Attacks of palpitation form a prominent symptom with some; the pulse is irregular and intermitting, there is much distress, and the patient believes that death is staring him in the face; and yet all these symptoms may vanish as soon as the bowels are relieved by a purgative.

At other times spasmodic affections of the gullet occur; the food is swallowed with the greatest care, and the practitioner is led to suspect some organic disease of the oesophagus; or the patient starts from his sleep with a sense of strangulation; there is a distinct crowing sound, like the false croup of infants, and the symptoms are only relieved by the evacuation of flatus from the stomach.

Of course, in no single case are all the above symptoms manifested. These differ according to the organ more particularly affected, the natural constitution of the patient, and the exciting causes of the malady. The gravity of the complaint is also regarded in various lights by different observers. Those who only estimate the severity of a malady by the amount of structural disease they can discover in the patient, are apt to regard the highly-coloured descriptions of a person affected in this way as mere exaggerations; whilst those who believe, as I do, that functional disorders of the nervous centres may lay the foundation of physical changes, will regard the increased sensibility as possibly indicating a serious and important disease. My own observation leads me to conclude that the condition of the nervous system here described is sometimes the forerunner of structural changes in the nervous centres, or of fatty degeneration of some vital organ.

CAUSES OF NERVOUS DYSPEPSIA.

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As "nervous dyspepsia" is really a disordered condition of the nervous system, we find that its causes can generally be shown to be some circumstances tending to affect this part of the body.

The chief and most important of these is longcontinued mental anxiety. Even amongst the poorer classes this has a vast influence in the production of indigestion; for we find that whilst 38 per cent. of those liable to dyspepsia had been subjected to excessive care, only 16 per cent. of those who were free from this disorder had endured much anxiety. Its ill-effects tell more severely on the female than on the other sex, and they are more injurious to persons of middle age than at an earlier or later period of life.1

The tendency of mental anxiety is to produce feeble digestion rather than gastritis; and this is more particularly the case with females and with those who are otherwise predisposed to this form of dyspepsia.

It is in the middle classes of society that we generally meet with the most severe examples of nervous dyspepsia." The student taxing his brain beyond its powers; the man of business exposed to the vicissitudes of fortune incidental to mercantile life; or that numerous class who are always struggling to maintain a position in society with insufficient means at their disposal-such are the classes of persons whose nervous system most frequently breaks down under the mental strain to which they are subjected.

1 Note C, Appendix.

In the treatment of this disorder the great point is to recruit the powers of the nervous system, and for this purpose a full measure of sleep is necessary. It will be found that in the majority of cases there is either sleeplessness, or the rest is broken and unrefreshing. In some it is a good plan for the patient to secure a short sleep in the afternoon, provided this can be done, without preventing rest at night.

Wakefulness is often the result of exhaustion, and it is then advisable to give some easily-digested nourishment before the patient retires to rest. Sometimes he awakes about two or three o'clock in the morning, and is unable to sleep again; and in such cases the best effects are produced by the simple expedient of having food ready by the bedside.

But in others, the sleeplessness seems to be connected with an excited condition of the brain, and it is necessary to have recourse to sedatives. Small doses of morphia answer this purpose, but if it affects the digestion or produces headache, hyoscyamus, conium, or hop may be substituted. Sometimes a combination of bromide of potassium with the tincture of Indian hemp and chloric ether is very serviceable. Very frequently, the compound tincture of camphor appears to soothe more completely than stronger sedatives.

In the slighter cases, relaxation from business is alone requisite; but in the more severe forms of the disease, mental exertion must be completely suspended. This is usually the one prescription which it is most difficult to induce the patient to employ, but it is absolutely necessary that it should be

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strictly carried out, if he wishes to regain his health. At the same time, nothing is more absurd than to condemn a person of active habits to a state of listless indolence, and it is of little use only to order what is called change of air.

Travelling seems to combine what is required for a patient in this condition. He is removed from the routine of his accustomed employments, his mind is pleasantly excited by the new objects presented to his view, and he obtains all the advantages connected with complete change of air and diet. But where, as is often the case, the disease has arisen from some severe and long-continued sorrow, this means will be found ineffectual, unless the attention be diverted from the subject on which it has been accustomed to brood, by providing an occupation which will interest the mind, at the same time that it involves no strain on the intellectual faculties.

Mental relaxation is necessary for all suffering from this disease, but as regards medical and dietetic treatment, we may recognise two distinct forms of the complaint; one in which the abnormal condition of the nervous system is associated with congestion of the liver and chronic gastritis; the other and more common case, in which the dyspepsia arises from a feeble state of the stomach.

When chronic gastritis is present, the patient has a foul tongue, defective appetite, thirst, heat of the skin at nights, confined bowels, and urine loaded with lithates. In this state it is advisable to keep him in the house for a few days, and apply fomentations or mustard poultices to the epigastrium. The diet should consist either of farinaceous food or beef-tea,

given frequently and in small quantities. If not contra-indicated by other circumstances, a few grains of blue pill, followed by a small dose of castor oil, may be administered once or twice a week, and a sedative mixture should also be prescribed. When acidity forms the prominent symptom, alkalies or bismuth may be resorted to.

Very careful treatment is required where the disease of the digestive organs seems to be solely connected with increased sensitiveness of the mucous membrane. Purgatives should be used with caution, as they tend to increase the irritation. I have seen much exhaustion of both body and mind produced by a small dose of castor oil; and in one case the patient was so affected by the irritation induced by a few grains of aloes that he left his house and wandered about the streets on a winter's night, in the hope of overcoming his excitement by fatigue. When an aperient is required, an electuary of senna or sulphur will be found useful, and as the patient's strength improves, a pill of rhubarb, galbanum pill, and hyoscyamus, or an electuary of sulphur and guaiacum, may be substituted. In other cases, it is better to trust entirely to enemata to relieve the bowels. When there is a tumour in the colon, stimulating frictions are of value.

Tonics, sooner or later, constitute the chief part of the treatment, and the selection of what drug we should use must depend upon the particular features of the case.

When the affection of the digestive organs forms the most prominent symptoms, we may have recourse to bismuth, silver, or iron.