commonly of slight and functional disturbance, and is a matter rather of present suffering, than of apprehension as to the result. Nevertheless, this remark does not hold true always. Obstinate cases

* The principal objection to laudanum is the danger of indulging the habit of taking it, which is the greater for the false supposition that the dose must be progressively increased. This, indeed, is the case, if the remedy is daily and hourly resorted to, but not otherwise. I have under my care a patient with disease of the womb, whom I have been obliged to allow to raise her daily dose of crude opium to seventy grains; the continual increase has been unavoidable, as the remedy is used for constant pain. It is surprising (I may observe incidentally) how little her mind and health are impaired. She says that her memory is not so perfect as it was; but she experiences no confusion of head, nor any form of mental disturbance. When the use of opium is not continual, the same dose, as with aperient medicine, serves a life-time. I am acquainted with a gentleman, who, several years ago, received a charge of shot in the calf of his leg; some of the shot have lodged in the tibial nerve, and he experiences constant pain in the foot, only varying in amount. To overcome this at one time it may be interesting to mention that he used to take 700 drops of laudanum daily: however, even this dose of laudanum was ineffectual, and he discontinued it, leaving it off by degrees. This gentleman is now, from time to time, subject to spasmodic pain at the stomach, after he has taken anything to disorder his digestion. He tells me that he then has recourse to laudanum, and finds the small dose of seven or eight drops always enough to pacify the nerves of that organ.

of pain at the stomach with flatulence, recurring irregularly, lasting several days or weeks, and gradually going away, then renewed, again going away and returning, are sometimes dependent upon ulceration of the lining membrane of the stomach. This complaint is of a serious nature; for although it is often recovered from, yet a certain proportion of those attacked with it, after weeks, or months, or years of capricious indigestion, die suddenly, through perforation of the stomach, and the escape of its contents into the cavity of the belly.

Pain of the stomach frequently recurring, although commonly dependent on trivial causes, should, therefore, always be looked at with suspicion, and all the points connected with it most carefully considered. The accompanying symptom, which gives it the most alarming complexion, is tenderness on pressure, not general soreness of the whole stomach (for whenever the stomach is distended, it is uneasy on pressure), but tenderness always to be found about one spot. When with this there is disinclination to food, the tongue disposed to dryness, occasional nausea and vomiting, one would entertain serious apprehensions of chronic inflammation, thickening, ulceration. In such a case, the greatest abstinence, leeches to the pit of the stomach, blisters, a superficial issue, the milder preparations of mercury, are the appropriate remedies.

D 3

III. Nausea and Sickness.-There are few subjects in pathology which have more extensive relations than the present. The stomach is the centre of sympathies: no organ can be suddenly deranged, but the stomach is drawn into consentaneous disorder, and vomiting is the readiest form of disturbed action into which it falls.

To take an extreme instance: in a case, in which I performed amputation at the hip-joint (the patient happily did well), for a few hours the utmost prostration existed, the patient hardly was heard to breathe, the pulse was quick and tremulous, no water was secreted, she vomited repeatedly. In injury of the head, or sudden effusion in the brain, vomiting is an almost constant attendant,-upon sudden and violent mental exertion, vomiting occasionally takes place, the same is produced by violent bodily exertion on a full stomach. If any inward action is going wrong, if a gall-stone is passing through the gall-duct, a calculus descending from the kidney,-vomiting appears to follow as a natural consequence.

The mechanism of vomiting is very simple, and the reverse of what it is popularly supposed to be. In vomiting, the stomach is perfectly passive. It does not act in expelling its contents. It is a flaccid bag, squeezed by external pressure. The muscles of the belly and the diaphragm suddenly and convulsively compress and empty it. This convulsive

The

action depends on the sensation of nausea. phenomena are paralleled by those of sneezing; if you look at the sun, or take a pinch of snuff being unaccustomed to it, a sensation is excited, which is relieved by an uncontrollable convulsed expiration. Nausea is the analogous sensation, which is relieved by retching.

The two forms of nausea and vomiting that are most familiar, are those attending early pregnancy and sea-sickness.

The vomiting of pregnancy is very variable. Generally it is first experienced shortly after conception, and terminates with quickening. Sometimes it is hardly experienced at all, in other cases, it lasts during the whole of pregnancy. Sometimes it gives little distress, in other cases it has been so constant as to compel the induction of premature labour to save the patient.

The vomiting of pregnancy seems, to a certain extent, dependent upon change of posture; the nausea and retching are commonly experienced on rising; the vomiting, however, frequently recurs after breakfast; the sufferer then lies down, becomes tranquil, and afterwards, as the day goes on, her stomach usually recovers its tone. The vomiting sometimes returns at other periods of the day. Preserving the recumbent posture always mitigates the disposition to vomit. The cause, however, of this sickness is in a small part only mechanical.