INDIGESTION AND NERVOUS DEPRESSION. 383 



through the heart, which is excited to increased contraction, and thus 

 the tension within the vessels is raised. In the case of the cold, the 

 pressure is also raised, not by stimulation of the heart, but by the con- 

 traction of the vessels, especially those of the stomach and intestine. 

 In the case of warmth, more blood is poured into the aorta by the ex- 

 cited heart, and where we apply cold less blood flows out of the aorta 

 into the veins through the intestinal vessels, and thus it is that in both 

 cases the tension is raised and the faintness removed. 



At each meal it is well for the patient to begin with the solids be- 

 fore he proceeds to the fluids, and at breakfast, instead of beginning 

 the meal with a cup of tea or coffee, he should finish a slice of dry 

 toast and a piece of fish, e^^, or bacon, before he takes any liquid at 

 all. The same rule should be observed at lunch and dinner. The 

 effect of this course is that the patient is less troubled with weight 

 and flatulence after meals. The explanation of the fact probably is 

 that the solids, entering the stomach first, stimulate it to secretion 

 and movement ; whereas, if it already contained a quantity of liquid 

 at the time they were ingested, they would not have this effect, and 

 imperfect digestion would be the result. At dinner, wine or beer 

 may be taken if the patient finds them agree, but in all probability 

 he will be better without them. There are some brain-workers who 

 require them and must have them, but it is better for a good many 

 others to avoid either wine or beer, and to take some effervescing 

 water instead. Not unfrequently we hear the complaint that effer- 

 vescing water is too cold, and where this is felt to be the case gin- 

 ger ale or zoedone may be substituted, the color of these beverages 

 and their more pungent taste rendering them more grateful both to 

 the eye and the palate of many persons. In some cases weak claret- 

 and-water may be used, and if the water be somewhat warm the 

 mixture will be better for the patients, and will not cause the feel- 

 ing of coldness in the stomach of which they sometimes complain. 



A medicine which has long enjoyed a great reputation in disorder 

 of the liver is nitro-muriatic acid, and I think this reputation well de- 

 served. We do not know how it acts, but in some way or another it 

 does tend to improve the digestion. Ten minims of the dilute nitro- 

 hydrochloric acid, either before or immediately after meals, combined 

 with some aromatic and carminative, such as chloroform and car- 

 damoms or orange, and from five to ten minims of tincture of nux 

 vomica, where the nervous depression is great, is a most efficient 

 remedy. 



But, even with all this care in food and drink, with all this atten- 

 tion to what is to be taken and what avoided, with medicine morning, 

 noon, and night, how are we to keep the liver in order without exer- 

 cise ? Sometimes the patient may be able to take walking exercise, 

 but when he does it is generally only for a short time during the day, 

 and of so gentle a character that the respiratory movements are but 



