147 
PATHOLOG Y. 
plunge is the beft mode of applying it; and much care 
lhould be taken that perfect drynefs, and indeed re-aftion, 
of thelkin, be produced, by rubbing with dry cloths. In 
fome cafes fponging only, followed by the lame fri&ion, 
is the furtheft attempt at cold bathing which the delicacy 
of our patients’ conftitutions will allow us to make. The 
warm bath does not require the lame limitation ; and it 
deferves in our opinion more confideration than it 
.generally obtains. A gentleman of much experience, 
.Dr. J. Johnfon, is of the fame opinion ; he obferves that, 
.if the general ufe of the warm bath lhould ever become 
prevalent in this country, it will produce a more bene- 
.licial revolution on the health and longevity of the in¬ 
habitants, than any change which the hand of time has 
ever wrought; and that, fo far from weakening or ener¬ 
vating the conftitution, it has a decidedly contrary ef¬ 
fect ; and therefore, in debilitated fubjeffs, it is infinitely 
more proper and fafe than the cold bath. Indeed the good 
effe£ts of the.latter refult from the re-aftio'n of the fyf- 
tem; but, as this re-affion is entirely an effort of the con¬ 
ftitution itfelf, to refill as it were, or undo, what the cold 
immerfion had produced, a confiderable degree of vital 
.energy is necelfary ; otherwife fome internal vifcus may 
fuffer. On the contrary, fays Dr. J. the warm bath elicits 
the blood to the furface of the body,'with hardly any of 
that re-acfion obferved after the cold bath. The whole 
contaneous fyftem of velfels is thus filled with blood, 
while the velfels of the interior organs are relieved, and 
that without any particular exertion of the heart which 
might render it liable to fubfequent exhauflion. The 
fpirits too are railed, the pulfe mended, and the appetite 
jncreafed; in Ihort, a general renovation is felt through¬ 
out the whole frame; an effedl more remarkably ob¬ 
served after exhauflion or fatigue. The oriental nations 
have long appreciated its virtues in this refpedl. Homer 
defcribes Ulyffes, among others, as refrelhing himfelf 
with the warm bath, on his return home ; and the nume¬ 
rous and fplendid baths, by the building of which the 
Roman emperors gained fo much popularity, will fhow 
that this comfort, or luxury, was no lefs elteemed in the 
weft. 
The warm bath will by no means be an effedlual reme¬ 
dy in dyfpepfra, unlefs the immerfion in it be of much 
longer continuance than, is ufual in this country. Dr. 
Thomas, a pra&itioner who has fpent fome time abroad, 
informs us, that “ upon the continent, where fo much 
good is produced by this powerful remedy, no one thinks 
of recommending a patient to flay lefs than an hour in 
the warm bath ; and at UfTat, where fo many cures have 
been effedled by means of- the bath, and by fuch means 
only, I have known many weakly delicate patients take 
two baths of one hour each every day for three weeks 
without intermiffion ; and I have no doubt in my mind, 
and the fame conviflion pervades medical men in general 
in France, that it is owing.to this manner of taking the 
warm mineral baths, that fo much.good is effefted by that 
remedy; and, by parity of reafoning, I may fay, that little 
good is obtained from them in this country, becaufe there 
is not fufficient time allowed for bathing.” 
. The vapour-bath is alfo a remedy of great efficacy in 
the complaint in queftion.- 
„ Thedifeafes for which the warm bath may be employed, 
are much more numerous than thofe where the cold bath 
can be exhibited with fafety. And in faft it may be ufed 
on moft occafions without premifing the accurate difcri- 
mination required ere we adopt the critical meafure of 
cold bathing. See the article-BATHiNG, voi. ii. p. 803. 
On the ; treatment of the Jccond Jioge of indigeftion, we 
have feen that, after a certain period, a - change takes 
place in the nature of dyfpepfia; that a difordered ftate 
pf the circulating velfels of the ftomach fupervenes to 
fufpenfion of nervous influence and of mufcular propul- 
fion ; that this change happens at various periods, fome- 
times in a few days or weeks, but that not unfrequently 
it is not manifefted for many months, more rarely for 
, t VOL. XIX. No. iz 9i . * 
years ; that this ftate is characterized by a change in the 
phenomena of the circulating fyftem, indicated by a hard 
pulfe; and that there is likewife pain in the ftomach. 
