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order would be one of greater success, were these points more steadily insisted upon, and less concession made to the morbid preference for medicines; arising partly from the natural indolence of the complaint, partly from the fashions ever prevailing in respect to it. This is one of the instances. where the general course of practice might be greatly altered and amended. Much is got, if the dyspeptic can be rescued from means, for the most part of doubtful or injurious effect; much also, if he can be led into habits which invigorate the circulation with safety to every part, and may be modified under more certain rule than any remedies of internal use. Here, unhappily, as in so many other cases, the simplicity of the means forms a hinderance to their sufficient application. What is obvious can rarely be brought into successful competition with what is vague and obscure in the treatment of disease.
* The ancients, as is well known, employed friction under a more general conception of its use than we do; not merely as a remedy for feebleness or swelling of limbs, but as altering the condition of the whole body. And, without adopting all they have affirmed on this subject, it is certain that its employment, even in our climate, might be beneficially extended in a variety of cases; in none more than those of enfeebled or disordered digestion. So applied, it affords another example of the many important relations subsisting between the external and internal surfaces of the body.
Of the use of anointing, as practised by the ancients, we know from experience much less. Some explanation of its employment in tropical climates may be found in the protection it gives against the direct effects of solar heat on the skin. There is reason, as well as scope, for making larger trial of it as a curative means, even in disorders of the alimentary canal. The harsh dry skin of the dyspeptic patient might be improved in its texture and functions by rubbing with warm oils, &c., where wholly unaffected by internal remedies given for the same object. In one or two cases, I have had cause to infer that much benefit was obtained by this method; but, like most other external means, it would require more time and perseverance than the temper of the dyspeptic will often concede to such remedies.
The recommendation of travel to dyspeptic patients is familiar and reasonable. Some caution, however, is needed as to details; nor ought these to be considered below the notice of the physician. The dyspeptic cannot wisely be sent to travel alone. His sensations and habits govern him too strongly to admit of his being subjected to these without aid. His earlier way must be smoothed to him; and some concessions be made to his indolence and extravagant demands for comfort, for the better chance of surmounting them in the end. I have known many patients return from the experiment, jaded and dispirited, with whom a more judicious plan would have prevented this disappointment. It is well, in the outset, to keep their travelling apart from the tumult of cities and spectacles. The dyspeptic cannot thus violently be removed from himself; and the failure of a first attempt renders others more difficult. Open or mountain air; - varied scenery, yet avoiding any such frequent change as may too greatly excite or fatigue the attention; — occasional pauses in travelling, to obviate any heat or excitement that may exist, or to prevent such; - the bodily exercise regular in amount, varied if possible in kind, and rarely passing into fatigue ;- short passages by sea, if they can be managed with comfort;— early and regular meals and hours of rest; and due attention to the state of the bowels, by the mildest means adequate to the effect; all these points are worthy of attention in advising the remedy of travelling to the dyspeptic. Their importance, of course, varies in different instances; but I know, from a good deal of experience in such cases, that it is never wise to disregard them, as unimportant to the result. And this is the more true, as it is peculiarly the character of the dyspeptic patient to be incapable of determining these things for himself.
Among the minor conditions to be looked to in stomach
disorders is that of habitual posture. The patient should be led, as much as possible, to keep the trunk of the body upright, and opened out freely in front. The compression of the stomach, pylorus, and duodenum, by the bending of the body forwards upon itself, is exceedingly injurious to the functions of these parts; as is proved from the sensations produced by making this movement suddenly, and with some little effort, when the stomach is full. Disturbance to digestion is immediately felt in a sense of uneasy weight, continued or increased as the act is repeated. The frequency of stomach disorders amongst those of sedentary pursuits, is doubtless owing in part to habits of posture unfavourable to digestion, especially in its earlier stages.
It may seem a trivial remark, yet is worth notice, that dyspeptics have frequently the habit of touching or pressing upon the epigastrium; a practice readily induced by uneasy sensation there, but bad in its effects on the complaint. Whatever the causes may be, no part of the body claims exemption so much as this from every interference. I have known the habit to such extent in one or two cases, as to form a principal cause of disorder; the symptoms ceasing when it was discontinued.
Another aid in the treatment of these complaints, deserving more notice than it receives, is the application of some uniform support, amounting to slight pressure, around the abdomen. Such pressure may be made and regulated in various simple ways. The dyspeptic gains by it, not only in the avoidance of many uneasy sensations from distension, and in the better performance of the functions which distension impedes, including the respiration as one of these; but also by the uniform warmth and freer circulation in the superficial vessels of this part of the body; effects of no small import to the healthy state of the internal mem
branes, the relations of which to the functions of the skin are so numerous and unceasing. The chest, as matter of custom amongst us, is carefully watched over with reference to these effects; though it may be doubted, looking to the structure and function of the respective parts, whether such care is really more beneficial here than in the case before us. Be this as it may, we cannot question the value of such aids in stomach complaints, and are bound to consider them enhanced by the simplicity of the means employed.
Among the external remedies insufficiently resorted to in dyspeptic cases, bathing may especially be mentioned. The warm bath under certain conditions, attested chiefly by the state of the skin; - the shower-bath, cold or tepid, in other cases; or occasionally the salt-water hip-bath, similarly varied as to temperature ; — offer means both of prevention and relief which no discreet physician will neglect. Here, also, we must keep in view that important relation of external and internal surfaces, ever operating in all the phenomena of health and disease, and which serves as a basis to so many facts both in pathology and practice.
I may state again, what indeed will be seen on the face of the foregoing observations, that they are not to be viewed in the light of a dissertation on this copious subject; but merely as remarks drawn from my experience, on points which appear to have obtained less than their due share of attention, or which are especially recommended by their general and ready application in this part of practice.
ON DISEASES COMMONLY OCCURRING BUT ONCE IN LIFE.
THE title, thus including only a single character of these remarkable diseases, might be extended to other circumstances in their history; which, though not exclusively limited to this connexion, are still so closely associated that it is impossible to view them asunder. Such are, the perfectly definite course of their symptoms in the ordinary form; the frequency of an external or eruptive stage in each; and the well-marked power of conveying infection by the reproduction or diffusion of the virus respectively peculiar to them; all points of the highest interest in pathology; and which, under the relations just expressed, involve some of the most abstruse questions in the whole range of science. Controversy, as might be expected, has made itself busy with various parts of the subject; but has yet done little to remove the obscurity which hangs over it.
In pursuing the above connexions, even in their most general form, we seem ever on the verge of some discovery, giving new inlet to the more mysterious parts of the animal economy, whether in health or disease. Such discovery indeed, if hereafter made, is not unlikely to be derived from methods of inquiry in which these relations are directly involved. In their nature it is scarcely possible they should be unproductive to research, however great the difficulties attending it. The simple enunciation of the fact, that certain diseases of definite course, and communicable by some manner of