NLM DD13fl2n 5 SURGEON GENERAL'S OFFICE LIBRARY. Section, No.. NLM001382195 v INDIGESTION f\ INDIGESTION WHAT IT IS; WHAT IT LEADS TO; A NEW METHOD OF TREATING IT JOHX BEADNELL G,ILL, M.D. Member Royal College Physicians, Edinburgh. FORMERLY SURGEON DOVER HOSPITAL J LATELY PHYSICIAN FOLKESTONE DISPENSARY AND INFIRMARY ; MEDICAL OFFICER OF HEALTH F^R .SANDGATE. AUTHOR OF AN "EPITOME OF BOTANY," " THE RUSSIAN-Bj^TH IN ACUTE AND CHRONIC DISEASE," "a NEW-METHOD 0*F, TREATING RHEUMATISM AND GOUT," ETC. «T|CV ETL KrK 1^ B RARY SUR8E9N GLN£RAt;5 OFFICE ThAb EBITBp${.% lo 1901 Ijf^ PHILADELPHIA P. BLAKISTON, SON & CO. 1012, WALNUT STREET 1883. wr US 3 PREFACE TO THE THIRD EDITION. I make no apology for placing the third edition of " Indigestion " before the public, as I trust that such a course is unnecessary. I invite the reader to bear in mind that true feeding consists in taking the exact amount of nourishment that can be assimilated, without the generation of the poisonous products of indiges- tion. 1 ask him furthermore, to endeavour to carry out the instructions that I put forth, to the very letter—e.g., when I order lemon-juice as a beverage, I mean lemon-juice—not water poured on to lemon-peel. Again, when I direct a sufferer to sponge from head to foot, I mean from head to foot, not from foot to head. Vi PREFACE TO THE THIRD EDITION. The few who attain to extreme longevity are, commonly, those who possess faultless digestive organs. Canon Beadon, who in July, 1879, died at the age of 102, was a member of the small but happy band just mentioned. Beadonism is, however, by no means a Utopian vision to him who will obey natural laws. Occasionally the physician is told a tale some- thing like the following :— " When I was a young man I could eat a horse ; now, thanks to past indulgence, I have a crib- biter installed in my inside. 'Tis unendurable! A stable, not a stomach, is the appropriate recep- tacle for a vicious quadruped." I commend this pithy oration to the notice of those individuals who love indulgence in good cheer. J. B. G. CONTENTS. chap. page i. On Indigestion.......1 11. What is Digestion ?......6 in. The Causes of Indigestion . . . 14 iv. The Symptoms of Indigestion . . 18 v. On Acute Indigestion.....21 vi. On Chronic Indigestion.....29 vn. On Hypochondriasis......47 vni. On Infantile Indigestion.....49 ix. On Indigestion of Youth.....63 x. Heads of Treatment of Indigestion in the Adult........65 xi. On Diet........67 xn. On Bathing—On the Russian Vapor-Bath . 84 xin. On Mental Occupation.....98 xiv. On Hygiene.......100 xv. On Drugs........107 xvi. On Galvanism . . . . .119 Vlll CONTENTS. CHAP. XVII. XVIII. XIX. XX. XXI. XXII. XXIII. XXIV. XXV. PAGE On the Inhalation of Oxygen Gas . . 122 On Surgical Interference . . . .124 On Change of Aie and Scene . . .126 On Clothing.......128 On Mixing with Society . 131 On the Cultivation of Music . . .133 On the Sun-Bath......135 Record of Cases . . . . . .138 A Passing Notice of Rheumatism, Gout, Consumption, Cancer, and Insanity . . 202 On Indigestion amongst the Poorer Classes.......225 Summary ........ 227 INDIGESTION, CHAPTER I. ON INDIGESTION. Even as I take pen in hand, I am almost tempted to lay it aside again—my subject is so vast, the organs that it more particularly deals with are so complex in structure, their mode of action is so imperfectly understood, their functions are so easily deranged, that the physician can scarcely hope to secure an adequate victory whilst doing battle with indigestion. We speak of indigestion as if it were a disease per se, yet, as a fact, it is a symptom of almost every disease. It covers the whole domain of medi- cine. Beyond question every disease from which man suffers is either directly dependent upon, or materially influenced by, the condition of the digestive tract. The stomach is the feeder of the o B n INDIGESTION. whole body. The blood, which nourishes every organ and tissue thereof, is elaborated from its contents. How, then, can the body be healthy if its larder be diseased ? No subject, in the practice of medicine, is more worthy of the study of the practitioner than that, the consideration of which I am about to enter upon. One does not overstep the bounds of truth whilst affirming that it enters into every relation of life; that it destroys the happiness of the wife, the welfare of the children; that it covers the land with strife ; that it fills the jail with occupants; that it feeds the divorce-court; nay, that it even decides the fate of empires ! The infant that should hang at its mother's breast is fed upon bread ; the father seeks refuge from its screeches in the public-house or the club- room ; he loses his love for home, and gradually becomes a drunkard! The youth becomes inca- pacitated from learning his tasks; his master inflicts corporal punishment upon him. The poor lad—keenly sensitive, as all dj^speptics are, and cowering under the disgrace inflicted—dips his hand into his father's cash-box and rushes from home to return no more. The clergyman ascends his pulpit feeling dissatisfied with his congrega- tion, and his congregation leave his church ON INDIGESTION. 3 dissatisfied with him. They meet him on the morrow; his nose is red and his face blotchy. The world says he drinks. Yet such an assertion is a cruel calumny. True, he possesses "the drunkard's nose;" yet, to the eye of the physician, such a blemish on the face signifies nothing beyond the presence in the economy of severe in- digestion. After a time he, disgusted with the injustice of his fellow-man, and depressed in spirits thereby, does begin to take brandy down in order to raise his drooping heart. Matters grow worse daily. Finally, the matter is brought under the notice of his bishop, and a worthy life is wrecked! The Premier, with an easily-led majority at his back, goes to the Senate-House ; he has dined with the Lord Mayor the previous evening, and has now butyric acid circulating in his blood. Fiends strive for the mastery in his internals. He declares that England must main- tain her position at the head of nations—as arbiter of Europe—so the dogs of war are unleashed, and man rushes at the throat of his unoffending brother!* The rich man—who is dying because occupation * The eighteenth century witnessed the destinies of England committed to the charge of a gouty Prime Minister, whose custom was to imbibe a bottle of port before appearing at St. Stephens' ! ! 0 tempora ! 0 mores ! 4 INDIGESTION. lights not the spark in his brain—imparts no vigour to his nerves, solaces himself with too frequent libations, infused from China's leaf. He becomes melancholic, draws his razor across his throat, and thus cheats the asylum ! This is no overdrawn picture—'tis literal fact. It has occurred already, will recur, if not to the end of Time, at least until man has studied physiology and learned to practise self-control. Abernethy used boldly to assert that no man would deny his stomach until death stared him in the face ! Alas, there was, in the days of indul- gence in which he lived, ample foundation for his caustic assertion. We, in 1882, are not much wiser than our grandfathers ! Yet we are ad- vancing. Many of the heads of the profession are now—all honour to them—reaping in the fields where smaller men ploughed thirty years ago. May-be, our grandsons will accept the dictum that it is not what a man eats, but that which he assimilates that nourishes him—that the amount that he ingests is large, whereas the quantity that he requires is small. Oh, halcyon Day of threadbare physicians, Thy timepiece warns for the Millennium ! The man who piled an elephant's load upon the back of a horse, or who coupled a goods train to the tender of a dwarf locomotive, would be justly ON INDIGESTION. 5 regarded by his fellow-man as a lunatic; yet such an act would be the parallel of that which the majority of mankind are, several times daily, performing in reference to their own digestive organs. CHAPTEE II. WHAT IS DIGESTION t Digestion is that process by means of which the assimilable portion of the ingesta is converted into blood. It is performed in the following manner:— The food, having been conveyed to the mouth, is there masticated and insalivated. The confor- mation of the teeth and of the digestive organs of man, proves that he stands between the grami- nivorous and the carnivorous animals, more nearly approaching the former; and that, therefore, his food should be, principally, if not entirely, vege- table in character.* The saliva, the secretion of several glands that * All the herbivora sweat, masticate, drink, and possess an abundance of saliva; not so the carnivora. The latter neither sweat nor masticate they lap; their saliva is secreted but in very limited quantities. The herbivora are easily, and to their own detriment, transformed into flesh- eaters. WHAT IS DIGESTION ? i lie close to the lower jaw, performs the office of dissolving the soluble portions. Its watery por- tion moistens that which is insoluble, and thus renders it susceptible of being swallowed without inconvenience. An animal principle, called ptyaline, is contained in the saliva. This sets up a change in the starchy portion of the food—more particularly when the starch has been cooked— converting it into sugar. Some physiologists also consider that by being frothed with air, it becomes the medium for conveying oxygen into the stomach—the presence of oxygen being, in their opinion, indispensable to the due performance of the digestive function. The food now passes backwards to the pharynx or upper portion of the oesophagus or gullet, de- scends that tube, and enters the stomach. The stomach is a muscular organ, not unlike a bag-pipe in shape, and lying partly under the ribs on the left side. Its greater end looks outwards, and to the left—that is to say, towards the left side-seam of the waistcoat. The food collects in the great left end of the stomach, and the latter becomes, during digestion, divided, by contraction of muscular fibres, into a greater (or cardiac) and a lesser (or pyloric) end. As further supplies of food descend, they pass to 8 INDIGESTION. the interior of the mass already there. The whole mass is now acted upon by the gastric juice— an acid fluid, secreted by follicles situated at the great left end of the stomach—under the stimulus of the presence of food. Its chief constituents are hydrochloric acid, and an animal principle called pepsine, belonging to the same class of substances as ptyaline. This pepsine, acting as a ferment, predisposes the mass to submit to the action of the acids just named. Thus the food is reduced to a pulp, grey in colour, and uniform in consistence, and especially the great nutritious principles—the fibrine, gluten, and caseine are all reduced to the condition of liquid albumen. The excess of water, plus whatever it may happen to hold in solution, passes, by endosmotic action, directly into the blood, sufficient only remaining in the stomach to impart to the chyme a due pulpy con- sistence. The surface of the food is first acted on. As soon as it has been converted into chyme, it is propelled by the action of the muscular coat towards the duodenum, or commencement of the small intestine. If a portion of food that is digestible, but not yet digested, appears at the pyloric, or small right end of the stomach, demand- ing a passage, it is stopped by the muscular WHAT IS DIGESTION ? 9 fibres which there form a sphincter, and sent back to the great left end, there to undergo further digestion. What a marvel is this pyloric orifice just men- tioned ! What a power of selection and discrimi- nation does it manifest! It is a fact that that which is perfectly indigestible—such as {e.g.) the seeds and skins of fruit—the pylorus allows to pass through, without itself showing any symptom of disturbance! In the duodenum (so called because its length is about equal to the breadth of twelve fingers) the clryme is mixed with the bile and pancreatic juice. The latter secretion is near akin to saliva : bile, however, is a neutral or weakly alkaline fluid, soapy in character, containing soda combined with two fatty acids called glycocholic or cholic and taurocholic or choleic acids. The two bile acids are present in various proportions in different animals. Bile also contains colouring principles, and a peculiar fat called cholesterine. This secretion neutralizes the acid of the gastric juice, acts on the oily constituents of the food, and renders them miscible with, and soluble in, water. Also the bile is a natural purgative, and excites the peristaltic action of the bowels. Little, how- ever, beyond its colouring matter passes off in the 10 INDIGESTION. faeces : furthermore, it is an antiseptic, and retards the putrefaction of the faeces. A perceptible change now begins to take place in the chyme, and continues during its passage through the remainder of the small intestines ; for it separates into two portions—a milky fluid called chyle, which is the nutritive portion, and the non-nutritive, called faeces. The chyle is absorbed by the villi of the mucous membrane, through the agency of micro- scopic cells, which pick it up and transmit it to the lacteals. These convey it through the mesen- tery and mesenteric glands to the receptaeulum cht/li, where it is mixed with the lymph brought by the absorbent vessels from the lower extremi- ties and pelvis. These two fluids, commingled, ascend through the thoracic duct (a tube about twenty inches in length, of the diameter of a small quill, and lying in front of the spinal column), and are poured into the circulation through the medium of the left subclavian vein. From hence it passes through the two right cavities of the heart, and goes to the lungs, there to be, in common with the venous blood of the general circulation, exposed to the action of the air, before it becomes blood in the full sense of the word. WHAT IS DIGESTION ? 11 Digestion is, in reality, a double process. It consists of— (I.) Digestion proper, which occurs within the alimentary canal, and which has for its object the rendering of the food soluble and susceptible of absorption into the circulation; and (II.) Assimilation, which occurs after it has left the alimentary canal, in the mesenteric glands, the liver, the lungs, and finally in the blood itself. The liver plays a prominent part in these changes, for it not only secretes some eight ounces* of bile * I am aware that the amount of secretion that I at- tribute to the liver is but a tithe of that set down by the majority of physiologists. I take my stand, however, upon the now-proven fact, that a man performing an ordinary day's toil does not require more than two pounds of nourish- ment to support him through his labour. No physician will, I think, venture to assert that the quantity of bile secreted amounts to more than one-fourth of the weight of food ingested. In cases of starvation, either partial or total, we have no good and sufficient evidence that bile is either vomited, retained in the system, changed in form, or expelled per anum; hence we are, I think, justified in arriving at the conclusion that the amount secreted bears a direct proportion to the quantity of food ingested. If the one business of the life of so vast a gland as the liver were the secretion of bile, a justification for the statement that it gives birth to fifty or sixty ounces in the course of the twenty-four hours would exist. Inasmuch as, however, this labour is a minor office of the organ in question, I am decidedly of opinion that a statement of the kind must be 12 INDIGESTION. in the course of twenty-four hours, but it also effects changes of the highest importance in the food-constituents, which, having entered the blood by endosmosis (as above stated) from the stomach and intestines, are brought directly to it by the vena portae. One product of this action is sugar, which is taken away in the blood of the hepatic veins. Nutrition is the further use made of the food in the body. Yet only certain ones of its many principles are really nutritious, and renovate the tissues. They are those already mentioned as digested in the stomach, viz., the myosin of meat, the albumen of eggs, the caseine of milk, and the gluten of bread and leguminous foods, such as peas and beans. The other principles, such as starch, sugar, and oil, are not really nutritious, but are consumed in supporting respiration, during the carrying on of which process, they are burnt very wide of fact. Hence, I again assert that the liver is intended to secrete only about eight ounces of bile in the course of the twenty-four hours. As a fact, man habitually over-eats. As a consequence the liver is perpetually over- worked, and (alas ! for his happiness and longevity) in a state of congestion. The portal system conveys a very large proportion of the venous blood from the abdominal viscera to the liver. It follows from this fact that con- gestion of the liver brings in its train congestion of many of the intra-abdominal organs. WHAT IS DIGESTION ? 