not to this stage of transition to feeble digestion, but only to the condition in which the symptoms of gastritis predominate.

Leeches and blistering to the epigastrium are seldom required in the treatment of acidity, as the free secretion of mucus tends of itself to prevent the more active forms of inflammatory action. The application of a counter-irritant like croton oil liniment, or of a stimulating plaster to the epigastrium is, however, almost always of service. In many

cases a bandage of silk or flannel to the abdomen is of great value. This is especially the case with females; and I have known dyspepsia which had resisted medical and dietetic treatment disappear after the simple expedient of maintaining an even temperature over the abdomen had been resorted to.

Purgatives are the remedies most generally employed in this form of indigestion. The choice of the particular drug must chiefly depend on whether the symptoms seem to indicate that the gastric inflammation is associated with a similar affection of the duodenum, and consequently with congestion of the liver, or with an imperfect action of the colon.

If the upper part of the intestinal canal be chiefly in fault, the purgative salts are beneficial, especially when exhibited in the form of some of the natural waters; at other times, rhubarb or senna is more efficacious. Croton oil in minute doses has been highly recommended where the duodenum is affected, but the results of my experience are not in favour of its employment. I have generally found it better to keep up a gentle and continuous action

TREATMENT OF CHRONIC GASTRITIS.

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on the intestinal canal, than to attempt to relieve the portal congestion by violent purgation.

Affections of the colon seem to give rise to gastric disorders, partly by lessening the muscular motion in the upper part of the intestinal canal, and partly by producing impurity of the blood through imperfect excretion. When the constipation arises from want of action in this part of the intestine, preparations of aloes, or repeated and small doses of castor oil, are most suitable as aperients.

Next to purgatives, alkaline remedies are most useful. When the urine is loaded with lithates and the bowels are confined, the carbonates of soda or potash should be preferred. In some cases the extrication of the carbonic acid contained in these salts gives rise to troublesome flatulence and giddiness, and under such circumstances, either the liquor potassæ may be substituted, or the discomfort arising from their use may be prevented by the addition of ammonia. Preparations of lime are valuable when there is a tendency to diarrhoea, or when the presence of mucus in the alvine evacuations shows that the lining membrane of the intestines is affected.

As the active stage of the complaint subsides, the mineral acids will be found more efficacious in removing the acidity than alkalies, and in other cases bismuth better answers this purpose.

Tonics are almost always prescribed in cases of acidity, but in the earlier stages they seem to do but little good. In the decline of the disease, bitter infusions are useful, by improving the appetite and giving tone to the mucous membrane.

L

The cases included under the third class, viz., those in which pain behind the sternum or in the epigastrium is relieved by the ejection of mucus or of a watery fluid, are often very rebellious to treatment. When the liquid is rejected during digestion and consists of mucus, the throat and pharynx, which will be generally found inflamed, should be occasionally sponged with a solution of nitrate of silver or perchloride of iron, and the mineral acids or preparations of iron should be prescribed at the same time that the bowels are carefully regulated.

In the form of waterbrash in which the pain occurs when the stomach is empty, astringents are chiefly to be relied on. Kino, alum, logwood, and bismuth may be prescribed, with or without opium ; but there is no remedy so generally successful as the nitrate or oxide of silver. One of these salts, in the form of a pill, should be taken at the time of the day at which the attack is most liable to occur. All irritating articles of diet, such as oatmeal, brown bread, &c., should be carefully avoided.

CHAPTER VI.

ON THE CONDITION OF THE STOMACH IN DISEASES OF

THE HEART.

IN diseases of the heart the morbid appearances in the gastric mucous membrane are more distinct than in any other malady. We must, however, remember that we only see these changes where the venous circulation has been retarded; for in other cases of heart disease no striking alteration can be remarked.

When we open the stomach of a person who has died of a disease of the heart, of such a nature as to prevent the free return of blood through the veins, we are at once struck with the dark and almost purple colour of its mucous membrane. This, in some cases, extends to the lower end of the oesophagus, and often affects the lining membrane of the intestinal canal. There may be frequently seen round, black patches of extravasated blood, or, in place of these, superficial ulcerations are met with in all parts of the organ, but most generally towards the pylorus.

The mucous membrane is usually covered with a layer of firmly-adherent mucus, which is generally thickest where the congestion is most intense. In some cases it is spread over the whole surface; in

others it is confined to the middle, or to the pyloric region.

There is seldom any post-mortem digestion, and when the mucus is removed, the membrane often presents a raw, uneven surface.

The whole organ has a firm, fleshy, thickened appearance; and it is, in reality, considerably increased in bulk. I carefully scraped off the mucous membrane in three males who had died of heart disease, and found the average weight amounted to 1026 grains; in three females who had perished from the same disorder, it was 800 grains. But as its average weight in fifteen males who had died of other diseases was only 864 grains, and in thirteen females it was 530 grains, it is evident that in heart disease the gastric mucous membrane is increased to about one-fifth beyond its normal bulk.

When we examine the middle and cardiac regions with the microscope, we do not find the evidences of disease so striking, as the naked eye would lead us to expect. If there has been much congestion, the

sections of the mucous membrane have a confused appearance, from the large quantity of blood and granular matters everywhere present; but after being soaked for some time in weak spirit and water, the structures become more apparent.

In one class of cases the tubes are very readily separated by pressure, can be easily torn asunder by needles, and there is only granular matters between and below them. The tubes themselves are, in almost every case, of unusually large size, and are loaded with cells and granular matters.

The blood-vessels are always enlarged and dis