disorder of health, laid it down as a rule, that saccharine articles of food, and particularly sugar, should, as much as possible, be avoided; and that the diet should consist chiefly of animal food, and the stronger farinaceous matters.

He advised also, that the patient should abstain as much as possible from alcoholic drinks, and that, when he cannot abstain entirely, he should select in preference to others, sherry, or brandy, properly diluted with water. In some cases, however, these are too heating, and sound malt liquor, or hock, or claret, may be substituted for them.

Many years have elapsed since these injunctions were made, and the wisdom of them, as general rules, has been fully established.

It is very important, also, that the patient should change for a time his habits of life. If he is an inhabitant of a large city, and exhausts himself with mental or bodily labour, country air, rest, and recreation, are often sufficient of themselves to restore the health.-Med. Times and Gazette, Feb. 25, 1854, p. 177.

51. ON THE REMEDIES FOR INDIGESTION.

By DR. GEORGE BUDD, F.R.S., &c.

[Dr. Budd gives us some very good hints on the different medicines used in cases of dyspepsia; and first, on the use of

Daubenton

Ipecacuanha. This medicine increases the secretions of the stomach, and is to be taken before meals in cases of slow digestion. was one of the first to point this out.]

Daubenton is careful in stating that the cases in which ipecacuanha is useful are where digestion is slow,-where the food lies heavy on the stomach, and there is an inability for mental or bodily exertion for some time after meals,-a kind of disorder which is, he states, especially common in men of middle age, or beyond it, who lead sedentary lives.

He believed that ipecacuanha owes its efficacy in such cases to its exciting peristaltic action in the stomach, and imparting an energy to its glands.

He recommends that it should be given in the morning fasting, and in quantity sufficient to occasion a slight feeling of vermiculating motion in the stomach, but without causing any sensation of pain or nausea. The quantity requisite to produce this effect varies, he says, in different persons, from a quarter of a grain to two grains. He advises, therefore, that very small doses be given at first, which may be gradually increased till a sensible effect is produced.

[Dr. Budd then gives us his own experience. He says:]

I have used ipecacuanha as a remedy for indigestion for several years, and believe that there is no other medicine we know of so

effectual in removing the uneasiness and sense of oppression after meals, and the various other evils that result from slow digestion.

Small doses of rhubarb, ginger, and pepper, have a similar kind of action, and may be given singly or together for the same purpose. I generally prescribe ipecacuanha, from half a grain to a grain, in a pill, with three or four grains of rhubarb. With many, a favourite remedy for the discomfort resulting from slow digestion is a grain of cayenne pepper, with three or four grains of rhubarb. The best time for giving medicines for the purpose in question is just before dinner, and before any other meal after which a sense of oppression is usually felt [Bismuth.-This medicine is useful in painful digestion, accompanied with cramp or violent pain in the stomach after meals.]

It is often of signal service, as Odier remarked, in the functional disorders of the stomach that are so common in women who are ill fed and overworked, or exhausted in any other way, and especially where the stomach is very irritable, so that pain and vomiting occur soon after meals.

It is an efficient remedy when pain in the stomach, with increased secretion of gastric acid, occur from tuberculous disease of the lung, or from some irritation elsewhere; and in infants, where this kind of disorder, with exhausting diarrhoea, results from the irritation of teething, or from improper food, or from the change of diet on weaning.

Against the pain in the stomach and vomiting, that result from simple ulcer and other forms of organic disease, it is only of use occasionally when the stomach secretes an unhealthy mucus, or when there is an excessive or untimely secretion of gastric juice.

It is of little use in the indigestion that depends on gout, and that occurs in well-fed and plethoric men.

It is of no use in the uneasiness of the stomach, of which I have before spoken, that results from slowness of digestion or a scanty secretion of gastric juice.

Bismuth, as applied to the stomach, was considered by Odier an antispasmodic. The action it exerts seems to be confined to the mucous membrane with which it is brought into contact, and to be a surface action. It restrains undue secretion, and has a sedative influence on the stomach, probably by its direct action on the coats of the stomach, as well as by preventing the outpouring of irritating secretions. It is best given, suspended in water, a short time before meals. Ten grains, three times a day, is, in most cases, an efficient dose; but it may be given, as Odier discovered, in much larger quantity, without any ill effects. It is soothing, rather than irritating, to the mucous membrane over which it passes; and, from being of such sparing solubility, has little effect elsewhere, except what it has indirectly from the action it exerts on the stomach. It has, indeed, of late, been recommended by more than one writer to be given by drachms rather than grains.

Bismuth may often be given with advantage with other medicines, -with opium, or magnesia, or chalk,-which allay pain or neutralise an excess of acid, or restrain undue secretion.

Chalk, and the vegetable astringents,-kino, catechu, krameria, and logwood, are generally given to restrain diarrhoea. It does not seem to be generally known, that they are just as effectual, perhaps more effectual, in restraining undue secretion from the stomach.

Chalk, like bismuth, from its sparing solubility, has little direct action, except on the mucous membrane over which it passes. The vegetable astringents have a more remote astringent influence. This is clearly seen in the colliquative stage of phthisis; where, besides restraining the diarrhoea, and stopping the vomiting with increased secretion of gastric acid that often occurs in this state, they restrain, often in a very striking degree, the profuse sweating.

They seem all to have much the same effect. I generally give the preference to krameria and logwood. Kino is not conveniently given in solution; and catechu is not only very nauseous, but, from being much used in the arts, is often of inferior quality. The most grateful to the taste is krameria; the most effectual, I believe, is logwood. Logwood has a mawkish taste, which is best corrected by cinnamon.