13 up in every tissue of the body in order to produce animal heat. If not consumed in this manner they are stored up in the form of fat, which is a reservoir of fuel, useful to maintain vital heat, should the supply of food be interrupted. From this it is evident that all kinds of food may be divided into the flesh-formers and heat-producers.* The faeces pass from the small intestines through the ileo-colic valve into the large intestine, where they are joined by excrementitious matter, the product of the follicles of the gut. The valve itself permits of no return. Finally, the faeces collect in the sigmoid flexure of the colon, whence they are expelled from the body. A limited amount of absorption takes place in the large intestine. * This an accepted theory. Inasmuch as, however, we see individuals—nay more, aggregations thereof—deriving all the elements necessary to nutrition from one or two articles of diet, we can only arrive at the conclusion that, whereas the workings of chemistry, even when unaided, are marvellous, its performances when multiplied by that intensifier, which we denominate Life, are simply beyond the scrutiny of the finite powers of man. The Irishman flourishes on his potatoes, plus, perhaps, a little milk; the Scotchman becomes brawny upon his oatmeal; the native Indian, also the Chinese, upon his rice ; the Turk develops into one of the most muscular and enduring of Europeans, upon little beyond bis handful of farinaceous dates; the Corsican perforins hard manual labour upon his pocketful of chestnuts ! CHAPTER III. THE CAUSES OF INDIGESTION. In the former chapter I gave a very brief sketch of digestion. Purposely I glanced only at main facts, passing minor details unnoticed. I now pro- ceed to inquire—What are the causes of dyspepsia ? The two principal causes of indigestion are— (1) Imperfection of the organs concerned in the process; (2) Unsuitability of food, either as regards quantity or kind. These two conditions usually co-exist. The accessory causes I must also mention. Their number is Legion, but the principal are as follows:— a. Imperfections of cookery. b. Carious disease in, or numerical insufficiency of, teeth. c. The presence on the palate of a plate for artificial teeth. d. Disease of tonsils. THE CAUSES OF INDIGESTION. 15 o. Adulteration of food. /. Impairment of the general health. g. Disease in a distant organ. h. Irregularity of meals. i. Smoking, chewing, and snuff-taking. j. Impurity of water used either for drinking or cooking purposes. k. Exercise, either insufficient or excessive. I. Alternations of temperature, unaccompanied by compensative changes in clothing. m. The stooping posture. n. Insufficiency of air. o. Mechanical pressure on the digestive organs. p. Taking either a hot or a cold bath at an improper hour. q. Use of opiates—more particularly of chloral. r. Excessive study. s. Impurity of air. t. Insufficiency of light. u. Mental emotions.* * The influence of the mind over the bodily functions is scarcely, I take it, sufficiently realized. Dr. Henry Bennet considers that " the condition of extreme moral depression " under which the Parisians laboured during the siege of the French capital in 1870, " constituted an important element in the fact that they ' died like flies in autumn.'" Did space permit, I should record many cases that have occurred in my practice, but which I have passed unnoticed, in which great mental emotion has been productive, not merely of 16 INDIGESTION. v. Changes of climate without compensative changes in diet. w. The lack of occupation. x. Sexual excesses. y. Insufficiency of sleep. Most of these conditions I shall, in due course, illustrate by appropriate cases. I conclude this chapter by dotting down a few aphorisms, which I recommend the dyspeptic to learn by heart. They are : — a. Let each individual take that which he finds, by experience, to suit him—not his neigh- bour ; carefully distinguishing between natural tastes and acquired bad habits. b. That which is one man's meat is another man's poison. c. Earn your loaf before you eat it. d. Always rise from table unsatiated. e. Stimulation must be followed by depression. /. Live peaceably with all men. g. Eat slowly. h. Refrain from drinking whilst eating. i. After dinner sit a while ; after supper walk a mile. functional derangement, but even, finally, of organic disease. As a rule, the intensity of the resultant mischief is directly proportionate to the swiftness with which the blow falls. THE CAUSES OF INDIGESTION. 17 ,/. Eat when you are hungry, not when it is meal-time. /.•. Eat only such a quantity that you shall be hungry when meal-time comes round J. Let your food be proportionate to your work. m. Be temperate in all things. n. Nature loves regularity. o. Dr. Diet is the best physician. p. It is not good for man to be alone. q. Idleness is the stomach's hangman. c CHAPTER IV. SYMPTOMS OF INDIGESTION. The symptoms of indigestion are, if possible, more numerous than its causes. It is not too much to say, that every feeling of discomfort, from which an individual suffers, from the crown of his head to the sole of his foot, may be caused by dys- pepsia. Some of the more common symptoms are the following :— 1. Flatulence. 2. Heartburn. 3. Depression of spirits. 4. Giddiness and staggerings. 5. Sudden loss of vision. 6. Sudden loss of hearing. 7. Loss of sensation in any portion of the body. 8. Palpitation. 9. Irregularity of action of the heart. 10. Flushings of face. SYMPTOMS OF INDIGESTION. 19 11. General cold perspirations. 12. Drowsiness. 13. Sleeplessness. 14. Extreme debility. 15. Retchings. 16. Asthma, or shortness of breath. 17. Cough. 18. Shiverings, either brief or prolonged. 19. Diarrhoea. 20. Constipation. 21. Acid-risings. 22. Water-brash. 23. Pain, even in distant organs. 24. Headache. 25. Excessive dryness or moisture of skin, more or less permanent in character; and either local or general in extent. 26. A chopped, furred, or peeled condition of tongue; or all three co-existent. 27. Eruptions on the skin. 28. Spasm in throat or large intestine. 29. Pains in back. 30. Pains in either shoulder. 31. Burning sensations in palms of hands or soles of feet. 32. Tenderness of eyeballs. 33. Wateriness of eyes. 20 INDIGESTION. 34. Piles. 35. Angina pectoris. 36. Sordes on teeth upon waking in the morning. 37. Epilepsy. 38. Chorea. 39. Several forms of insanity. 40. Sickening pulsation at the epigastrium. It will appear from the above list that many of the symptoms enumerated are, apparently, antagonistic in character. Why should I lengthen this list ? To speak succinctly, the symptoms of dyspepsia, like its causes and its results, extend, I repeat, over the whole domain of physic. CHAPTER V. ACUTE INDIGESTION. Acute indigestion, or bilious attack, as it is usually termed, almost invariably arises from over-indulgence at table. The symptoms of this disorder, nearly every man is, unfortunately for himself, acquainted with, having learned them in the school of suffering. They are—Xausea, vomiting, a loathing of food, diarrhoea, utter pros- tration, insomnolence, headache, thirst, feverish- ness, rapidity of pulse. The treatment is of the simplest character; yet, even in this matter, I am, I fear, somewhat heterodox in my opinions. I contend, that to endeavour to arrest the vomiting—that is to say, to compel the stomach to retain an oppressive load —an irritating burden—is to commit a great mistake. The plan that I, for good or for evil, follow, is to assist the organ in its endeavours to cast off its incubus. 22 INDIGESTION. Case I.—One evening, about nine o'clock, I was sent for to attend upon C. C, a tradesman, aged about fifty. I found him rolling on the floor with agony ; perspiration, literally, dripping from nose and chin. His attendant informed me that he had been suffering under cramps in his stomach for about two hours, and that neither hot- baths nor turpentine-flannels, nor, in fact, any of the means resorted to, had done him the slightest amount of good. This was clearly a case in which the relief of pain was the first object to be aimed at. I sent to the nearest druggist's for some chloroform, and this I administered, very cautiously, until my patient obtained ease from his sufferings. I then gave hot water till vomiting occurred. Under the influence of this he ejected a small quantity of perfectly undigested meat. Almost instantly thereupon he felt relieved. We made him a shakedown on the floor, and I left for the night. The following morning I examined him care- fully. He stood about five feet ten inches, when in his slippers, and was a model of manly develop- ment. There existed, however, a general dilatation of the venous system; the liver was somewhat enlarged, and the tongue, which was much furred, ACUTE INDIGESTION. 23 appeared as if it had been hacked all over with a minute chopper. He stated that he was, at all times, well enough in health, provided he did not take either beer, wine, spirits, or solid meat. He added that he seldom took a meal from home, because people worried him by declaring that he was starving himself. That he had dined with a friend that day, and had foolishly eaten a little roast mutton, which had upset him, although he had adopted the precaution of cutting it very small. I explained that his was a highly sensitive organism, one that, clearly, could not tolerate stimulants. That whereas he would derive much benefit from animal food taken in the fluid form (as milk), or semi-fluid (as butter), from solid meat he would acquire only harm. I added that he must strengthen his internal skin by deputy (so to speak), viz., by sponging the surface of his body, from head to foot, with cold water every morning. Twelve years have elapsed. My patient is one of those satisfactory clients who are content rigidly to follow prescribed injunctions. His diet consists exclusively of fruit, vegetables, boiled fish, bread and butter, plus cocoa or water. He is, he states, always well, though he inherits a ruined constitu- tion from a drunken father. 24 INDIGESTION. C. C, very wisely, carefully eschews drugs. Ten years since, circumstances separated me from C. C. Some three years ago he fell ill. His medical attendants insisted upon a return to the eating of meat, and added thereto the drinking of sherry. I paid C. C. a friendly visit in the summer of 1881. Softening of the brain had set in. November, 1882.—C. C. is still alive, though dead to the world. Case IT.—One day, as I sat at luncheon, I was requested to visit L. H. instantly, as he was dying of diseased heart, and would most likely be dead before I could reach his house, and his doctor was engaged at a case that was likely to engross his attention for several hours. I laid down my knife and fork, and walked as briskly as the intense heat of the weather would permit, to my patient's house. I found him a broad-shouldered, muscular man of sixty-eight years of age. He was suffering the most intense agony. With his right hand he either beat his breast or clasped his left wrist, all the while exclaiming, " Oh, doctor! Oh, mv wrist! Oh, doctor! Quick! My chest! I'm dying!" I put to his relatives my universal question as ACUTE INDIGESTION. 25 to that which he had recently either eaten or drunk, and elicited that he had just partaken of a full dinner, and imbibed a quart of ale that was a little hard. I administered hot water until he vomited. He threw up, inter alia, an enormous quantity of imperfectly masticated cabbage. Instantly he expressed his deep joy at the relief given. Inasmuch as L. H. belonged to the class that refuses to believe in cure without the aid of physic, I ordered him a mixture containing soda, bismuth, sal volatile, and lime water (a dose to be taken every four hours) ; and took my departure. At the request of his usual medical attendant, I visited him the following day for the purpose of, if possible, instilling caution into his mind. The action of his heart remained somewhat tumultuous, though he had become, as he stated, a different creature since yesterday. I spent ten minutes explaining fully what he should eat, drink, and avoid. He replied, " Thank'ee, doctor, Mr. C---- told me the same nigh upon forty years ago!" I confess to having felt very small. This case, that so closely simulated angina pectoris, was simply one of acute indigestion! 26 INDIGESTION. Thirteen years have elapsed. The patient is a hale man of eighty. Case III.—One afternoon, in May, 1868, I was summoned to the house of a butcher to pre- scribe for the proprietor's nephew, aged twenty, who had fallen into convulsions. On my arrival, I found a young man, of very full habit, just recovering from an attack of epilepsy. He had been out, for a day's pleasure, with some associates, and had eaten largely of boiled beef and pickled cabbage, plus carrots, potatoes, rhubarb-tart, and bread and cheese. He had also drunk, somewhat heavily, of bottled stout, Shortly after dinner he was, whilst batting at cricket, suddenly seized with faintness and vomiting. These symptoms persisted till con- vulsions set in. His friends, very wisely, brought him home without delay, and sought medical aid. I cautioned him to live sparingly, and upon light food; also to avoid stimulants, irritants, and excitants of all kinds, and, that too, for a period of at least six months. He rigidly adhered to my instructions. When last I heard of him, now some eight years since, he had experienced no return of his alarming symptoms. ACUTE INDIGESTION. 27 Case IV.—II. A., aged seventeen, was staying in Dover in the year 1864. On one occasion, he climbed a very steep hill immediately after dinner. The result was that, upon his descent therefrom, he became faint and ejected his dinner. His stomach did not recover its tone for several days. I suggested his retirement to bed. To this penance he, however, declined to submit. I allowed him only spoon diet, and gave him an effervescing draught every four hours. At the end of a week he was quite himself again. Doubtless the vomiting prevented a serious attack of congestion of one or more of the internal organs. Case V.—On the evening of 7th July, 1881, I was called hurriedly to visit M. R., aged six years, whom, on arrival at the house of his parents, I found suffering from convulsions. Enquiry elicited the facts, that not only was the little patient accustomed to eat fruit gathered from the garden to any extent that pleased him, but also that he had that day partaken largely of beef-pudding. I administered an emetic of Vin. Ipecac, which caused the child, forthwith, to eject from his 28 INDIGESTION. stomach a large amount of undigested food. I directed that he should be placed in bed, and should ingest nothing beyond cold water until I had seen him a second time. Upon calling the following morning, I found my little patient quite recovered from the effects of the excesses indulged in on the previous day. CHAPTER VI. CHRONIC INDIGESTION. I now come to a disorder, more grave in character and more difficult of management, than that of which I have just treated, viz., Chronic Indigestion. The causes of indigestion, both acute and chronic, also its symptoms, I have already referred to. I now proceed to mention its results. The reader must bear in mind, that, though we are accustomed to speak of the body as the aggre- gation of a number of organs, these organs stand to one another in the relation of the wheels of a watch, or of a steam-engine. If one becomes untrue to its office, the whole machine suffers—if one breaks down, it comes to a standstill. The Results of Dyspepsia. Again the whole domain of medicine stares us in the face. For the information of the reader, I will trace afetv cases through to their termination:— 30 INDIGESTION. a. Congestion of stomach ; congestion of liver, leading to congestion of the majority of the abdominal viscera, and terminating in ulcer- ation, or even cancer, of one or more of them. Death. b. Congestion of stomach ; congestion of liver; fatty liver; fatty heart. Sudden death. c. Congestion of stomach ; congestion of liver ; rheumatic fever; endocarditis. Death, near or remote. d. Congestion of stomach ; congestion of liver; deposits in various organs. Lingering death. e. Congestion of stomach ; congestion of liver; rheumatism; diseased heart; clot carried to the brain ; softening of the brain. Death. /. Congestion of stomach ; congestion of liver; eczema on skin; sudden accession to the brain; epilepsy. Death. g. Congestion of stomach ; congestion of liver; erysipelas. Probable death. h. Congestion of stomach; congestion of liver ; congestion of kidneys ; disease of kidneys ; stone in kidneys; stone in bladder; operation. Possible death. i. Congestion of digestive organs ; congestion of spinal-cord ; epilepsy. Death. CHRONIC INDIGESTION. 