PATHOLOGY. 
haps the beft in indigeftion, and has this advantage over 
the other forts, that it operates more diltinftly on ano¬ 
ther part affefted in dyfpepfia, viz. the (kin. It is pecu¬ 
liarly ferviceable in thofe cafes, u here fweating, which is 
not unufual, is tooealily induced by exercife ; for much 
tendency to fweating indicates relaxation, not vigour of 
the Ikin. 
There are few cafes of indigeftion in which iron is not 
found more or lefs ufeful at an early period, if no ten¬ 
dency to the fecond ftage of the difeafe has fliown itfelf. 
Its goodeffefts are increafed by combining it with bitters 
and aromatics ; and, in idiopathic indigeftion, the carbo¬ 
nate has appeared to us its beft preparation, provided it 
can be taken fcruple-dofes, without producing a feeling of 
heat and oppreflion in the ftomach. In the opinion of 
many, the fulphate of zinc given in very fmall dofes, alfo 
holds a diftinguifhed place among thefe medicines. It 
may be given at later periods than iron, but it requires 
caution; and, if its good effefts do not foon appear, 
fhould be laid afide. It is one of thofe powerful agents, 
which mult always be employed with fome degree of fuf- 
picion. 
The medicines we have fpoken of hitherto feem prin¬ 
cipally to exert their influence on the contraftility of 
the mufcular fibre, or the capillary veflels. But, as we 
have before feen that, however various may be the caufes 
which aft on the mufcular fibres of the ftomach, or on its 
nerves; yet thefe powers are fo connefted, that whatever 
impairs the one neceffarily affefts the other; fo we (hall 
find that a fimilar obfervation applies to the means of re¬ 
lief; that thofe medicines which tend to reftore a healthy 
nervous power to the ftomach, tend likewife to form the 
food into that fubftance which is beft fitted to excite the 
mufcular fibres of this organ ; and that whatever excites 
the natural aftion of thefe fibres, tends to relieve the 
nerves from uneafy impreflions, and, in the moft favour¬ 
able way, to bring into contaft with their extremities the 
food on which they are to operate through the interven¬ 
tion of the fecreting veflels. 
There are fome remedies which aft peculiarly on the 
nervous fyftem of the ftomach. Thefe are irritants, or 
thofe which increafe the production of the nervous power ; 
and anodynes or narcotics, the eft'eft of which is to dull 
the fenfibility. The potent nature of the firft clafs is 
fliown by their exhilarating effefts on the fyftem at large. 
It is thus that diftiiled fpirits and aromatic tinftures pro¬ 
duce fo much alleviation from the uneafy fenfations of 
dyfpepfia. It is well known, however, that the meafure 
of vigour which fpirituous potations afford is generally 
followed by increafed debility ; and we (hould therefore 
be cautious in the exhibition of them. They can be given 
with fafety only under the following circumftances ; viz. 
when patients have fo long indulged in their ufe, that we 
have to fear the increafe of dyfpeptic fymptoms from the 
fudden relinquilhment of the habitual ftimulant, or when 
we have fo far correfted the date of the other vifcera and 
of the fyftem in general, that the ftomach feems only to 
want fome additional nervous excitement to call its na¬ 
tural aftion into full play. Even when exhibited with 
thefe intentions, it is beft to give fpirits only in conjunc¬ 
tion with bitters, and in fmall dofes. This rule does not 
of courfe apply to violent or fpafmodic paroxyfms of dyf¬ 
pepfia, in which fomewhat aftive dofes of diftiiled fpirit 
are often admiftible. When combined with bitters, the 
medicines of this clafs render the former medicaments 
more permanent in their eft'eft ; and indeed, the aftion of 
the latter feems often neceffary to enable the ftomach to 
bear the former without oppreflion. The quantity of 
diftiiled fpirits in fuch mixtures (hould always however be 
fmall; a twelfth, at moft an eighth, of the whole. In the 
exhibition of aromatics lefs nicety is required: the pro¬ 
perties of all are fimilar, though fome fuit the ftomach 
and the tafte of individuals better than others. Thus 
ginger may be ufed when cardamoms ftimulate the fyftem 
145 
too much ; and cardamoms will relieve flatulence and 
fpafmodic pains, when ginger fails. 
