absorption; I have found them decidedly serviceable when aromatics had failed. They are best adapted to those cases where a continuance of the disease has produced much debility, and con sequent languid circulation, without much tenderness of the epigastrium, or hard pulse, or any sensation of burning in the hands or feet at night." 180. External heat to the region of the stomach, and frequently renewed, is often of more service in relieving gastrodynia than internal heat. Warm water internally, however, is no bad remedy, when not abused by too frequent repetition. Very small proportions of opium, as two or three minims of the tincture, two or three times a days, "often prove highly serviceable in allaying morbid irritation," their constipating effects being easily counteracted. We have found pills composed of two grains of extract. col. comp. one grain of pil. hyd. one grain of Cayenne pepper, or some oil of cassia, with a quarter of a grain of opium, taken twice a day, or two or three of them at bed-time, prove exceedingly useful in the class of complaints now under consideration. Dr. Philip prefers the pulvis ipecacuan. comp. from two to four grains given every six or eight hours, discontinued and renewed from time to time. For what are termed, and perhaps not improperly, nervous symptoms, castor, myrrh, valerian, and assafoetida, afford temporary relief-especially to that palpitation which results from indigestion, provided no inflammatory disposition has supervened. But for the prevention of a recurrence of indigestion, "bitters and astringents are those on which we chiefly rely," their effects being increased by combining them with a small quantity of the stimulant before alluded to. Of the bitters, chamomile, orange peel, and wormwood, appear to be most devoid of stimulating principles. Calumba possesses this quality in a greater degree than gentian and cascarilla-cinchona most of all. "All the foregoing bitters, if we except the bark, which is often oppressive to the stomach, are well suited to the first stage of indigestion; but in proportion as the second stage approaches, we find the less stimulating bitters auswer better; and in the second stage, even the gentian, which, of those that deserve the name of stimulating, possess, perhaps, the least of this property, is often too heating, and the bark in general cannot be borne, even for a few days. While in the earliest periods of the disease, when it supervenes on debilitated states of the constitution, and the stomach still retains considerable comparative vigour, a cold infusion of the bark is often the most beneficial of all bitters." 185. Of astringents, which Dr. Philip thinks, must sometimes be resorted to, at the expense of correcting their effect on the bowels, iron deserves the first place. "In chlorotic indigestion, combined with stimulants, it is the most powerful medicine we possess ;" and there are, Dr. P. thinks, "few cases of indigestion in which it is not found more or less useful at an early period." Its good effects are increased by combining it with bitters and aromatics. Next to this, Dr. Philip considers the sulphuric acid as the best stomachic astringent, especially where sweating is too easily induced by exercise. The white oxyd of bismuth has lately been much commended in gastrodynia. Sarsaparilla is much esteemed by our author, though not so much in early stages, as in protracted cases. In the early stage, and while the disease is confined to the alimentary canal, mercury he conceives to be unnecessary, if not prejudicial. Aperients, of course, hold a distinguished place in all stages of the disease. Our author has found none, employed merely for the purpose of supporting a regular action of the bowels, so generally useful as pills composed of ipecacuanha, compound extract of colocynth, and soap, taken occasionally at bed-time. The stomach and alimentary canal may also be acted on sympathetically through the medium of the skin. Tepid and cold bathing, friction, blistering the epigastric region, and covering the same with stimulating and anodyne plasters, are useful auxiliaries, in the treatment of indigestion. When the alvine discharge begins to deviate from the healthy state, the treatment becomes more complicated. The secreting power of the liver, and probably of the pancreas, participates in the derangement. We must now, therefore, combine with the foregoing remedies, such others as tend to "correct the morbid state of the liver." Mercury is our principal remedy in this case, and the great art consists in so managing its exhibition, that it shall produce as little injury as possible to the other parts of the system. In the first stage of indigestion, there is no necessity that the remedy should enter the system. Its local effects on the primæ viæ and liver are sufficient. Neither should the medicine be long continued, even in this restricted manner, without attending to the state of the alvine discharge, and ascertaining the necessity for its continuance. "In the more obstinate cases indeed where the disordered state of the liver constantly recurs at short intervals, it is better for a certain time to give a moderate dose at stated intervals, by which the alimentary canal will suffer less, as a smaller dose is required for the prevention of this state, than for its removal." 199. In this early stage of indigestion. inunction is not neces sary. Calomel and blue pill are the two forms in general use the former, most aperient, should be given when the bowels are most languid-the latter when they are more easily excited. "The blue pill is generally most oppressive to the stomach; the calomel most irritating to the bowels.” But as small doses often hang in the bowels, so they are often more irritating than larger doses, which more quickly carry thmselves off. "The irritation of the bowels is most effectually prevented by taking an opening draught some hours after the calomel." Dr. Philip has known a warm mercurial plaster worn over the region of the liver, for months and even years, with great advantage, in cases rather obstinate than severe, "the symptoms constantly recurring when it was laid aside." The mineral acids, and in some cases dandelion, Dr. P. considers the best substitutes for murcury. But they seldom maintain a due action in the liver for any length of time. Finally, Dr. P. sums up thus: "The treatment of the first stage of indigestion, then, consists in promoting the due action of the stomach and bowels, by the various means which have been detailed, and correcting the secretion of the liver, if it deviates from the healthy state, by the occasional use of mercury; care being taken neither to employ it in greater quantity, nor for a longer time, than is necessary for this purpose, as its effects on the stomach and bowels are evidently in opposition to the other parts of the treatment." 