31 /. Congestion of digestive organs; general irrita- tion of nervous system; insanity. Death. k. Congestion of digestive organs ; congestion of lining membrane of eyelids ; eversion of lower eyelids; irritation of exposed eyeballs. Blind- ness. I. Congestion of digestive organs ; leprosy of skin ; or chronic spottiness of face. m. Congestion of digestive organs ; congestion of lining membrane of lungs; bronchitis; con- sumption. Death. n. Congestion of digestive organs; bron- chitis ; asthma ; diseased kidneys ; diseased heart. Death. o. Congestion of digestive organs and consequent generation of acid ; rheumatism of the eyeballs ; opacity of the lens ; cataract. Blindness. p. Congestion of digestive organs; rheumatism ; chronic rheumatism of middle ears ; deafness. q. Congestion of digestive organs ; gout, affect- ing every organ of the body. r. Chronic gastritis ; ulceration of stomach or duodenum. Sudden death. s. Congestion of digestive organs; vomiting of blood. Death, near or remote. 32 INDIGESTION. Chronic Indigestion May be, I think, for convenience of description, subdivided as follows :— Sloiv Digestion—or simple dyspepsia. Undue Acidity in digestion — dyspepsia with acidity. Painful Digestion—dyspepsia with gastric pain and frequent soreness. Foul Digestion—dyspepsia with fetid eructa- tions. Impaired Digestion, with mental disturbance —dyspepsia in which mental symptoms pre- dominate. Feeble Digestion, with clamminess of skin. Indigestion, with irregularity of action of heart. Indigestion, with sordes on teeth. Slow Digestion Occurs more frequently in men than in women, and is, most commonly, found to attack those who follow sedentary occupations. Such individuals are, usually, irritable and fretful. They speak and act—nay, unfortunately, eat also, in a very impulsive manner. They, generally, feel relieved CHRONIC INDIGESTION. 33 as the day advances, enjoy a heavy supper, and awake, the following morning, clammy in mouth, and, in no degree, fitted to perform the toil of the coming day. Commonly, they suffer acutely from flatulence. Sometimes they will tear open the clothes, and rub violently at the abdomen, until the wind is expelled in volumes. Commonly, also, the urine deposits a sediment, yellow or brown in colour, and soft and chalky to the touch. These men are highly energetic ; usually live to a good old age, and do more than a fair share of the work of the world. Acid Dyspepsia. This is, by far, the most common form of indigestion. Individuals who suffer from acid dyspepsia are, usually, of the nervous tempera- ment, and both act and speak in a very decided and energetic manner. Their tempers are so hot, as to render them, scarcely to be tolerated, by their neighbours and belongings. The appetite is bad. Sometimes, however, it is voracious. The gnaw- ings in the stomach are, frequently, mistaken for D 34 INDIGESTION. those of hunger—hence food is ingested when, in reality, the stomach is already overburdened. Even their breath smells of acid. Their energy is commonly boundless. Doubtless nature's object in keeping them, perpetually, on the move, is the elimination of superfluous acid from the system, through the medium of both skin and lungs. They are sometimes pale and thin; but, more commonly, plethoric and gouty. The urine gene- rally deposits a red sand, which feels hard and gritty when touched with the finger. The amount of cold they can endure is astonishing, provided always that they keep on the move. Usually, they wear no more garments, out of doors, than when sitting at their firesides. This, too, they do with impunity. Nevertheless, it behoves them to use caution, as they are very prone to suffer from deposits in various organs—those in the abdomen aggravating indigestion ; those in the lungs, as a rule, terminating in phthisis; and each one increasing the natural tendency to the forma- tion of deposits of a similar character. Pleurisy, bronchitis, and peritonitis frequently attack the victims of acid dyspepsia, and are, practically, suppressed rheumatism ! Theory would affirm that all forms of saccharine and starchy matter must be inhibited in the plan CHRONIC INDIGESTION. 35 of treatment. Practical experience, however, dis- tinctly negatives such a course of proceeding. Rheumatism, gout, and disease of kidneys are very prevalent among the victims of acid dys- pepsia. Painful Digestion. This is a most annoying malady, even when existing in its milder forms—terrible when it assumes a grave type. The pain usually comes on shortly after taking a meal. The period of its duration is doubtful— sometimes it lasts only a few minutes; more frequently, it persists for several hours. It is felt in a spot situated between the lower ribs—that is to say, in the region of a mass of nerve—a small brain, in fact, called the great solar plexus. It, by no means follows, however, that the cause resides in the spot at which the pain is felt. On the contrary, it is the opinion of those physicians who have given their attention to the subject, that the fans mali may reside either in the pancreas, or the commencement of the small intestines. My individual experience is, that it may exist in any portion of the alimentary canal that lies on the distal side of the oesophageal 36 INDIGESTION. opening of the stomach, and that the pain is felt at the spot indicated, simply because it is the seat of the nearest nevve-mass. Satisfied am I, that it, not unfrequently, depends upon a congested condi- tion of the solar plexus itself ; strumous deposit in the pancreas ; superficial ulceration of the mucous membrane of the stomach or small intestines ; and nervine atony. In my experience, this form of indigestion is more common amongst women than amongst men. Foul Digestion. Foul digestion is the result of eating food, either too large in amount, or too rich in quality. Again, the principal sufferers are those who follow sedentary occupations, more especially when they work in rooms, either heated through the agency of gas, or insufficiently ventilated. Journeymen- tailors, also shoemakers, are, markedly, subject to foul digestion. The symptoms do not, usually, present themselves until the lapse of several hours after the cause of the mischief has been swallowed. The process of digestion appears to be arrested half-way—as if the stomach had given up, in despair, the hope of working through its load. CHRONIC INDIGESTION. 37 Putrefaction occurs, accompanied, of course, by the evolution of volumes of foul gas. There are, co- existent,therewith, constitutional disturbances of a very severe character, including headache, nausea, heat of skin, great thirst, foulness of tongue, pains in head, back, and limbs; sometimes nervous tremors or twitchings. Usually, also, there is diarrhoea; the fseces smell almost putrid; nay, the breath and vomited matters possess an odour as of decomposed eggs. If sufferers from foul digestion sleep after partaking of food, a fit of dyspepsia is the almost certain result. Veal or pigeon pie, or, in fact, any dish contain- ing eggs cooked in a confined space, also eggs boiled beyond due limits, constitute some of the bitterest foes that sufferers from foul digestion are called upon to contend with. This disease is sometimes intermittent in cha- racter. Frequently it depends upon the presence in the economy of a blood-poison, acquired months, or even years, previously. Impaired Digestion, with Mental Disturbance. In this form of indigestion, the stomach- symptoms frequently occupy but a very subordinate 38 INDIGESTION. position, the head-symptoms alone being those of which the patient complains. He consults a physician for his brain, as he tells him. His stomach is right enough, he, not unfrequently, adds, his words proving that almost unconsciously to himself, he is aware of the existence of gastric derangement. He will, not uncommonly, walk his room con- tinuously—even while he is reporting the details of his case. He is, seldom, without imaginary enemies, many of whom desire to place him in a lunatic asylum. This is the class of case that is most difficult to deal with. If left to itself, it usually terminates, either in confirmed hypochondriasis, or some form of insanity. Many of these cases depend upon rheumatism, suppressed, yet attacking the encephalon, and are commonly much benefited by the twofold agency of light diet and vapor-baths. As a rule, how- ever, some disorder of the digestive organs lies at the root of the mischief. In women, the organs of reproduction are, by no means, sinless in these cases. CHRONIC INDIGESTION. 39 Impaired Digestion, with Clamminess of Skin. The patient is, usually, slenderly built, has a pale, thin, anxious face, and is frequently, but by no means always, stunted in growth. His shoulders droop from mere inability to hold them up. He is round-backed and hollow-chested. Commonly, he is taciturn and tranquil—yet, once excited, his face lights up with enthusiasm. Talented and persevering, he is one who can go anywhere and do anything. Nothing is too much for him to undertake; no obstacle daunts him. The pabulum prepared by the digestive organs is insusceptible of development into blood, contain- ing the due proportion of red corpuscles. The taking of food, except it be of the lightest character, forthwith induces cold perspiration, which latter is, sometimes, local, and sometimes general. The sufferings of the victims of this dire dis- order, amount, in the aggregate, to a living death. Dissolution is, commonly, the object of their ambition ; yet their morality is of so comparatively lofty a type as to preclude the idea of self-destruc- tion. Such persons faint under the pressure either of 40 INDIGESTION. slight pain, or any form of mental excitement. They detest the sight of blood, or the thought of physical suffering. They are wretched sailors,'and naturally cowards ; yet, once nerved up, will face any odds. One of England's foremost naval heroes must have been a sufferer from this form of dyspepsia. I regard that now under consideration as one of the most serious phases of indigestion, on account of its strong tendency to run into con- sumption. Yet no form of indigestion, is, as will be shown hereafter, more amenable to rational treatment. It is more common in men than in women ; yet, among those seriously attacked, more fatal in women than in men. The sympathy that exists between .heart and digestive organs, is so great as to be incredible to him who has neither suffered from it, in propria persona, nor watched its intensity in others. At the date of writing this paragraph, I am in attendance upon a patient, aged about forty-five, who will, not infrequently, actually become faint, shortly after either imbibing a cup of tea, or eating a small portion of meat-pie containing egg, or par- taking of stuffing made with herbs. Yet this same individual can, without inconvenience, either stand erect for twenty minutes, in a vapor-bath, heated CHRONIC INDIGESTION. 41 to 120° Fahrenheit, or deliver an extempore lecture two hours in duration. Indigestion, with Irregularity of Heart's Action. This is a most serious form of dyspepsia; so serious indeed, that I shall feel bound to write of the treatment thereof, in a special manner; never- theless, it is commonly amenable to treatment if grappled with before functional derangement has developed into organic disease. It is more common in men than in women. It is comparatively frequent in children suffering from Tabes Mesenter- ica ; the age of puberty, however, being once satis- factorily surmounted, it, usually, slowly recedes, and seldom reappears before middle life is passed. It generally possesses a history of prolonged an- tecedent palpitation. It has several phases, viz.:— A. That in which the assumption of the recum- bent posture at once tranquillizes the weak and irritable organ. These cases are curable under the influence of light diet, mental occupation, obedience to hygienic laws, and prolonged rest in the recumbent posture. Both alcoholic stimulants and purgatives should 42 INDIGESTION. be avoided. Pepsine, bismuth, hydrocyanic acid, strychnine, and phosphorus are the drugs to be employed in this malady. Occasionally the physician meets with a case of this disease which proves absolutely unamenable to treatment. Clearly it is one of heart, or rather of brain, starvation. Such cases terminate sometimes in epilepsy, sometimes in sudden death. Now and then nature, determined, as it were to gain the victory, extinguishes the batteries that preside over locomotion, in order that the whole of her efforts may be concentrated upon the work of increasing digestive ability—prolonging life. Paralysis having set in, the patient's general health improves, and his heart resumes tranquillity of action. These cases are few in number; and the propor- tion that terminates unfavourably is fortunately very small indeed. B. That in which the irregularity of action sub- sides as the day advances, or, in other icords, as the internal congestion inseparable from sleep passes away. Sufferers from this form of dyspepsia are, commonly, decrepid in the early hours of the dav, but rise almost to the health-standard as evenino- approaches. They avoid much suffering by re- CHRONIC INDIGESTION. 43 maining in bed, fasting, for two or three hours after rousing from slumber. Usually they refuse to retire to rest until the small hours of the morn- ing have arrived. Light diet, gentle exercise, mental occupation, attention to general hygiene, the avoidance of alcoholic stimulants, and the use of the vapor- bath, together form the course of treatment to be pursued. Cholagogues irritate even to the point of induc- ing colonic spasms. Natural purgation, however, brought about by the ingestion of ripe fruit, affords vast relief. Pepsine, lactopeptine, bismuth, glycerine, hy- drocyanic acid, rhubarb, phosphorus, strychnine, and high-class cod liver oil, are the drugs usually selected as adjuvants. C. That in which the irregularity of action persists during the entire twenty-four hours. This is a disorder demanding the serious atten- tion of the physician. Sufferers from this form of dyspepsia can seldom ascend even a flight of stairs without suffering, more or less severely, from dyspnoea. They are acutely sensible of the exist- ence of a weak spot in their organism, hence they live in a state of chronic mental perturbation, and 44 INDIGESTION. are to be seen constantly examining the state of their pulses. Frequently they faint—occasionally they die—under the pressure of either deep emo- tion, or, for them, severe muscular effort. Now and then they are found to have died tranquilly during sleep ; and, when such a calamity happens, it is usually traceable to exceptional indulgence in unsuitable diet. Light food, gentle exercise, absorbing mental occupation, abundance of sleep, and the avoid- ance of stimulants, irritants, and excitants, are the chief points of treatment to be attended to. Infusion of digitalis is the drug to be depended on. It may be administered in half-drachm doses, and repeated at brief intervals. In my opinion, it not only tranquillizes the heart, but also acts as a sedative to the mucous membrane of the stomach, and, furthermore, eliminates much morbid matter, probably rheumatic in character, through the medium of the kidneys. No remedy, however, can rival the Russian bath in the treatment of this form of indigestion. As soon as the patient becomes thoroughly heated, he expresses his sense of relief afforded. Frequentlv, the irregularity of action of the heart ceases at the same period, nay more, remains in abeyance for many hours after quitting the bath. CHRONIC INDIGESTION. 