22 



ft- stance which must materially influence our treatment, 

 and still more our prognosis ; for while we may hope 

 to relieve the most obstinate dyspeptic symptoms, as 

 long as the structure of the part is unimpaired, so our 

 prospect of success must always be very small on the 

 contrary supposition. In this latter case, the disease 

 is to be regarded as entirely symptomatic, and, until 

 the primary affection be removed, not only would most 

 of the remedies that are proper for Dyspepsia be useless, 

 but probably even injurious. When we have reason to 

 suppose that the affection of the stomacli is altogether 

 independent of the structural disease, our first object 

 is to inquire into the habits and modes of life of the pa- 

 tient, and especially into the nature of the diet; and, 

 for the most part, we shall find that, by a proper regu- 

 lation of these points, the most urgent symptoms may 

 be relieved even more effectually than by the exhibi- 

 tion of the most powerful medicines. Yet painful and 

 distressing as the complaint is, so much so as to destroy 

 all the comforts of life, and even to render existence it- 

 sett a burden, so inveterate are the habits of self-indul- 

 gence, and so unable is the patient to resist the calls of 

 a pampered appetite, craving for its accustomed grati- 

 fications, that we too frequently find all our admoni- 

 tions to be in vain, and our advice to be totally ne- 

 glected. With respect to other remedies, the numbers 

 that have been employed, and the various forms in 

 which they have been administered, to accomodate the 

 taste or the caprice of the patient, are almost infinite ; 

 but we may arrange them under the three heads of 

 evacuants, stomachics, and tonics. It generally hap. 

 pens that the intestines are either torpid or in an un. 

 natural state, and there is perhaps no instance of Dys- 

 pepsia, of all the numbers that fall under our care, in 

 which we shall not find it highly beneficial to com- 

 mence with active purgatives. They will be frequent- 

 ly found to supersede the whole tribe of carminatives, 

 antispasmodics, and antacids, which have been so li- 

 berally prescribed in this complaint, and will lay the 

 best foundation for the subsequent use of stomachics 

 and tonics. It would not be consistent with the na- 

 ture of this treatise to enter into any account of the 

 particular medicines or combinations of them, which 

 may be adapted to the various symptoms or conditions 

 of the disease, but we generally think it desirable to em- 

 ploy them in a simple form and in small doses, and 

 rather to rely upon a change in the external circum- 

 stances, which may be conceived likely to promote the 

 general health, than upon the administration of any 

 particular article of the materia medica. Country air 

 and exercise, temperance in diet, avoiding the oppres- 

 sive cares of business ; and, we may add, as what is 

 scarcely less necessary, the unreasonable pursuits of 

 pleasure, are the grand remedies for Dyspepsia; and 

 we conceive that no one who has given them a full 

 trial, and has experienced the relief which is obtained 

 from them, will be disposed to relapse into those luxu- 

 rious habits, from which it is so difficult, in the first 

 instance, to wean the patient. 



Among the remedies which are of the most decided 

 benefit in Dyspepsia, next to purgatives, and after they 

 have performed their full effect, we may place the tribe 

 of stomachics, consisting of the simple bitters, of which 

 perhaps the most efficient are gentian and quassia and 

 of those substances which seem to consist essentially of 

 a bitter and an aromatic, of which we should select ca- 

 lomba and cusparia, as the most generally useful. Of 

 the tonics, perhaps the most powerful in strengthening 

 the digestive powers, is the union of one of the stoma- 



7 



MEDICINE. 



chics with iron : for simple pain of the stomach, the Practice. 

 oxide of bismuth has been recommended upon high au- T"'"'' 

 thority ; but we apprehend that the complaint in 

 which this medicine has been found so efficacious, is 

 rather to be considered as a species of Autalgia, than 

 the pain which is symptomatic of Dyspepsia. A very 

 valuable medicine, and one which is applicable to every 

 form of the disease, is the carbonate of potash ; it ap- 

 pears not only to neutralize any acid which may exist 

 in the stomach, but so to regulate the process of diges- 

 tion as to prevent its formation ; and it has been found, 

 that it may be taken for months or years if necessary, 

 without producing any kind of injurious effect. An 

 irregular state of the alimentary canal is almost a con- 

 stant attendant upon Dyspepsia, and although it general- 

 ly produces constipation, it occasionally manifests itself 

 <n the opposite state of diarrhoea. Except in very pro- 

 tracted cases, or where there is reason to suspect some 

 structural derangement, this symptom generally yields 

 to a cautious exhibition of purgatives, together with a 

 due attention to the state of the diet ; and without any 

 specific treatment the bowels acquire their proper tone, 

 as the system returns to its healthy state. Astringents 

 we conceive to be seldom necessary, and for the most 

 part injurious; diaphoretics, particularly opium com- 

 bined with ipecacuanha, are frequently found benefi- 

 cial, and this may be regarded as the best form of giv. 

 ing opium, where pain or any other symptom indicates 

 its employment ; it must always be preceded or accom- 

 panied by mild purgatives. 



SECT. II. Diabetes. 



Next to Dyspepsia we have placed Pyrosis and Pica Pyrosis and 

 in our list of diseases, which depend upon a defect of Pica - 

 the digestive organs ; the former of them consisting in 

 the eructation of a watery fluid from the stomach, at- 

 tended with pain, heart-burn, and flatulence ; the latter 

 in a species of perverted appetite, by which the patient 

 is seized with an almost unconquerable desire of eating 

 indigestible substances, that are not properly articles of 

 food. Although these are usually considered by sys- 

 tematic nosologists to be distinct diseases, and occa- 

 sionally occur almost unconnected with any other 

 symptoms, yet we are induced to regard them as mere 

 modifications of Dyspepsia; and, with respect to their 

 treatment, we have little to offer in the way of general 

 principles that has not been stated in the preceding 

 section. We shall merely remark that Pyrosis is gene- 

 rally supposed to originate from the habitual use of 

 an indigestible diet, which must of course be attended 

 to in the cure, and that Pica is commonly found to be 

 connected with a torpid state of the uterine system, as 

 well as of the digestive organs. 



The next disease which we have placed in this divi- Diabetes, 

 sion is Diabetes, an affection of a very peculiar nature, 

 and which, both with respect to its origin, its proxi- 

 mate cause, and its treatment, has given rise to much 

 controversy. Its most remarkable symptoms are a 

 great increase in the quantity of urine, a voracious 

 appetite, a stoppage of the cutaneous perspiration, 

 thirst, emaciation, and great muscular debility. The 

 urine is not only prodigiously increased in its quantity, 

 but likewise has its composition completly changed; 

 the substance named urea, which it contains in the 

 healthy state, is entirely removed, or exists in very 

 small proportion, while in its stead we find a large 

 quantity of a body possessing the physical and chemi- 