•We confider thefe fymptoms as indicating chronic inflam¬ 
mation of the ftomach; and we may remark, that this 
opinion is borne out by analogical reafoning on what takes 
place in other parts, and by the diffeffions of the more 
marked cafes which are recorded by foreign practitioners. 
We have therefore to reduce inflammation ; and of courle 
the flimulating meafures which we have ufed in the firft 
ftage of indigeftion are to be laid alide ; but, in ad’opting 
the oppofite or antiphlogiftic treatment, we inuft confider 
that the ftoma'ch is the feat of complex functions; and 
that, though inflammation has fupervened, nervous de¬ 
rangement and mufcular inaftion ftill remain. More¬ 
over, the periodical affioh of the ftomach, and its conftant 
expofure to irritants, render general or fudden depletion 
of the contents of its velfels of little avail, lince, how¬ 
ever the latter may be depleted, and however perfectly 
they may recover their natural diameter, the frequent fti- 
mulus of foreign fubftances will tend to reproduce the 
morbid ftate of vafcnlar fullnefs. The impeded nutrition 
which is prefent caufes a debility of the fyftem quite ob¬ 
noxious to vafcular depletion. The treatment of this 
ftage of dyfpepfia requires therefore particular attention, 
inafmuch as we have to reduce inflammation by one train 
of precedes, and produce mufcular and nervous action 
by another. As thefe are incompatible indications, the 
lefs mult give away to the more important; that is to fay, 
wemuft reduce the inflammatory adtion firft, and confider 
the mufcular and nervous debility afterwards. The for¬ 
mer intention muft be effected by applying leeches to the 
epigaftrium, by cooling applications, as effervefeing 
draughts and folutions of nitre, cold water, See.' and by 
a very abftemiotis vegetable diet. When thefe mea¬ 
fures are luccefsful, we may cautioufly return to the ufe 
of bitters, &c. and thereby endeavour to remove the'caufes, 
i. e. morbid diftention and diminilhed nervous power, 
which have produced the difeafe in queftion. When the 
inflammatory ftate has not continued long, and has not 
appeared till the nervous indigeftion has been of long 
Handing, we generally prognofticate its removal by the 
above-mentioned means with certainty; bur, in propor¬ 
tion as it becomes more thoroughly eftablithed, we lhall 
find lefs marked relief from the bleeding, and a much 
more aggravated and fudden return to inflammation when 
we attempt to ftiipulate by bitters. 
It is at this period of indigeftion that ipecacuanha is 
an excellent remedy. The effect of this lubftance is to 
produce fecretion from the ftomach, though, it muft be 
allow'ed, not that which is commonly called the gaftrlc 
juice ; the nature of that fluid, or at lead: its peculiar ef¬ 
fect on the nervous expanfion, being altered. That fe- 
cretion is an excellent means of removing local plethora 
is well known ; and hence appears the advantage we de¬ 
rive from this drug. In regard to its dole, we fhouid give 
as much as induces fecretion without caufing naufea, a 
phenomenon which tends to debilitate the mufcular fibres 
of' the ftomach. A grain and a half, two, or in fome cafes 
three, grains will be fufficieht. It is necelfary, however, 
to produce fecretion from a more extenlive furface than 
the ftomach itfelf: the bowels fhouid be kept in an open 
ftate, and the hepatic fecretions lhould likewife be pro¬ 
moted. . In taking the firft ftep, we lhould employ thofe 
purgatives which produce the leaft pain or irritation in 
their operation. Vegetable diet, which we have before 
fpoken in commendation of, will in many cafes relax the 
bowels; but, where this effect is not produced, aperients 
muft be given. They fhouid be of a mixed kind ; they 
fliould comprehend many ingredients of this numerous 
clafs, avoiding however fuch as produce nervous irrita¬ 
tion. We have commonly recommended, when it is fuf- 
ficiently aitive, the Confectio fennte; but many other 
formula will no doubt anfwer the purpole equally well. 
Of courfe, when one part of the bowels is more fliig 
Q ft gilh 