45 I frequently experience some little difficulty in inducing dyspeptics who manifest a tendency towards faintness, to make trial of the vapor-bath. As a fact, however, they may, with the most perfect confidence, dismiss all fears on the subject. The Russian bath is, in no sense, a depressing agent. Moreover, the recumbent posture, which patients who use this form of vapor-bath invari- ably assume, precludes the possibility of such an untoward event as the supervention of faintness taking place. The rapidity with which some individuals, who appear to be in a hopeless condition, in con- sequence of indigestion complicated with irregu- larity of the heart's action, rise again, under the influence of the treatment indicated, is scarcely credible to him who has not been an eye-witness thereof. In my experience, indigestion, with continuous irregularity of heart's action, occurs only when the stage of suppressed rheumatism or gout has been reached. Indigestion with Sordes on Teeth. That this is a serious form of indigestion, is proved by the number of deaths that occur among 46 INDIGESTION. its victims, when an ailment, in itself trifling in character, is superadded to already existing mis- chief. This is accounted for by the knowledge that it is usually a sequela of antecedent disease. In my experience, it is more common in women than in men, in the proportion of ten to one. The remote cause is, usually, an inflammatory affection of one or more of the abdominal viscera, terminating in the formation of adhesions. Puer- peral peritonitis or cellulitis together constitute the great predisposing causes of the disease. The treatment consists of light diet, gentle exercise, the prolonged administration of iodide of potassium, combined with orange-peel, cascarilla, or cinchona, and, above all, steady perseverance with the Russian bath. Blood-poisoning after child-birth is of very frequent occurrence in individuals already suffering from indigestion with sordes on teeth. This phase of dyspepsia is sometimes mistaken for a form of chronic typhoid fever, and, to the detriment of the patient, treated with high living and quinine. CHAPTER VII. OF HYPOCHONDRIASIS. Volumes have been written on this subject; octavos will yet be penned thereupon; yet I fear that, if we desire to retain our character for truth- fulness, we must confess that, after all, we know very little about either its causes or its treatment. It is, commonly, a disease of middle age and advanced life. Sometimes it attacks the young, continues through middle life, and recedes, or even entirely disappears, as age creeps on. It involves great suffering to the patient. It attacks both sexes indiscriminately. It causes the individual to be regarded as " that nuisance So-and-So," or " that crazy old A. B." During my years of study of indigestion, I, like my predecessors, have, at various times, located the disease in liver, kidneys, pancreas, spleen, stomach, intestines, and, finally, solar plexus. I now, however, freely confess that my knowledge 48 INDIGESTION. of the subject is most unsatisfactorily small in amount. That it is, appropriately, named hypo- chondriasis is beyond question, inasmuch as the greater part of the pain that it induces, is referred to a spot situated under the cartilages of the ribs. Some of its causes are as follow :— In Women.—Most commonly, irritation in some portion of the genital tract—womb and ovaries being the organs usually affected. In Men.—Also irritation in some portion of the genital organs, and commonly intensified, if not initiated, by gonorrhoea or syphilis. In both Sexes.—Tape worms (even in very advanced life), obstructed colon, sacculated colon, constricted colon, internal piles, calculi in the gall-bladder, tumours of all varieties; any disorder • of the abdominal viscera—strumous deposit in the pancreas being one of them—also mental anxiety, the whole aggravated by an excess of blood, pre- sent in the solar plexus. The general treatment consists of mental occu- pation, light diet, the avoidance of stimulants and irritants, the use of the vapor-bath, followed by the cold sponge, needle, or shower ; nervine tonics and outdoor exercise. Any special cause of disease must, of course, and if possible, be removed. CHAPTER VIII. INFANTILE INDIGESTION. I consider it incumbent upon me, before entering upon the general plan of treatment of indigestion in the adult, to write a few lines on infantile indigestion. It is a law the whole creation through, that the young animal shall derive its nourishment from the mammse of its own mother. (I, of course, employ the word animal in the sense in which it is commonly accepted.) The stomach of the infant of the superior animal is constituted to digest human milk, and nothing else; that is to say, animal nourishment, living, and in its most assimilable form. Now, human milk is extremely watery and very sweet. Infants fed thereupon, usually, grow rapidly, and are both intelligent and peaceful. The middle classes, as a body, recognize this fact; not so, however, either the upper or the lower. e 50 INDIGESTION. The former refuse to give up the pleasures of society, in order that they may attend to the requirements of their infants; the latter, through ignorance of physiology, insist upon feeding rather than suckling them. The result is—a rate of mortality amongst infants so large, that one cannot contemplate it without dismay. I do not hesitate to affirm that, according to my individual experience (and that experience, to my knowledge, of a, by-no-means, exceptional character), three-fourths of all the infants that die are killed—some by mistaken kind- ness, I freely grant—yet, nevertheless, killed. It is the exception for a child to be born diseased. Physicians find it difficult to bring home to the minds of mothers, either the possibility of an infant starving, though its stomach may be full, or the fact of the future man being, not unfre- quently, either made or marred, within the first twelve months of his existence. A well-meaning neighbour comes in, and admonishes Mrs. A----, that her baby is not satisfied, and that she must therefore give it something to eat. Something to eat is accordingly given. The infant soon begins to suffer the torments of dyspepsia—possibly of colonic spasms—and roars lustily. The admoni- tress now suggests the exhibition of a little INFANTILE INDIGESTION. 51 soothing-syrup. Soothing-syrup is accordingly administered. As soon as the effects of the sedative have passed away, neighbour Number Two appears upon the scene, and urges the giving of a little port wine. So, at once, the poor little creature, that is unable to tell the tale of its woes, has a wretched mixture of logwood and beet-root brandy poured down its throat. It sinks into a drunken slumber, rouses in a state of depression, and, of course, yells again. Neighbour Number Three now steps in, declares that the little darling is starving, and almost insists that some sopped bread be given in order to fill its poor little stomach. Sopped bread is accordingly administered. The yells increase. The mother grows fretful, and the father leaves the house in disgust. The child wastes. Eczema—nature''s attempt at cure—breaks out on its skin, and spreads over the greater portion of the surface of the body. One day neighbour Number Four becomes the medical attendant. She brings the little sufferer a piece of cake. The plum-cake is given. Convulsions supervene. The doctor is summoned. He makes inquiries; at once divines causes, and gives in- structions for future better treatment. These are fairly well carried out. But, alas ! the digestive organs are, already, permanently injured. The 52 INDIGESTION. child grows to maturity, with enlargement of joints, projection of forehead, soreness of eyelids, a drooping of shoulders, a bend in the back, and a hollowness of chest. He dies of consumption at the age of thirty ! Let us make another sketch. A. B. resides in Belgravia. He is born some- what weakly in constitution, his mother having injured her health by late hours, spent in a whirl of fashion; also, she has usually indulged in a little more alcoholic stimulant than is good for her. Of course she refuses to suckle her infant, inas- much as the following of such a course would in- terfere with her pleasures. Under the advice of a celebrated physician-accoucheur, cow's milk, goat's milk, and ass's milk, are alternately put on their trial. One morning the physician-accoucheur looks grave, and says that human milk alone can save the child's life. A wet-nurse is obtained. She is examined by the physician-accoucheur and pronounced to be, as far as he can judge, in good health. For a time all goes well. Shortly, how- ever, the man of science is again summoned. The child has a constant running at the nose, he turns his thumbs on to his palms, and has ugly copper- coloured spots upon his skin. The doctor now looks very grave indeed; says the child must be INFANTILE INDIGESTION. 53 forthwith weaned, and must, moreover, go through a prolonged course of physic. Alas! the tiny patient has contracted syphilis from his nurse. In a few months a little coffin is carried to the house in Belgravia. Another child is born at the West End mansion above mentioned. Once more the mother refuses to perform maternal duties. The services of the physician - accoucheur are not again sought. Clearly he did not use caution in the selection of the former nurse, so an M.D.-Baronet is called in. A healthy mother is brought from the country, and the child progresses fairly well. He does not exactly thrive, but then, who can wonder thereat, inasmuch as she, from whom he draws his susten- ance, is continuously bemoaning her absence from her own darlings. As a boy he manifests painfully fierce tempers. As a young man he dislikes the society of his equals—spends his time with jockeys and rat-hunters. " What a bear is young Lord A. ! " says Lady B. " And how horribly ugly and common!" adds the Countess of C, in bated tones. " And how like his wet-nur.se, both in face and manners ! " adds the Duke of D. " And cares more for her than for his parents ! " chimes in Mrs. Dives. Yet another sketch ! 54 INDIGESTION. This is a dear, placid little angel. Its mother is in society, and, of course, therefore, cannot be expected to minister to the necessities of her own offspring. The doctor does not quite like the aspect of affairs, and suggests a change of nurse. Nurse Number Two is imported. Alas, however, her little charge screams during the greater portion of his time. The honest woman, conscious of rectitude, yet unable to account for the change that has taken place, insists upon relinquishing her situation. The nursery has to undergo a cleansing process; accordingly, the corner-cup- board is cleared out; a regiment of empty bottles, labelled " Soothing Syrup " is unearthed! As the infant develops into a child, its relatives discover that it is a semi-idiot! Now for a brighter picture. This smiling, happy lady was, formerly, a clergyman's daughter. The lessons of duty, acquired in early life, have, in her case, borne abundant fruit. The head of the household is a physician. The mother permits nothing to in- terfere with the due performance of her sacred duties. The greater portion of her life is spent in the society of her children. Like Cornelia, the Roman matron, these are her jewels. She cares not for show, for glitter, for purple and fine linen, INFANTILE INDIGESTION. 55 for luxury, for the stencil of society. Her home is her world. Both she and her husband take their meals with the little ones. They seldom touch alcoholics—the children never taste them. The two youngest sleep in cots that stand beside the parental couch. All are fed with a sufficiency of plain food, of which milk forms an o'ertowering item; they are bathed daily; they are warmly clad; they are not overburdened with study. Now for results.— The home is the abode of peace. Sickness but rarely crosses the threshold. Sound repose is the portion of that household. The mother is con- tented, the father peaceful. The daughters are certain to marry well—they are so fresh, so happy, so ladylike, so natural! Fred—the eldest—is an athlete at Cambridge. Already he shows symptoms of becoming, at no distant date, a family prop. Let any one dare to injure a hair of the head of father or mother! or to whisper a letter derogatory to either of his sisters ! Fred would flay him alive ! At once the question arises, what is to be done in those exceptional cases where the mother would, willingly, suckle her infants, were it not that suppression of milk prevents her so doing. To this I reply—Few, very few, women are physically 56 INDIGESTION. incapable of performing the maternal function, provided only they will study their digestive organs, and obey general hygienic laws. I will illustrate this fact by stating a case. In the first year of my practice, F. H. con- sulted me. She stated that she had already borne three children; and that her milk had left her, in each instance, when the child arrived at the age of six weeks. Of course she desired that, for many reasons, a similar misfortune should be, if such were a possibility, avoided during future lactations. Falling in with the customs of the day, I ordered her to eat plentifully of meat; also to drink half a bottleful of stout, in which two grains of quinine had been mixed, at each of the three meals—luncheon, dinner, and supper. Her milk disappeared as heretofore, though she carried out my injunctions to the very letter. She ceased to take medicine. Some three months afterwards, I, incidentally, lighted upon F. H. She informed me that, a few days after last seeing me, she met a teetotal friend, who persuaded her, on the one hand, to abandon the use of alcoholics—also meat, except in very moderate quantities—and, on the other hand, to partake plentifully of vegetable diet, and to drink at least a quart of milk in the course of INFANTILE INDIGESTION. 57 each twenty-four hours; she added, that she followed her friend's advice, with the result that her milk not only reappeared, but flowed in abundant streams. I stumbled across this patient, in London, some eight years since. She told me that she frequently, during the periods of successive sucklings, drank as much as two quarts of milk daily; and added that, so long as she continued to do so, she experienced no difficulty in suckling her infants. It would be unworthy of me, either as a logician or a physician, to measure the universal by the standard of the particular. The details of this interesting case did, however, set me cogi- tating. Experience has since taught me, that, the number of women who are physically incapable of suckling their infants, provided they are willing to follow the example of F. H., is very small indeed. What steps must be taken in cases where a mother either refuses to suckle her offspring, or is actually incapable of imparting the re- quisite amount of nutriment ? The plan that must, under such circumstances, be followed, is —In the absence of Nature, follow on her heels as closely as possible. The outside foods best calcu- 58 INDIGESTION. lated to supply the place of human milk rank in the following order:— 1. Ass's milk. 2. Groat's milk. 3. Cow's milk. 4. Anglo-Swiss milk. I am often requested to express an opinion as to the relative merits of the various kinds of Prepared Foods that are offered to the public, at the present day. I can only repeat that which I have already stated, viz., that an infant's stomach is constituted to digest human milk, and human milk alone—that is to say, animal food, living, and in the form most easily assimilable—and that, therefore, vegetable food, of any kind, must be, and is proved to be, more or less, unsuitable in character. I am frequently told that the con- stituent elements of the two kinds of food are identical. To this I reply that constituent elements, built in Nature's laboratory, produce resultants differing widely from those piled up in man's workshop; and that the universality of Nature's law, in reference to the nourishment of the young animal, proves it to be a matter not to be lightly set aside. Many individuals point to leviathan-children, fed according to irrational principles, and, with INFANTILE INDIGESTION. 