An ounce of logwood shavings, and a drachm of powdered cinnamon, may be infused for four hours in ten ounces of boiling water, and then strained. An ounce and a half of the strained infusion may be given two or three times a-day, a short time before meals.

[Hydrocyanic acid, is also used when there is pain in the stomach, or vomiting, but must not be given when inflammation or ulceration are suspected.]

It is of most service in the gastralgia, and in the sympathetic vomiting, that occur in nervous persons from irritation elsewhere, without inflammation or ulceration of the coats of the stomach, and without undue secretion of gastric acid.

Given alone, or in conjunction with soda, it is the most effectual remedy we know of for the gastralgia that is apt to occur when the stomach is empty of food in nervous persons who have been subjected to exhausting influences; and for the vomiting that results from granular disease of the kidney.

It is of no use when pain or vomiting result from an inflammatory condition of the stomach.

It aggravates pain and vomiting when these symptoms are caused by an ulcer, or when they depend on excessive or untimely secretion of gastric acid. It often, for example, increases the vomiting that occurs in phthisis, which alkalies and the vegetable astringents will prevent.

When there is undue acidity of the stomach, it may, however, often be given with advantage in conjunction with soda or potash, when it would not be of service if given alone. The alkalies neutralise the

excess of acid, and the sedative influence of the hydrocyanie acid is is then exerted.

[Alkalies and mineral acids are also very useful in particular kinds of indigestion. But these are so well known that we need not here recapitulate their uses.-Med. Times and Gaz., April 15, 1854, p. 365.

52.-Treatment of Urticaria. By Dr. G. BUDD, F. R. S.-When nettle-rash is brought on by eating some substance in common use, and recurs frequently, the offending substance may sometimes be detected by the plan followed by Willan. He says: "I have desired several persons affected with chronic urticaria to omit first one and then another accustomed article of food or drink, and have thus been frequently able to trace the cause of the symptoms. This appeared to be very different in different persons. In some, it was malt-liquor; in others spirit, or spirit and water; in some white wine, in others vinegar; in some fruit, in others sugar; in some fish, in others unprepared vegetables. Í must, however, confess, that several cases have occurred to me where a total alteration of diet did not produce the least alleviation of the complaint."

It sometimes happens that a nettle-rash resulting from defective digestion is brought on not merely by some one substance, but by several substances in common use; and it is then very difficult to detect the offending substances or to prevent the disorder by any restriction of diet to which the patient will submit.

In such cases, the disorder may sometimes be prevented by giving daily, immediately before dinner, or before breakfast and before dinner, a pill containing three or four grains of rhubarb; or what is still more effectual, three or four grains of rhubarb, and from half a grain to a grain and a-half of the powder of ipecacuanha.

I several years ago learnt the occasional efficacy of rhubarb given at such times, from a lady, who told me that she was harassed by frequently recurring nettle-rash for many years, and consulted many physicians, and tried various remedies in vain, until some person who had suffered in the same way advised her to eat a few grains of rhubarb every day, just before breakfast and just before dinner. She followed the advice, and was freed from the nettle-rash. After some time she left off the rhubarb, and the nettle-rash returned. She took the rhubarb again, and the nettle-rash again disappeared. This experiment she often repeated at distant intervals, and always with the same result. When she gave me this account she had continued the practice of thus eating rhubarb for several years, with the occasional intermission of a few days, by way of experiment. She had a persuasion that if she then left off the rhubarb, the nettle-rash would recur.

Small doses of rhubarb and ipecacuanha are, as I have before observed, often of service where, from slowness of digestion, a sense of weight and oppression at the stomach is felt for some hours after

meals, and seem to quicken and strengthen digestion by increasing the flow of the gastric juice.

While taking these medicines, the patient should endeavour to strengthen digestion by exercise and fresh air; should be careful not to eat too much at a time, or too often; and should live on a very simple diet-avoiding spirits, and cheese, and pastry, and undressed vegetables, and, in particular, those substances which have an especial tendency to bring on nettle-rash.

It sometimes happens, especially in women, that the nettle-rash though depending immediately on the stomach, occurs only when digestion is weakened by over-fatigue, or by anxiety or some other mental emotion, or by profuse monthly discharges, and that remedies of a different class are availing.

In some such cases, where all the means of which I have before spoken had failed, I have known the eruption disappear under the use of carbonate of ammonia, alone or in conjunction with tincture of gentian.

Serpentaria is another remedy that has obtained some repute in the treatment of this disorder, but I have never made trial of it.

I may as well observe here, that an excellent application for allaying the irritation of nettle-rash, whatever be its cause, is a lotion made by mixing 3ss. of acetate of lead and 3ss. of tincture of opium with Zviij. of water.—Medical Times and Gazette, March 18, 1854, p. 258.

53.-Treatment of Pyrosis. By Dr. G. BUDD, F.R.S.-In the treatment of water-brash, our first endeavour should, of course, be to remove the conditions that may seem to have brought it on or to maintain it.

If the disorder should seem to be caused mainly by a diet not sufficiently nutritious or consisting too much of farinaceous substances, the most effectual remedy will be a wholesome nourishing diet, containing a proper quantity of animal food in its most digestible form. Little permanent benefit can, indeed, be expected from medicine unless the diet is improved.

If the disorder should seem to have been induced, or to be kept up, wholly or in part, by fatigue, it is very essential that the patient should rest; if by constipation, that this condition should be removed by purgatives, such as aloes or colocynth, that do not offend the stomach.

After these points have been attended to, much further good may be done by medicines.

The medicines that have been found most useful in pyrosis are

1st. Medicines which have an astringent action on the coats of the stomach. Among these may be classed bismuth, lime-water, and the vegetable astringents-kino, catechu, krameria, logwood.