209. Treatment of the Second Stage. This stage generally does not take place till the function of the liver "has been disordered for some time, or its disordered state has repeatedly occurred." When this stage is established, "bitters and aromatics cease to give any effectual relief”—indeed, in many cases, they increase the feverish restlessness. More tonic medicines have still a worse effect. "The patient often thinks that his disease admits of no relief, but from aperients, and particularly mercurial aperients, of the good effects of which he is always sensible, and, consequently, is very apt to fall into an excessive use of them.' 211. Dr. Philip considers that we should be guarded in the use of purgatives and mercurials, since, in the second stage, the epigastric tenderness and hard pulse leave little doubt that inflammatory action, or a state approaching to it, has there supervened. "Stimulating measures are therefore to be employed with more caution, and anti-inflammatory measures become more or less necessary." The application of leeches to the tender part of the epigastrium ap peared to our author to throw light upon the nature and treatment of the second stage of indigestion. "The effects I found were not merely that the tenderness was relieved, and the pulse softened; but that the patient breathed and walked better, that the bowels were more easily moved, and the skin appeared more relaxed, the feverish tendency which frequently shows itself in the evening, being in the same degree lessened." P. 217. But this was not all. On resuming the plan of treatment it soon appeared that the patient bore the use of tonics much better than before, and in some instances, a recurrence to the plan of treatment pursued in the first stage removed the disease. But such fortunate cases were comparatively few, "and a repetition of the leeches became necessary." "Each repetition to the same extent generally produced less relief than the preceding, and if a larger quantity of blood was taken, the relief was obtained at too great an expense of strength. "The application of a blister to the part from which the blood was taken, immediately after its abstraction, I found, tended both to increase the effect of the leeches and render it more permanent; but even with this aid their repetition in the more inflammatory cases soon became necessary. In those less inflammatory, blisters sometimes relieved the symptoms without the aid of leeches, but, like the leeches, they often failed to give permanent relief." 219. The lighter bitters, as chamomile or orange peel, and even occasional aromatics, can still be borne, and a very little light animal food, as chicken once in two days, supports the strength better than a diet composed wholly of animal food. Where wine is given at all, it should be well diluted. If active inflammation be threatened, the diet must of course be reduced to its lowest ebb. "In a few, particularly when a considerable degree of hardness of pulse, notwithstanding the use of the above means, continued, I have seen a diet wholly vegetable, and even a total abstinence from wine, which is much less permanently stimulating than animal food, strikingly beneficial. It is common for the appetite to improve on lessening the quantity of animal food. This depends in part on other food affording a less proportion of nourishment, but very much, I believe, on the tendency to fever being lessened by the change." 221.. The bowels are often not only torpid under the use of animal food, "but purgatives act imperfectly, and with great irritation." Vegetable diet frequently relaxes them, without the aid of medicine. To obviate the inflammatory tendency in these cases, Dr. Philip has found nothing equal to a very dilute solution of nitrate of potash, with a little gum. The latter seems to defend the bowels from the irritation of their contents. "Eight or ten grains of the nitrate in an ounce and a half of water, with a twelfth or sixteenth part of mucilage of acacia, have been given three times a day, and repeated every hour or hour and a half, when the skin became hot generally, or the hands and feet began to burn. Two or three doses thus taken seldom fail to reduce the increased temperature, and relieve the restlessness which it occasions; and thus, simple as those means are, they often procure good nights, when the want of sleep, as frequently happens in this age of the disease, is the effect of feverishness. The draught, the sulphate of potash, and other medicines of thisual to the above nirate." 223. descrip have similar effects, but none of them appear commo to me ed 36 In addition to these means a freer use of aperients will be necessary: Acrid or drastic purgatives are manifestly improper. If the inflammatory symptoms still continue to recur, Dr. P. recommends a perpetual drain, "established in the most tender part." As greater or less disorder of the liver is "a constant attendant on the second stage, we still find mercury by far the most efficacious." 225. In the earlier periods and milder forms of the second stage, the local effects of mercury, especially of the blue pill, kept up for some time, will often be sufficient, provided the antiphlogistic measures have been duly employed. "But in many cases, and in a large proportion of those of long standing, this effect often fails." Our author's plan then was as follows: "I have generally given a grain of the blue pill, sometimes only half a grain, twice or three times in twenty-four hours, till the secretion of bile appeared to be healthy, repeating these doses when it was again disordered; and by such doses, which may appear to many little better than trifling, I have seen the bile gradually restored to a healthy state, when larger doses had been employed in vain. They not only often succeed where larger doses fail, but the change, in proportion as it takes place more slowly, seems generally to be more permanent." 228. That the above plan, which a good deal assimilates with that of Dr. Ayre, of Hull, may prove equally efficacious in the hands of others, we sincerely wish. In our own practice, which has not been very confined in these complaints, we did not trust to such cautious administrations of the remedy, and therefore we cannot offer an opinion on Dr. Philip's plan. We present it for the trial of our brethren. The doses of the medicine were so small that, to use the |