59 apparent reason, ask, how my assertion can be founded on truth whilst we see fed-children develop as such and such a child has grown. My reply is five-fold in character. It is— 1. If it be desired that a child should develop into an intelligent, superior animal, let it be fed upon superior animal. 2. It is a mistake to imagine, that because an infant is a mountain of flesh, it is, therefore, a mountain of health also. 3. The physician alone is cognizant of the total number of children who die of improper feeding. 4. The death-rate amongst fed infants is ten times higher than amongst suckled children. 5. Though some few possess the vitality necessary to fight against unnatural surround- ings ; the majority will sink under their weight. And now arises a further question. It is— What is the best food to administer to infants in cases where, on account of special circumstances, milk, in sufficient quantities, is unobtainable ? I reply that all the Patented Foods usually answer fairly well. Lloyd's Universal Food is, in my opinion, almost without a rival, not only in the case of infants, but also for invalids of all ages. I use it largely in my own nursery ; and recommend it extensively to my patients. These failing, 60 INDIGESTION. either baked flour or the Patent Corn Flour will stop a gap with tolerable efficiency. Any food that has undergone fermentation—and, therefore, bread—is to be, as much as possible, avoided. If alone available, it should be scalded at least twice, and the water employed poured off and thrown away. Thus the amount of ferment, present in the bread, will be reduced to a minimum. Are spirits or soothing syrup never to be employed ?—I am not unfrequently asked. I reply, Never, except under the direction of a qualified medical man ; when, of course, they will be called into requisition for the purpose of meeting a temporary emergency, and their use abandoned as soon as the special circumstances that demanded their administration have ceased to exist. Young children must not be permitted to encounter over-excitement. Their imperfectly developed nervous centres are unable to cope with an ordeal so trying in character. Every organ of the body suffers from an infliction of the kind mentioned. The results are convulsions, thirst, heat of skin, rapidity of pulse, vomiting, diarrhoea, spasmodic croup, insomnolence. Now let us sketch a few of the results, both near and remote, of improper infant-feeding and INFANTILE INDIGESTION. 61 consequent indigestion, bringing in its train mal- nutrition : 1. Indigestion, gradual wasting. Death from actual starvation at the age of four months. 2. Indigestion, intestinal irritation. Death from diarrhoea at the age of six months. 3. Indigestion, irritation of the digestive tract. Death from convulsions during dentition. 4. Indigestion, permanent disorder of the digestive tract. Death from disease of kidneys at the age of five years. 5. Indigestion, rickets, curvature of bones— even of spine, permanent disfigurement. Early death. 6. Indigestion, formation of acid in the diges- tive organs. Rheumatic-fever, between the ages of six and eighteen. Death from disease of heart at the age of twenty-one. 7. Indigestion, water on the brain. Prolonged suffering. Death between the ages of two years and twenty. Case VI.—In the summer of 1880, I was consulted in reference to M. C, aged two years, the child of a watchmaker. This child had been improperly fed from the hour of its birth. The result was that it obtained 62 INDIGESTION. no sound sleep ; but lived almost continuously in a state of tears and fidgets. A very carefully regulated system of diet, reduced the child, in the course of about a week, to a state of something like normal placidity. In the early spring of 1882 the mother of M. C. was compelled to spend forty-eight hours or so at the bedside of a dying relative. Her instructions given in reference to the feeding of her child were not carried out during her absence from home. The result was that, on her return, weary from much travelling, she found M. C. in her former condition of unbearable restlessness. A resumption of a more suitable course of diet, however, speedily restored M. C. to her late happy condition both of body and mind. General Hygienic Considerations, I shall, of course, touch upon in a future chapter. CHAPTER IX. OF THE INDIGESTION OF YOUTH. This also is a more serious matter than the indigestion beginning in adult age, for the reason that it occurs whilst the body is still in a state of transitional development, and when, consequently, due nutrition is a matter of primary importance. The boy is pallid and restless, usually drowsy, and unable to fix his attention upon his studies. His muscles become flabby; he begins to stoop; he appears loose about the knees; is irritable in temper, disinclined to mix in youthful sports, as of yore, his appetite is uncertain and depraved, and his repose is interrupted by dreams so fright- ful in character, that he absolutely dreads the approach of night. Inappropriate diet, excessive book-work, evil practices, or terror either of the master or a dictatorial fellow-pupil, rapidity of growth, 64 INDIGESTION. foulness of air, or insufficiency of clothing, are the 'more common causes of the indigestion of youth. This form of indigestion is, also, very amenable to treatment. Man has reason to congratulate himself on the existence of this fact, since youth, not age, is the season for successfully fighting the battle with indigestion. The treatment consists in light diet, unlimited sleep, pure air, a sufficiency of outdoor exercise, daily ablutions, temporary remission of study; also the separation from any cause of terror that may exist. The principal of every educational establish- ment should pass through a course of instruction in physiology, chemistry, and practical hygiene. I hope to see the day when schools shall be registered, and placed under the surveillance of a qualified physician, who shall make a daily visit to each seminary.* * See a three-page pamphlet on " Education/' written by myself. CHAPTER X. THE GENERAL TREATMENT OF INDIGESTION IN THE ADULT. Once more the whole domain of practice of therapeutics lies spread out before us. The various items constituting the treatment of indigestion should, in my opinion, be classified in the following order :— 1—and most important of all—A carefully regulated Diet. 2. Baths — i.e., Hydropathy, scientifically applied. 3. Mental occupation of an engrossing cha- racter. 4. Hygienic considerations. 5. Drugs. 6. Galvanism, scientifically applied. 7. Oxygen gas (Inhalation of). 8. Surgical interference. F 66 INDIGESTION. 9. Change of air and scene. 10. Sufficiency of clothing. 11. Mixing in society. 12. Scientific cookery. 13. The abandonment of tobacco-smoking. 14. The cultivation of music. 15. The employment of the sun-bath. CHAPTER XI. ON DIET. Volumes have been written in days gone by; nay, doubtless, will be penned, in years to come, and that, too, by physicians of eminence, on the subject of diet in dyspepsia. To me it appears that, after all, the subject is included within a small boundary-line. The rationale of it all may be summed up in one sentence, viz., " The more nearly one's digestive organs approach, in weak- ness, those of an infant, the more nearly must the diet approach that of an infant also." This is a fact, difficult of reception by the public at large ; nevertheless, it is a fact, and one, moreover, that any individual may, by calling his perceptive faculties into requisition, observe for himself. Maximinus was accustomed to eat forty pounds of meat, and drink six gallons of wine daily. Tarrare, a Frenchman, could, at the ag- of seventeen, devour a quarter of beef in twenty- 68 INDIGESTION. four hours ! A relative has seen a Derbyshire coal-miner lay a thick piece of raw steak upon a huge slice of bread, cut the two into fingers, and eat them thus. On the other hand, a mutual acquaintance can place her index on two middle- aged men (one of whom is a baronet, and con- sequently in a position, by mere length of pocket, to command every luxury of the table), who have learned in the hard school of physical suffering, that if they desire to enjoy even an approach to bodily comfort, their diet must consist exclusively of milk. During the late sad Russo-Turkish War, the amount of food on which the subjects of the Sultan, not only fought like demons, but also enjoyed splendid health, was almost incredibly small. The Indian contingent, who took part in the Egyptian war just concluded, and whose physique was simply superb, were vegetarians and total abstainers. Nevertheless, they fought magnificently. Dyspeptics must, most rigidly, abstain from the practice of taking suppers. The brain cannot sleep if the stomach be at work ; the stomach can work but imperfectly if the brain be asleep. The outcome of supper-eating consists in the generation of the irritating—nay, I may say PN DIET. 69 poisonous resultants of partially suspended diges- tion ; the S}rmptoms, manifesting their presence in the circulation, are restlessness, horrible dreams : foulness of mouth, and debility the following morning. The Grape-Cure has, within the last few years, done marvels to comers from every nation. Yet, what is its essence ? Simply this—That at Durkheim, in Germany, patients prostrated by various forms of disease, are received, and fed— all principally, many entirely—upon ripe grapes ; and, with results that are astonishingly good. They recover health with a rapidity that is scarcely to be credited by him who has not witnessed resurrections of the kind. Unfor- tunately, grapes, at Durkheim, as elsewhere, remain in season for two months in the year only ; unfortunately, also, the occurrence of disease is not limited to a certain season, hence this pleasant mode of cure lies within the reach of only a few of the sick ones of Europe. Fortunately, however, milk—the grapes of the animal kingdom—remains in season the whole twelve months through. It is a most regrettable circumstance, that so comparatively few indi- viduals can be induced to place full reliance on this all-sufficient article of diet—this truly power- 70 INDIGESTION. ful medicine. I can fully understand a dweller in a large city, refusing to partake of the milk of a cow, that passes its life in an urban shed. I should, myself, refuse to do so; knowing, as I must, that an animal, whose nature is to roam at large in the fields, can no more retain health under such conditions, than a man can enjoy freedom from disease, if confined in a cupboard both dark and dirty. Yet, I ask, what reason exists for urban-cowsheds in these days of rail- ways and macadamized roads ? Certainly the dwellers in agricultural districts may reckon upon a perfect immunity from so unwholesome an infliction. The pea and bean tribe of plants supplies us with food, most nourishing in character. Lentils occupy, probably, the first position in this truly valuable family. It is generally believed that a certain Patent Food, that bears an African name, is composed entirely of lentils, ground to extreme fineness, thus exposing the greatest possible amount of surface to the action of the gastric juice. Yet, beyond doubt, the food in question has saved the lives of thousands of our fellow- countrymen. Why ?—Because it presents to de- bilitated digestive organs nourishment of a kind that is most easy of assimilation. ON DIET. 71 I have, very frequently, been requested to enlighten patients, as to the comparative diges- tibility of various kinds of food. I will shortly draw up a table setting forth this matter; yet premising that digestibility is a relative term; also that that which is food to the many may prove poison to the few; and that, moreover, I write principally for the benefit of those who are inhabitants—not of foreign countries, but—of the British Islands.* For much of our knowledge in reference to the stomach portion of the digestive function we are indebted to the case of Alexis St. Martin, f He was a Canadian, of French descent; and, in 1822, received a wound in the stomach by the accidental discharge of a musket. His case is unique. Within three months, from the date of receipt of the injury, a natural valve had formed, which, on the one hand, entirely prevented efflux of food, but, on the other, admitted of being, readily, * Since penning the above paragraph, letters of consul- tation that have arrived from North America, Canada, India, South Australia, and New Zealand, convince me that the rules of diet that I lay down are susceptible of very general applicability. t Alexis St. Martin is still (January, 1881) alive. He is far advanced in years, yet, in spite of the existence of the aperture in his stomach, enjoys very fair health. 72 INDIGESTION. pushed back, from without, by the finger of an operator. From experiments conducted upon him by Dr. Beaumont, his medical attendant, the following facts were obtained : — Time o ccupied Article. Mode of cooking. in conversion into chyme. h. m. Rice Boiled ...... 1 0 Sago ...... „ 1 45 Tapioca „ 2 0 Barley „ 2 0 Bread Baked (new) 3 0 „ ...... „ (stale) 2 0 Sponge-cake ...... 2 30 Vegetables— Cabbage ... Raw ... 2 30* Cabbage (Vinegar much assisted) Boiled ...... 4 0* Potatoes ... Roasted 2 30 „ Boiled ...... 3 30 Carrots 3 15 Beets ...... 3 45 Turnips 99 3 30 Beans 9> 2 30 Parsnips ... ...... 2 31 Fruit— Apples Sour and hard 2 50 „ ...... Mellow ...... 2 0 „ Sweet and ripe 1 30 Peach Mellow ...... 1 30 * I am inclined to the belief, held by many physiologists, that these figures should be transposed. ON DIET. 73 Time occupied Article. Mode of cooking. in conversion into c hyme. h. m. Fish and Shell-fish— Trout ...... Boiled or fried 1 30 Cod..... Cured and boiled ... 2 0 Oysters Undressed ... 2 50 „ Roasted 3 15 » Stewed 3 30 Bass Broiled 3 0 Flounder .. Fried ...... 3 30 Salmon Salted and boiled ... 4 0 Poultry, Game,&c.— Turkey ...... Roasted 2 30 ,, ... ... Boiled ...... 2 35 Goose (Wild) Roasted ...... 2 35 Fowls (Domestic) Boiled or roasted ... 4 0 Ducks (Tame) Roasted 4 0 „ (Wild) ... ...... 4 30 Butchers' Meat, &c. Soused Tripe • ... Fried or boiled 1 0 Pigs' Feet...... Boiled ...... 1 0 Venison Steak Broiled 1 35 Calf's Liver „ 2 0 Lamb's „ ,, 2 0 Sucking Pig Baked 2 30 Mutton ...... Broiled 3 0 n Boiled ..... 3 0 ...... Roast 3 15 Beef (Fresh) Broiled 3 0 „ Roasted 3 0 „ Lightly salted and boiled 3 36 „ Old hard salted 4 15 Pork Steak ... Broiled ...... 3 15 74 INDIGESTION. Article. Mode of cookin S- Time occupied in conversion into chyme. h. m. Pork Lately salted boiled and 4 30 „ Stewed ... 3 0 ... Roast 5 15 Veal Broiled 4 0 „ Fried 4 30 Varieties— Eggs Raw ... Roasted 2 2 0 15 „ Soft-boiled ... 3 0 ,, Hard-boiled or fried 3 30 Custard Baked 2 45 Milk Uncooked ... 2 0 Butter and cheese Uncooked ... 3 30 Suet Boiled ... 4 30 Oil...... Uncooked ... Rather longer Apple Dumplings... White Calf's-foot Boiled 3 0 Jelly ... Uncooked ... Rather more than 30m. Of course, inasmuch as we, in England, are not Canadians by birth, do not reside in the clear though biting Canadian climate, nor feed upon the fruits of Canadian soil, it behoves us to .use caution and judgment in applying a standard, like that of St. Martin, to our own requirements. Without doubt, however, this table is, as a whole, and as above stated, susceptible of a near approach ON DIET. 75 to general applicability. If called upon to draw up a table suited to the requirements of the white races, and arranged according to digestibility, I should set down my articles of diet in the fol- lowing order:— Fruits. Grapes. Then—after a long Cherries. gap- Currants, Red. Strawberries. White. Pears. Black. Oranges. Gooseberries. Melon. Apples (ripe). Raspberries. Almonds (blanched) and Mulberries. Raisins. Greengages. Figs. Nectarines. Almond-Nuts. Peaches. Barcelonas. Pine Apples. Brazils. Vegei ABLES. Lentils. Potatoes. French-Beans. Parsnips. Scarlet-Runners. Carrots. Vegetable-Marrows. Broad Beans. Cauliflowers. Cucumber. Broccoli. Herbs containing essential Peas. oils, as— Celery (stewed). Mint. Artichokes. Thyme. Spanish Onions. Sage. Lettuces. Marjoram. Fi 3H. Turtle. Turbot. Oysters. Sole (boiled). Eels. „ (fried). 