Among the drugs which augment nervous fenfibility, 
we have to mention ammonia. The operation of this 
fubftance is by no means Ample. It accelerates the pulfe 
for fome time after reception into the ftomach, while it 
ftimulates the contraftile fibres of that vifcera, and is 
alfo a grateful and permanent ftimulus to its nerves. It 
is well calculated to relieve thofe patients in whom the 
force of the circulation is below par ; provided, how¬ 
ever, that no tendernefs of the epigaftrium, hard pulfe, or 
any lenfation of burning in the hands or feet at night, is 
experienced ; for the latter fymptoms would undoubtedly 
be formidably augmented by its adminiftration. Cam¬ 
phor poffeffes fome of the properties of ammonia in a 
(lighter degree. Its property of alleviating ficknefs ren¬ 
ders the nuftura camphorae a good vehicle for other me¬ 
dicines. 
We have recommended much caution in the ufe of ir¬ 
ritants : the ufe of anodyne remedies demands perhaps 
ftill more. The only medicine of this clafs which produces * 
effefts worth notice is opium. In violent fpafms this 
medicine may be given fomewhat freely ; but Dr. Philip 
fays, that very fmall dofes,* two or three minums of tinc¬ 
ture of opium for example, repeated two or three times 
a-day, often prove highly ferviceable in allaying morbid 
irritation ; their conftipating eft’eft is eafily counter- 
afted ; and fometimes indeed they have very little of 
this efteft. A better mode of exhibiting opium is under 
the form of the Pulv. ipecac, comp. From two to four 
grains of this preparation, given every fix or eight hours, 
appears to have a peculiar efteft in allaying the irritation 
attending indigeftion, which probably arifes from its 
aftion on the (kin. It appears to be beft adapted to thofe 
cafes in which that combination of languor and reftleff- 
nefs, often fo remarkable in this difeafe, prevails. It is 
better from time to time to difcontinue and renew its 
ufe, than to exhibit it for a great length of time without 
interruption ; which, even when the dofe is very fmall, 
is apt to occafion fome confufton or other uneafinefs of the 
head ; an efteft which goes far to increafe eventually all 
the dyfpeptic fymptoms. 
While thefe remedies are then in aftion, we ftill have 
to contend with paroxyfms of pain and nervous irrita¬ 
tion. To thefe, opium, ether, cardamoms, and the whole 
hoft of antifpafmodics, are the ufual and effeftual reme¬ 
dial agents. Among thefe means of temporary relief, 
very-warm water holds a higher place perhaps than is ge¬ 
nerally fuppofed. To its frequent ufe there are the fame 
objections as to other powerful ftimulants ; but occafion- 
ally it relieves dyfpepfia in a very decifive manner. It de- 
ferves mentioning, although it is difficult to explain it, 
that a confiderabie degree of heat applied externally to 
the region of the ftomach is as effeftual, provided it be 
continued for a fufficient length of time, in removing 
cramp, as any application of heat we can make internally. 
It is alfo frequently relieved by heat applied to the feet. 
It is during this ftage of dyfpepfia that galvanifm is often 
advantageous ; but in the ufe of this ftimulant we muft 
be careful to regulate it fo that it may not excite inflam¬ 
matory (ymptoms. 
When the bowels become implicated in the difeafe of 
the ftomach, a more briik and continued date of purging 
is required. To fpafmodic affeftions of thofe parts the 
fame fpirituous remedies that relate to the gaftric affec¬ 
tion are applicable. 
When, from the fullnefs of the right hypochondrium 
unattended by deficiency of bilious fecretion, we have 
realbn to fuppofe tardinefs of aftion in the duodenum, 
thofe purgatives which excite the periftaltic motions are 
preferable to all others. Of thefe, the combination of 
rhubarb and fenna may be mentioned as one of the beft. 
When, on the other hand, mucous feeretions are apparent 
to excefs in the faeces, the faline cathartics (hould be em¬ 
ployed. 
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