76 INDIGESTION. Fish—cont inue d. Brill. Herrings (fresh). Bloaters. Plaice. Salmon. Cod. Mackerel. Shrimps. Lobster. Crab. Poultry . Chicken. Turkey (boiled). „ * (roast). Duck. Goose. Game. Pheasant. Partridge. Prairie Hen. Grouse. Woodcock. Snipe. Ptarmigan. Hare. Rabbit (Wild). Flesh. Mutton (boiled). 1 Beef, Round (roasted) Beef „ „ Eibs Mutton (roasted). Lamb. Beef, Sirloin (roasted). 1 Veal. Animal Foods. Butter (fresh).* | Butter (salt). Cheese. Glo'ster. Gruyere. American (good). Dutch (good). Stilton. * It behoves the dyspeptic to use great care in the selection of butter. Probably no article of diet is more. adulterated. ON DIET. ( t Arrowroot.* Eice, Ground. „ Whole. Tapioca. Red Currant Jelly. Black Currant „ Greengage Jam.f Strawberry „ Raspberry „. Blackberry „ Farinaceous. Maccaroni. Vermicelli. Semolina. Corn-flour. Preserves. Pine Apple Jam. Apricot „ Red Currant „ Gooseberry „ Plum Damson The dyspeptic must make up his mind, when he places himself under treatment, to obey the injunctions of his doctor even when they run counter to the wishes of friends and relatives. The moment the latter see him losing flesh, they begin to experience alarm ; apparently, they are unable to realize the fact, that the adipose tissue of the sufferer from indigestion, is usually un- healthy in character, and that he is better without it;—that it, like the deposits of rheumatism and gout, lies outside the circulation, and as a con- sequence, practically outside the body also; that Nature's object is to eject it from the blood, inas- * It is not generally known, nevertheless it is a fact, that high-class arrowroot retains its semi-solidity even when it has been allowed to become cold. t Jams possessing a good brand should alone be pur- chased. The foundation of the commoner sorts is either vegetable-marrow or turnip. 78 INDIGESTION. much as if retained therein, it brings death in its train. Seldom, indeed, can they be brought to be- lieve that a few ounces of properly selected nourish- ment will afford more nutriment than many pounds taken haphazard. Yet such is the fact. A trifling amount of indulgence at one meal, will, frequently, undo the benign work of days of self-denial. Non-Alcoholic Beverages. Coffee with Dandelion. Coffee and Chicory. „ (French). (English). Soda Water. Ginger Beer (aerated). „ (as usually sold). Lemonade. Seltzer Water. Beckitt's Fruit Syrups. Ginger Wine.* Water (if impure, boiled and filtered through char- coal, or, better still, spongy-iron). Cocoatina (Schweitzer's). Cocoa (Epps'). Cocoa (Van-Houten's). Cocoa (commoner varieties of). Tea (cold infusion of, heated to desired temperature). Tea (hot infusion of). Acoholics. Brandy (diluted to extreme tenuity). Whisky (diluted to extreme tenuity). Clarets. Light Wines high-class). Gin (diluted tenuity). (Continental, to extreme Sherry (old and dry). „ (recent). Rum (diluted to extreme tenuity). Light Ale. Strong „ Porter. Stout. Port (old and dry). * Ginger wine contains so trifling an amount of alcohol that I prefer to write of it as a non-alcoholic beverage. Messrs. William Rankin & Son, wine merchants, of ON DIET. 79 It is needless to add that, in the preparation of a list, suited to the dimensions of a book the size of that which I am now penning, I can only allot sufficient space wherein to mention the articles of diet in more general use. For the second time, I impress upon my readers that I can deal but with generalities—that, in exceptional cases, the old adage, to the effect that that which is one man's meat is another man's poison, is literal truth. In regard to alcoholics, the dyspeptic may safely adopt the broad principle that the less alcohol he imbibes the better for his digestion. Dr. Beaumont's experiments performed upon Alexis St. Martin, already mentioned, proved that the ingestion of even a very small quantity of this fluid invariably induced inflammation of the lining membrane of the stomach. My own observations entirely support those of Dr. Beau- mont. One marked result of the treatment of indi- gestion, by means of diet and hydropathy, consists in the voluntary abandonment of alco- holics by the patient. Kilmarnock, sell a high-class rich, pale, ginger wine, which I have found admirably suited to the requirements of dyspeptics. Messrs. Beaufoy, of London, have sent me a very nice sample of inexpensive ginger wine. 80 INDIGESTION. I must not pass from the subject of drinks in dyspepsia without writing a few words on the beverages usually found on the breakfast and tea table. Schweitzer's cocoatina, when brewed weak, and drowned in milk, is as grateful to an irritable stomach, as it is nourishing to the body. Next in order, comes Epps's Cocoa, then Yan Houten's, and, finally, the numerous preparations of the bean, that appear in the market. It is a most exceptional event to meet with a dyspeptic whom cocoatina does not suit. When brewed in strength cocoatina possesses a bitter taste, and under these circumstances, is sometimes found to disagree with him. The process of boiling much increases its assimilability. Coffee, either conjoined with, or separate from, chicory, scalds the stomachs of the great majority of dyspeptics. Herbert's coffee; also the tarax- acum and coffee, are the least irritating forms of the berry. Tea is, as a rule, most sedulously to be avoided by dyspeptics. Not one in fifty can partake of it without paying a most severe penalty for his indulgence. The symptoms that follow its use are—depression of spirits, frequently amounting to melancholia ; flatulence; ON DIET. 81 foulness of mouth ; shortness of breath; insomnia ; temporary suppression of urine; tremulousness of muscles ; colonic spasms; a scalding sensation in the stomach, and acid risings. Many dyspeptics absolutely refuse to abandon the use of tea. Under such circumstances, it behoves the physician, to devise means by which the injurious effects of the beverage may be reduced to a minimum. This object is, in my opinion, most easy of attainment, by using high-class leaf, and infusing it with cold distilled water. The latter being unattainable, I recom- mend the substitution of rain-water, boiled, allowed to stand till cold, and then filtered through charcoal or spongy-iron. The infusion may be heated, as required, to the desired temperature. By a recourse to these measures a considerable amount of flavor is obtainable, yet conjoined with the minimum of astringent principle. It is seldom necessary to allow the water to remain on the tea for a longer period than two hours. Another plan is to infuse the tea with hot water in a coffee-percolator, and to drink the infusion as soon as it has passed into the receiver. G 82 INDIGESTION. A third is to pour the infusion into a second tea-pot five minutes after infusing the leaf. Messrs. Phillips and Co., tea dealers, of King William Street, London; also Mr. Scott, tea dealer, of Canterbury, have afforded me valuable aid in experimenting with various kinds of tea. Both firms have sent me fine specimens of leaf. The Kaisow Congou of the former; and the blend of Kaisow Congou with Assam Pekoe, supplied by the latter, are, to my judgment, particularly little unsuited to the sensitive stomachs of dyspeptics. Doubtless, however, it is scarcely necessary for me to warn the reader that no low-priced teas may be indulged in. As far as I can learn from dealers, four shillings per pound may be safely set down as the mini- mum sum that they should pay for their tea. The Chinese and the Russians are the most extensive consumers of tea in the world. Neither the one nor the other would, however, be content to make use of the inferior qualities of the leaf with which the English market is glutted. Messrs. Phillips have also sent me a specimen of dandelion-coffee. This appears to be a con- siderable improvement upon the crude berry. It is not, however, palatable. Possibly this insufficiency may be, in due course, remedied. ON DIET. 83 The Mode of Cooking the food of a sufferer from dyspepsia is a matter not to be hghtly passed over. Thus, meats should be placed on table, either hot or cold, roasted, boiled, or steamed—never baked, never twice cooked, never cooked enclosed in a crust. In the case of pastry, the fruit should be prepared separately from the crust, and spread upon it shortly before eating. The cooking utensils must be maintained in a state of absolute cleanliness. The mistress of every household should charge herself with the surveillance of this very important matter. No doubt exists as to the truth of the assertion that digestion begins in the kitchen. One might, indeed, with safety, go much further back even than this. CHAPTER XII. BATHING. A brief sketch of the skin and its functions, is a necessary introduction to the hygienic considera- tion of the question of indigestion. The skin is composed of three layers, viz., the Epidermis, or covering; the Basement Membrane ; and the True Skin. The last is that which, principally, concerns us, at the present moment. It eovers the whole surface of the body, and is liberally supplied with blood-vessels and nerves. These endow it with acute sensibility, and enable it to excrete fluids from its surface. It possesses the threefold power of tension, extensibility, and contractility. The Perspiration is derived from the sudoriferous glands. These exist in almost every portion of the skin, and discharge their contents through openings, or pores. High authority sets down the number of pores, of an ordinary sized body, as bathing. 85 7,000,000 ; and the length of tubing that com- poses these glands at twenty-eight miles. The average quantity of perspiration cast off by the pores is believed to amount to two and a half pounds in the course of twenty-four hours. A vast amount of impurity is eliminated from the economy through the medium of the skin. It is, in fact, one of the sewers of the body. In consequence, however, of the variations in at- mospheric influences, and also of the insufficient use of the bath, it is a most rare occurrence, to meet with an individual, whose skin discharges its functions with, even, medium efficiency. The result is, that much work to which they are un- suited, is thrown upon the internal or mucous membranes, congestion of which, as a natural result, follows. Mucous membrane very nearly resembles skin ; so closely, indeed, that if everted and kept dry, it speedily assumes the characteristics of integu- ment. On the other hand, skin, if inverted and kept moist, speedily puts on the appearance of mucous membrane. The whole of the skin secretes an acid humor ; the whole of the mucous membrane of the alimentary canal, with the exception of that of the stomach, gives birth to one that is alkaline. 86 indigestion. Even in health, but more particularly in disease, the due performance of the functions of the skin, is a matter of primary importance. The investing membrane is the regulator of the temperature of the body; and also the principal safety-valve for discharge of diseases or disorders of the internal organs. Whatever agency directly affects either of these membranes, indirectly influences the other also. Theoretically, it is a matter of paramount im- portance that the functions of the skin should be maintained in a healthy condition. This is found, practically, to be absolutely true. The skin of the adult, is, when in a state of health, almost as soft as that of a young child. Let us, however, examine the integument of almost any individual, and we find it in the opposite condition to that in which it should be found. Nature has, however, provided a remedy, as abundant as it is inexpensive, for this universal disorder. This is Water, used at various temperatures, and applied by hands that have studied the profession from its first rudi- ments. I have no faith—and that, too, not without reason—in amateur hydropathy. I am satisfied, that, unqualified aspirants to hydro- pathic honors inflict not only temporary pain, but BATHING. 87 also permanent mischief upon their too-reliant patients. I recommend every sufferer from indigestion to try, in his own person, the two experiments now to be suggested. 1. Let him enter a water-bath, the contents of which, have been raised to a temperature, as high as he can comfortably tolerate, and let him invite a second person to knead him thoroughly, whilst reclining therein, from head to foot. As a result, the amount of impurit3r, that the operator will extract from the pores of the bather, will be so large that the patient will shudder with disgust; or 2. Let him get into a bath of similar character, and both soap and scrub himself thoroughly—the latter either with a rough-glove or a flesh-brush,— also from head to foot. After the lapse of fifteen minutes, let him leave the bath. When sufficient time has elapsed to permit of the subsidence of solid matter, let him pour away the water, leaving only the dregs in the bath. He will stand astonished at the quantity of impurity that he has removed from the surface of his body. Surprise, No. 3, will be his portion when, by passing his hand gently over his skin, he realizes 88 INDIGESTION. the velvety softness of surface that he has acquired. Should he, after immersion, feel weak and exhausted, he may restore himself, to his pristine strength, either by taking a shower-bath, or sponging, with cold water, from head to foot. If one of my readers desires to prove, in propria persona, the tonic powers of water, used in its natural condition, let him try one or more of the following experiments:— 1. Let him plunge into cold water, and come out therefrom, as speedily as possible ; or 2. Let him take a shower-bath three seconds of time in duration. Or, fearing either of the above courses, 3. Let him request a friend, the latter having caught him whilst sleeping, to let fall upon his face a single drop of cold water. He will thus discover that as soon as the water touches his skin, a sensation of intense coldness will be in- duced, which coldness will, however, after the lapse of a few moments, be succeeded by a glow, more or less permanent in duration. If, as the hour of refection approaches, he feels totally disinclined to eat, let him take a vapor- bath, followed by the cold sponge or the cold shower. By these means he will relieve internal BATHING. 89 congestion, and, in all probability, feel that he can enjoy a good meal. If appetite fails to return, he may rest assured that his system does not stand in need of food. If a dyspeptic partakes freely of indigestible food—say meat-pudding—or drinks a couple of glasses of port wine, he frequently finds that a sensation of general flaccidity, accompanied by a feeling as of greasiness of skin, overtakes him. Let him, under these circumstances, sponge from head to foot, or, even, sluice his face with cold water, and apply a large sponge, partially wrung out, to his abdomen, retaining it in position for about fifteen minutes. He will find, as a result, that his unnatural sensations have been, to a great extent, dispelled. When heated and applied to the skin for a brief period—say, two or three minutes—water draws the blood to the surface; if maintained in contact therewith, for a prolonged period—say fifteen to twenty—it is a powerful depressant. If applied cold, and for the duration of a few minutes only, it is a vigorous tonic; but if applied for a long period, it becomes an energetic de- pressant. Beyond question, every individual who enjoys a fair share of vitality, ought, if he regards the 90 INDIGESTION. preservation of his health, to wash from head to foot, daily, upon rising from bed. The mucous membranes are continuous with the skin, and, as already stated, are very similar in structure. Whatever affects the one, necessarily, therefore, affects the other. An old proverb asserts that the man who laughs, must, of necessity, and as a consequence, grow fat. This statement, contains, however, but partial truth. The fact is, that the individual who will take the trouble to get his digestive apparatus into good working order, will not only acquire reasonable rotundity, but will also become more or less hilarious. The Forms of bath most useful in indigestion are— 1. The Russian vapor-bath. 2. The Turkish-bath. 3. The Hot-air-bath. 4. The ordinary Steam-bath. 5. The Cabinet Turkish-bath. 6. The indoor portable Turkish-bath, as it is generally called. I have arranged them in order of merit. The last I scarcely care to mention, (1) Inasmuch as it is too feeble to be productive of real BATHING. 91 benefit; and (2) because its employment always involves the peril of setting fire to the sur- roundings of the patient. Cold baths I classify as follows:— 1. The Cold Plunge fresh-water bath. Advisedly, I write fresh water, it being my experience, after a prolonged term of residence at the seaside, that salt-water baths do not suit dyspeptics. 2. The Shower-bath. This is a most invigorating tonic in cases where the shock it induces can be tolerated. 3. The Sitz or hip-bath. This also is a tonic of no mean power. It is most serviceable in cases where the debility appears principally to invade the lower portions of the body, as, e.g., in cases of congestion of the haemorrhoidal veins, and in prolapsus of the womb or lower bowel. 4. The Hand-basin-and-sponge bath. The last-named is the most useful, because it is at all times obtainable ; because inexpensive ; and because, in no degree, calculated to impart a shock to the nervous systems of dyspeptics, the enormous majority of whom are keenly sensitive. It does not possess the power to unload a blocked skin; but it will maintain it, when unloaded by 92 INDIGESTION. more powerful measures, in reasonably good working order, thus enabling the pores to open at the approach of warmth, and to close at the approach of cold. Cold baths of all kinds, are great safeguards against the taking of a chill. Only those individuals who feel in a glow upon emerging therefrom should resort to the use of the cold bath. When the latter causes blueness of surface, shiverings, or temporary death of extrem- ities, it must not be taken. In such cases the patient may warm the water he employs, according to his requirements. A course of Yapor-baths will, usually, speedily put a point to the unhealthy condition of skin just recorded. The Ascending Douche is most useful in cases of prolapsus of the bowel or womb; in piles, thread-worms, and inability to retain urine for the normal period; also in impotence dependent upon nervine atony. The sensitiveness of every portion of an in- dividual not afflicted with organic disease, is directly proportionate to the sensitiveness of his digestive organs. I so often mention the Russian vapor-bath in my pages, that it behoves me, I take it, to write a few lines in reference both to the mode of BATHING. 93 construction and the therapeutic action of the apparatus. It consists of a wooden chamber, about six feet in length, three in depth, and six in height. It is lined with metal, and contains a galvanized-iron couch. Upon this couch, when covered with blankets, the patient reclines. It is provided with windows, also with a ventilator fitted to the roof. Owing to the existence of the latter, the patient is enabled to bring the temperature of the bath into harmony with his own sensations. Upon emerging therefrom, he may proceed to cool himself by means of either the needle- or the shower-bath; or, if he prefer so doing, may sponge thoroughly with warm or cold water. The head of the patient being included in the bath, the lining membrane even of the nasal passages, throat and lungs, is exposed to the healing action of the vapor. It secures a uniformity of perspiration, and that, too, at a temperature rarely exceeding 115°. A resort to temperatures so exalted as 150°, 160°, 170°, as is the case when the Turkish-bath is employed, is never found necessary. It is the most powerful of the baths that I am acquainted with in regard to therapeutic results. Its drawbacks are that it is cumbersome; should 94 INDIGESTION. be built as a fixture; and necessitates the ex- penditure of two hours of time in the process of satisfactorily getting up steam. One patient only is bathed at a time ; hence all fear of inspiring infection is done away with. It is readily susceptible of disinfection should occasion require. The bath is, contrary to popular belief, in no sense, a depressing agent. By withdrawing im- purities, which are causes of depression, it becomes a most invigorating tonic. The process of taking a bath occupies only about half an hour. Hence, individuals whose time is, already, fully occupied,—such as heads of business-houses and mothers of families,—are not debarred from its use. Inasmuch as the patient assumes the recumbent posture, whilst taking the bath, all tendency to palpitation or faintness is done away with. It is arranged in such a manner as to admit of the addition of medication, as with sulphur or herbs ; or the use of electricity. By unlocking the pores of the skin, it removes all sensation of chilliness ; it renders the patient intolerant of excessive clothing; and, usually, destroys his craving for alcoholic stimulants. I may add that I have succeeded in perfecting BATHING. 95 a cupboard-form of the bath, which takes to pieces, and thus becomes portable. The result is, that individuals who are too infirm to travel to it, may have it carried to them. Gas, or, when that is unobtainable, Gasoline, forms the heating agent in this case. Those patients who are, however, compelled to rest content with a substitute for either the Russian or the Turkish-bath, will, I think, do well to purchase from Messrs. Ellis & Co., 165, Fleet Street, E.C., one of their Cabinet Turkish-baths. In conclusion, and en passant, I may mention that the Russian-bath is as potent an engine for good in the treatment of rheumatism and gout—each the offspring of dyspepsia—as it is in the alleviation of indigestion itself. The uninitiated are somewhat apt to assert, that hydropathic treatment is, from its very nature, susceptible of but extremely limited application. Now, whilst freely admitting that such gigantic appliances as the Russian and the Turkish-bath lie only within the reach of the few, I must, nevertheless, remind the com- plainant that the greater portion of the water- treatment lies within the reach of every man. Thus—Who cannot apply the pack in his own bedroom ? What man is unable to resort to 96 INDIGESTION. the use of the compress ? Who is debarred the hot-water bath ? What individual is so straitened in means as to be unable to extem- porize a vapor-bath of no mean power, by the simple process of 'placing a heated brick in a pailful of hot water, and sitting over it, whilst enveloped by blankets ? Or so empty in purse as to be compelled to forego a hot-air bath called into existence by seating himself a little above the level of a couple of bricks heated and laid across the stand of a flat iron ? Again, is the soap-and-water bath a luxury of the rich man alone ? Or the cold sponge-bath an appliance forbidden to the million? Will not even a hank of tow, or a discarded stocking, do duty for a sponge ? The fact is, that water-medication is as generally applicable as it is potent and inexpensive. Can any non-dyspeptic individual gauge the amount of comfort that his less fortunate brother derives from permitting a stream of cold water to flow into his palms, for the space of a few minutes, when a portion of his organism (be it ears, face, stomach, feet, or hands) is of fiery heat in consequence of indigestion ? To pack a patient.—Envelope him in a sheet that has been previously dipped in tepid water, BATHING. 97 then wrung nearly dry. Wrap him in a dry blanket, and cover him with three or four others. Tuck a down coverlet over all. Let him remain packed for a period of thirty to sixty minutes, according to the sudorific effect produced. Re- move every covering, dry him, sponge him over with cold water. Dry him a second time. Let liim rest. H CHAPTER XIII. MENTAL OCCUPATION. The curse of Work, was one of the many blessings conferred, in a disguised form, by the Deity upon man, at the time of his Fall. No class of men suffer more heavily, under the depressing influence of idleness, than the dyspeptic. AVith them, occupation, of such a character as shall engross not only their thoughts but their time also, leaving no idle hours wherein to brood over their ten thousand unpleasant sensations, is a matter almost of life, certainly of comfort. Industry generates an electrical fire in the brain, that sends nerve- force to the fingers' tips, bearing renewed life in its current. It is, of course, desirable that the prescribed occupation should, if possible, stop short of overtaxation of the physical powers of the individual; still—better even excess of toil MENTAL OCCUPATION. 99 than destructive idleness. Their rest should consist in a variation of occupation. They must carefully avoid the perusal of pro- fessional literature, as they are certain to consider themselves the victims of every disease of which the volume treats. Under no possible conca- tenation of events may they study the quack publications of those disreputable advertisers, who sell their brochures below cost price, and whose object is to entrap the sensitive and the unwary into unlimited mental anxiety and consequent wholesale outlay. Light novels bore them; they cannot condescend to such trivialities. Works treating of history and science are com- monly the mental pabulum best suited to their requirements. CHAPTER XIY. HYGIENIC CONSIDERATIONS. Pure Air.—This is a most important matter. The more nearly a dyspeptic can live in pure air, the less he will suffer. If he can, without taking cold, even sleep with the upper sash of his window' lowered to the extent of two or three inches, it is very advisable that he should do so. A residence out of town is, when possible, to be secured. Pie should refrain from burning gas either in bed- or sitting-room. If compelled to use it in his office, he should take care that the gasalier is arranged in such a manner that the products of combustion may either ascend a chimney or pass through perforations in the ceiling, so as to be, at once, conveyed to the exterior of the premises. The forthcoming days of electric-lighting will be happy for the dys- peptic. HYGIENIC CONSIDERATIONS. 101 The obtaining of fresh air, without draught, and, at a minimum of expense, is, at all times, a problem difficult of solution. The most inex- pensive plan is, to raise the lower window- sash about two inches, and to place beneath it a piece of wood exactly filling the opening thus created. By these means the air enters between the two sashes, and is'directed upwards to the ceiling, Heavy furniture should not be placed in front of a window. Practical experience demonstrates the fact that the upper sash is never lowered unless it is get-at-able. In cases where such an arrangement proves inevitable, an endless rope, knotted to a staple affixed to the top of the frame of the sash in question, passing over a pulley screwed into the top of the casement, and hanging within easy reach of the hand of a domestic, proves a great inciter to the admission of fresh air. Sewer Gas is destructive to the sufferer from indigestion. He should take steps to ascertain that no uninterrupted communication exists be- tween the main drainage and the interior of his premises. His sewer-pipes should be placed without his house, and made of earthenware. Even the joints of the rain-water pipes should 102 INDIGESTION. be most carefully stopped, and that, moreover, to the very roof of the house. It is most im- portant, in these days of lax building, that the head of each family should ascertain for himself that they are all properly connected with the sewers. Drain pipes should not be laid from front to back of the house, but should pass along both the back and the front thereof. Water-closets have no right of existence whatsoever inside dwelling-houses—certainly they should not be tolerated near dormitories. If placed within the outer walls, a ventilating shaft should be carried from a point below the valve of the soil pipe to the highest line of the roof. This shaft should not be attached to a chimney- stack lest it prove the means of admitting foul gas to a dormitory through the medium of the chimney of the apartment. Let us, however, do what we may, water-closets will frequently smell, more particularly during the occurrence of rainy weather. The one safe course is to place them outside the house. The traps of drains should be kept, at all times, in their places. No refuse-matter, either animal or vegetable, should be permitted to remain in or near the premises. All such should be thrown on to the fire and destroyed, as HYGIENIC CONSIDERATIONS. 103 soon as it becomes refuse. No live stock should be allowed to dwell in proximity to the house. The house should be surrounded by grass and flowers, and, at a short distance, by trees also, because the vegetable kingdom absorbs impure gases and gives out oxygen. Clothes-washing, mangling, and ironing should be done on the premises, thus avoiding the probability of contamination at the dwelling of a laundress. The house should stand either on gravel, chalk, or sand, and in an elevated position; in no case, either upon clay or upon a site that has been, at any known period, the abode of im- purity, such as, {e.g.,) a rubbish-heap or a dried- ditch. It should face south ; and, if situated in a town, should stand at the western end thereof. It should also be sheltered from both the east and the north wind. The water-supply should be obtained from the works of a public company, never from a well, inasmuch as well-water is frequently found to be contaminated with percola- tions derived from factories, cesspools, churchyards, or even adjacent dwellings. The drinking-water cistern should be made either of galvanized-iron or of slate, and should be kept carefully covered. It should be placed within easy reach of the members of the household, thoroughly cleansed at 104 INDIGESTION. intervals not exceeding three months, and its locale should be set, as far distant as possible, from a water-closet. The over-flow pipe must have no direct communication with the sewers. Even spring-water frequently receives con- taminations as it flows; hence, in country districts, if doubt arise on this point, rain- water, boiled and filtered through charcoal, or, and better still, porous iron, should be used, not only for drinking, but also for cooking purposes. No Paper should be allowed to hang on the walls of rooms. The latter should be annually washed with a solution of slaked-lime, colored according to taste. The admission of plentiful Light is a matter not to be overlooked. Neither animal nor vege- table can flourish in the absence thereof. The Italian proverb, " Where the sun does not come the doctor does," is literally correct. Blinds should be drawn to the top of the windows, and curtains thrown back. Excessive heat—either fire or solar—is extremely enervating to the dyspeptic. During the hot months of the year, he should dress in white outer garments, and wear a light hat made of straw, undyed and loosely-plaited. He should HYGIENIC CONSIDERATIONS. 105 avoid heated and crowded rooms, and should, frequently, have recourse to the bath. Yenetian sun-shades are a great comfort to a sufferer from indigestion. He should spread out all his bed-clothes to air the moment that he leaves his bed. At night, he should hang up all his day-attire for the same purpose. On the other hand, he should be careful, during cold weather, to keep his chest—but more particularly his abdomen—well protected. He need not, as a rule, irritate his skin by wearing a flannel-vest next thereto, provided that he uses the bath daily. Merino vests, also chamois-leather, are very useful. Chilly dyspeptics may wear either the furry skins of animals or the fleecy- wool hosiery. Cork-soles worn in the boots will shield the dyspeptic from many an attack of indigestion. Those inclined to suffer from rheumatism will avoid much trouble by wearing Cording's water- proof boots during snowy or even very rainy weather. It is advisable, under these latter circumstances, to wear woollen stockings con- jointly with waterproof coverings for the feet. It is preferable that not only the waistcoat, but the upper portion of the trousers also, should be lined with cricketing-flannel. 106 INDIGESTION. Tobacco is a narcotic, sedative poison, and should not be used by the dyspeptic. That it destroys appetite, by paralyzing the minute ex- tremities of the nerves of the digestive tract, is an established fact. These nerves are far too highly organized to endure, without reprisal, tam- pering with in such a manner. The sickening process through which smokers pass during their early attempts to reach brevet-rank, tells a long tale as to the antagonism that naturally exists between tobacco and the human economy. CHAPTER XY. DRUGS. Drugs should, in the treatment of indigestion, be, as much as possible, dispensed with. The dyspeptic invariably possesses a highly sensitive digestive tract, lined with membranes that are, usually, intolerant of medicines. Consequently, he should refrain from taking physic, except under medical supervision. Yet drugs, when exhibited by skilled hands, are undoubtedly valu- able accessory means—nay, will in many cases alleviate, in the few, cure. The drugs most commonly used for the cure of dyspepsia are—Pepsine, the digestive principle of the gastric juice ; lactopeptine, and pancrea- tine ; ginger, rhubarb, ipecacuanha; bismuth, opium, hydrocyanic acid ; ice, morphia, and carbonic acid; soda—both bicarbonate and sul- phate—potash, and magnesia; tincture or infusion of orange, of cascarilla, of calumba, of gentian, of I 08 INDIGESTION. hops, of chiretta, and of cinchona; quinine; salicine; nitric, hydrochloric, phosphoric, citric, and sulphuric acids; phosphorus, strychnine, morphia; iron—more especially the ammonio- citrate, the ammonio-tartrate, and the lactate; cod-liver oil; sulphuric ether and ammonia; hyposulphite of lime, permanganate of potash, and carbolic acid; wood charcoal, silver, zinc, aconite, pure oxide of manganese; mineral waters. Castor oil, with essential oil of almonds; colocynth ; rhubarb-pill; sulphur combined with magnesia and ginger. The difficulty that meets us in the treatment of indigestion by means of drugs, is, that their action varies with individuals—nay, with the same individual at different seasons. I confess that I have not yet succeeded in dis- covering a test, by means of which to prophesy, for certainty, whether acids or alkalies will prove the more appropriate remedy in a given case. In fact, I generally put to each patient the leading question: " Do you crave for sour things ? " If he answer affirmatively, I begin with acids; if negatively,—and this happens in the great majority of cases—I administer alkalies. Nevertheless, the answer given does not prove by any means an unerring guide. DRUGS. 109 Frequently do I find that the individual who affirms his inability to tolerate the presence of acids in his stomach, improves rapidly under the administration of lemon-juice. In fact, the more I see of indigestion, the firmer becomes my conviction that to attempt to treat. it upon principles or theories is in many cases to court failure. Doubtless all physicians have their favourite formula}. I, certainly, have mine. A few of these I shall give on future occasions. Alkalies are especially indicated in cases of acid dyspepsia. Soda is very grateful to the stomach; it also induces a slight secretion of bile. Potash is useful in cases of extreme acid- ity, where lithates appear in the urine; in all cases its exhibition should be, as soon as possible, suspended,, as, if given in excessive quantities, it is likely to burn, so to speak, the mucous membrane of the stomach. Magnesia is not only an antacid but a sedative also to the lining membrane of the stomach. These drugs should be administered in carefully-graduated doses, lest an excess of them more than neutralizes exist- ing acid. They should be given at the moment of greatest suffering from acidity, and this period usually occurs from two to four hours after meals. 110 INDIGESTION. Unfortunately, the taste for alkalies becomes a growing evil. Pepsine is one of our most valuable remedies. It is an assistant digester—literally, a pony that helps a debilitated cart-horse to do its work. Lactopeptine must be regarded in a similar light. Ginger is a most useful stomachic; rhubarb is the best tonic to the stomach that the pharma- copoeia holds out to us. Many a sufferer from indigestion, experiences vast comfort, from chew- ing a morsel of the root, the size of a pea, several times daily. Bismuth, opium in small doses, hydrocyanic acid, carbonic acid, also ice, swallowed in tiny fragments, sometimes prove charms in cases of irritable mucous membrane. The vegetable tonics—orange-peel, hops, calumba, cascarilla, gentian, chiretta, salicine, cinchona, and quinine—are occasionally valuable, more particularly when administered in conjunction with either acids or alkalies. Phosphoric, nitric, citric, and hydrochloric acids are useful tonics. The various preparations of iron appear to be especially indicated in those cases where extreme pallor of face shows that the digestive organs do not possess power adequate to the generation of the red corpuscles of the blood in due quan- tities. It is better to begin with small doses DRUGS. Ill of the mildest form of the drug—say one grain of the lactate—and, after a time, to pass through the ammonio-citrate, and to finish with the am- monio-tartrate. Steel wine is frequently found useful, more particularly when administered in small doses, yet its use continued for months certainly, for a year or two possibly. The tincture of steel but rarely suits a sensitive lining membrane. Pancreatic-Emulsion is a medicinal food, through the instrumentality of which other articles of diet are rendered assimil- able. Its employment is indicated in cases where loss of digestive power, followed by loss of flesh, is a foremost symptom. It is especially serviceable when cod-liver oil cannot be tolerated, also when the functions of the pancreas become, from any cause, suspended. Cod-liver oil, either crude, or in the form of jelly or hydrated oil, is both food and physic, when it can be borne.* It is necessary to begin with tiny doses, * Messrs. Allen & Hanburys, of Plough Court, London, have supplied me with a beautiful specimen of Perfected Cod-liver Oil; it possesses almost no unpleasant taste. The majority of dyspeptics can tolerate it. One of my patients, whose stomach was in such a hyper- aesthetic condition, that he was unable to take even this form of oil, whilst in its crude state, found that he could retain it, without inconvenience, when oil of cinnamon, in the ratio of six drops to a pint was shaken up therewith. 112 INDIGESTION. and to increase them very cautiously. Zinc is a tonic, but, in my opinion, not worthy of reliability in dyspepsia. In small doses it is valueless, in large it is apt to induce much burning pain in the stomach. Oxide of silver, also nitrate of the same metal, are considered by some to be valuable sedative tonics. In my opinion the Charcoal vended by the Medical Carbon Company, of Nottingham, stands un- rivalled amongst charcoals for therapeutic power ; nevertheless, the vegetable charcoal, reduced to the form of biscuits, such as those manu- factured by Messrs. Bragg, of London ; perman- ganate of potash, and carbolic acid are highly serviceable in cases of fermentative dyspepsia. A feeling of relief comes over me as I begin to write on Strychnine. It is one of the very few drugs, used in indigestion, the therapeutic action of which may be, with tolerable accuracy, foretold. Almost every case of dyspepsia is accompanied with a greater or less amount of nervine atony. Strychnine is a most powerful nervine tonic. At the same time it is usually a non-irritant; hence, both in theory and prac- tice, it meets the requirements of the dyspeptic. It should be administered in very small doses. Small is, indeed, scarcely the term to apply. I DRUGS. 113 ought rather to write, in doses that are abso- lutely homoeopathic. Years since, a gentleman, prematurely aged through domestic anxiety, derived vast benefit from the taking of the five-hundredth part of a grain of the alkaloid, three times daily. His is, by no means, a unique case. It is generally found necessary to extend its exhibition over a prolonged period —three or four months, in fact. It should always be given in the form of a pilule, scien- tifically coated, and, consequently, rendered tasteless; inasmuch as, in any form other than that mentioned, its intensely bitter taste proves most irritating to the palate of the dyspeptic. The usual dose of strychnine is the thirtieth, fortieth, or fiftieth part of a grain. It should be taken immediately after meals. Its use is especially indicated in the large subdivision of cases of indigestion, that are accompanied by neuralgia, chorea, or great depression of spirits. Aconitine is, also, a drug of considerable value in the treatment of indigestion. It is a power- ful nervine sedative, and, of course, called for in those cases that are accompanied either by pain or acute nervous irritability. It may be admin- istered either in combination with, or separate from, strychnine. The fiftieth of a grain usually i 114 INDIGESTION. suffices to afford relief. This drug may, like strychnine, be obtained from respectable druggists, in the form already mentioned. Strychnine and aconitine are, in my opinion, the two pharma- copceial crutches of the dyspeptic. Phosphorus is useful in those cases of indigestion that have prostrated the nervous systems of the sufferers. Many years ago, Dr. Pereira wrote of it: " After its absorption it acts as a stimulant to the nervous, vascular, and secreting organs. It excites the mental faculties and the sexual feelings, raises the temperature of the skin, increases the frequency of the pulse, promotes the secretions, and operates as a powerful sudorific and diuretic. It is administered as a stimulant to the nervous centres in convulsive and old paralytic cases." It cannot, in my judgment, take rank with strych- nine as a permanent improver. It is an anodyne as much as, if not more than, a tonic. Useful adjuncts to phosphorus are strychnine and quinine. Of late (November, 1882) I have met with most encouraging results from the administration of Fellow's Syrup of the Hypophosphites, more particularly in the class of cases that have been complicated either with bronchitis or nervine atony. The medicine contains both phosphorus and strychnine. DRUGS. 115 Tincture of opium is a valuable medicine in cases of hypersesthesia of the stomach, more especially when complicated with asthma, and dependent upon irritation in the medulla oblon- gata. It is usually found necessary to administer it in full doses. Purgatives are seldom admissible in the treat- ment of indigestion. The lining membranes of the dyspeptic are in a condition, much too sensitive, passively to tolerate their presence. Even when they afford temporary comfort, such relief is followed by an aggravation of original symptoms. The least injurious of them are almond-oil, olive-oil, castor-oil (the last combined with small doses of liq. opii sedativus), magnesia, sulphur, confection of senna, and Tamar Indien. I never travel beyond these confines when a patient insists that I shall prescribe a purgative ; indeed, the avoidance of purgatives constitutes a primary element in my plan of treating indigestion. Fortunately, diet and hydropathy supply us with all the means of purgation that we usually require. Fruit, vegetables, stewed-prunes, stewed- pears, brown-bread, oatmeal porridge, ginger- bread, lemon-juice, or rhubarb-jam usually effect the desired object. Even the last named I seldom employ, as I find that the oxalic acid 116 INDIGESTION. which is a constituent element of rhubarb fre- quently acts as an unendurable irritant. I recom- mend every dyspeptic to make trial of the Whole Meal Bread, before resorting to the use of purga- tives. It frequently induces an alvine evacuation, when drugs have failed so to do. It is, however, desirable that the meal should be ground much finer than is commonly found to be the case. Kneading the abdomen should not be omitted under similar conditions. Mineral waters, some dyspeptics find useful as purgatives; to others, the taste of them is particularly repugnant. A third of a tumbler of cold-water, taken before breakfast, and repeated twice or three times, at intervals of six hours, frequently proves advantageous. A current of Electricity, passed from tongue to anus, often proves of essential service in indigestion complicated with constipation. In hydropathy, however, the physician's strength lies. An enema of soapy water, used either warm or cold, seldom fails when properly employed, to procure an evacuation. It is, unfortunately, frequently but imperfectly applied, hence it unjustly acquires the reputation of producing little or no benefit. The object to be aimed at is to fill the large intestine— DRUGS. 117 employing two quarts or so for the purpose. Thus used, its success is, commonly, predeter- mined. There are, however, many individuals in existence to whose feelings, both mental and corporeal, the use of the enema is abso- lutely repugnant. Let such make trial of the following means:— 1. Dipping the hips into and out of a deep sitz cold bath for about five minutes ; or, 2. Taking a sponge in either hand, dipping one into hot and the other into cold water, and ap- plying them alternately, for a few seconds, first to the abdomen, then to the loins; and continuing the process for about ten minutes ; or, 3. Irrigating the perineum twice or thrice daily, and for five minutes at a time, with the ascending- douche. If the patient possess a bath-room it is only necessary to affix to his cold water-tap a vulcanized tube, terminating in a galvanized-iron elbow, fixed to a base, and surmounted by a rose. This can be placed at the bottom either of a sitz, or a large chamber-utensil, and he can sit over it. These means, when persevered with for a reasonable period, seldom prove inadequate to the obliteration of constipation. 118 INDIGESTION. Constipation must, by no means, be regarded as invariably a disease. Experience has taught me that it is the nature of some individuals to have but infrequent evacuations. In this case purgation invariably aggravates indigestion. CHAPTER XYI. GALVANISM. I use this agent principally in cases of consti- pation. I apply the negative pole of the battery to the tongue—the positive to the anus. I avoid the introduction of a rheophore into the bowel, knowing, as I do, that dyspeptics are, invariably, preternaturally sensitive, both in mind and body, and that the physician who fails to bear this fact in mind, will speedily lose the confidence of his patient. The Constant or Galvanic Current, applied for the space of from three to ten minutes, generally suffices to induce a tolerably satisfactory motion. In exceptional cases, it is necessary to repeat the electrization after the lapse of six hours. Dyspepsia is, however, as a rule, a chronic ailment. It is, therefore, highly advisable that the patient be provided with a battery that shall be, not only, at all times, in working order, but 120 INDIGESTION. also of such a character as to admit of home application. Such an instrument is the magneto- electric machine. The patient must bear in mind that the left is the negative or stronger pole. For constipation let him place the negative pole over the spine about the middle of the back, and pass the positive from above downwards over every portion of the abdomen, from the ribs to the pubis, for about ten minutes twice daily. The power employed should be high. This is slowly curative. When an immediate evacuation is desired, let him proceed according to instructions given in lines two and three of the present chapter, The current employed must be, at first, gentle, and should be slowly increased in power. An action on the bowels is commonly obtained within the lapse of five minutes. Sometimes the effect of the electrization is instantaneous. In cases of colic, let the patient magnetize himself as for constipation—slowly curative. For chronic dyspepsia, let him place the positive pole over the middle of the spine, and with the negative, wander over the whole of the abdomen for fifteen to twenty minutes twice daily. The power should be of medium strength. For dyspepsia-bronchitis, let him apply the posi- tive pole to the middle of the spine, and pass the GALVANISM. 121 negative over the surface of the chest, for fifteen minutes thrice daily. The power should be some- what feeble. For dyspepsia-asthma,