instance is to remove it, either by means of an emetic or the stomach-pump: exclusive reliance ought on no account to be placed upon the employment of reputed antidotes. In infants, the treatment of acute gastritis is somewhat different, and is founded upon a knowledge of what appears to be the real source of the disorder in a large majority of such cases. It usually occurs whilst the infant is suffering from dentition: the digestive process is deranged; the ingesta undergo chemical changes, by which they are rendered highly irritating to the stomach, and in many instances to the whole of the alimentary canal, as shown by the sour smell of the matters vomited, and by the sour smell, green colour, and watery consistence of the stools. Hence, the practice which we have found most uniformly safe and successful, consists in relieving the irritated gum by a gum lancet, and correcting the acid condition of the primæ viæ. It may, indeed, be prudent to apply two or three leeches from time to time to the scrobiculus cordis, and immerse the patient in a warm bath; but almost certain relief will be procured by a cautious use, at the same time, of antacids and absorbents. If the mucous membrane of the bowels appears to be involved, as indicated by the diarrhoea, the chalk mixture, made with plain instead of aromatic water, in a dose of one, two, or three teaspoonsful, according to the age, frequently repeated, either alone or with a very minute quantity of laudanum, from one-fourth of a drop to a drop, will often answer exceedingly well. In other cases, whilst giving the chalk mixture by the mouth, a little thin starch, either alone or with from six or eight to fifteen or twenty minims of syrup of poppies, may be administered as a glyster. If, on the other hand, the bowels are confined, from two to six grains of magnesia may be substituted for the chalk; and if insufficient to move the bowels, half a scruple or a scruple of sulphate of magnesia may be added to each dose. In cases where the bowels are only very moderately relaxed, a mixture of chalk and magnesia may be used with very excellent effect. The frequent application, for a short time, of a mustard poultice to the scrobiculus cordis will sometimes tend to allay the irritability of the stomach if it should prove stubborn. Of course, if the patient be an infant at the breast, a healthy nurse ought, if possible, to be immediately procured; a step equally necessary when the disease appears to be induced by attempts to wean, and the consequent use of improper or irritating food. Under such simple treatment and management, we often have had the satisfaction of observing the febrile excitement, the vomiting, and purging, speedily abate; whilst the diminished suffering of the child has been abundantly attested by its ceasing to cry, by its comparative quiet, and by its being able to enjoy natural and refreshing sleep. The treatment proper during convalescence will be that of chronic gastritis. CHRONIC GASTRITIS. Much has been said and written on the subject of chronic gastritis, and vast importance has been attached to it in modern times both as a cause and as a complication of a great variety of disorders; but in as much as the symptoms to which it is supposed to give rise are for the most part slight; as these symptoms often exist without evidence of actual inflammation existing; as its progress is in general remarkably slow, even when it is supposed to prove fatal; as it is only by an inspection of the body after death that we can arrive at positive certainty; and as even the postmortem appearances are not at all times very satisfactory; it will not surprise any person of experience to be told that few diseases are involved in greater obscurity, or afford a wider field for professional controversy. Although the result of experience, therefore, the student must receive what follows with circumspection, and regard it as amenable to the various sources of fallacy inseparable from the present state of the subject. Ordinary cases of chronic gastritis are principally indicated by some modification of pain or uneasiness in the stomach, divers lesions of digestion, certain changes in the appearance of the tongue, sallowness of the complexion, and very commonly by more or less emaciation. The pain is usually of a dull character, increased by firm or abrupt pressure, by taking stimulating food, and occasionally by stumbling, or any other sudden and considerable movement of the body: it is sometimes constant, although aggravated at intervals; at other times it is intermittent: it now and then seems to pass through to between the shoulder-blades, or is felt in that situation only, or is observed to dart or shoot towards the back, or into the hypochondriac regions: it is often accompanied by a sense of heat, fulness, or oppression, especially after meals; the sense of fulness may pervade the whole region of the stomach, or it may be more circumscribed, and limited to the large curvature of the organ, when it is frequently attended with a beating or pulsation either of the heart or of the large vessels in the neighbourhood. In general the appetite is impaired; but in some instances it is but little affected, and, in more rare cases, morbidly increased. The patient often complains of nausea or globus, or even experiences occasional attacks of vomiting; the bowels are flatulent and irregular in their action, being either costive, relaxed, or costive at one time and relaxed at another-these varieties being determined, in some measure at least, by the presence or absence of enteritis or colitis, of the same chronic character. The alvine discharges, although occasionally quite natural in appearance, for the most part present some deviation in colour, being pale, clay-coloured, greenish, or very dark, and of an offensive odour; the tongue is usually covered with a white or yellowish fur in the centre, and especially towards the base; whilst it is either of natural appearance, or morbidly red and injected at the sides and tip: in some cases, however, the tongue is almost morbidly clean, sometimes tender, or even manifests, in common with the whole internal mouth and throat, a disposition to become aphthous. The patient often complains of a sense of heat in the throat, or of a degree of irritation which produces a huskiness of the voice, or even cough; and on inspection, the parts about the fauces are found to be unnaturally red and relaxed: he usually complains also of thirst, and frequently of headache, giddiness, or dimness of sight; his urine is sometimes quite pale, sometimes cloudy, sometimes scanty and high-coloured, with or without a lateritious deposit on standing; he is languid or low-spirited; he loses flesh and strength; his countenance appears sallow, with a dark areola around the eyes, and a remarkable yellowness extending over the cheek-bones towards the temples; the pulse varies very much, being sometimes quite natural, but more commonly frequent, sharp, and perhaps intermitting: the sleep is in general disturbed or unrefreshing; and an irregular form of hectic now and then prevails, particularly in aggravated or in advanced cases. With a greater or less number of these symptoms the disease may proceed for months or years, and at length gradually subside, either through the natural efforts of the constitution, or as the result of appropriate remedies and management. In a considerable proportion of such cases, however, the patient at length sinks, either in consequence of the supervention of some disorder connected, apparently, directly or indirectly, with the original affection of the stomach, such as a stubborn diarrhea, dysentery, or in phthisis pulmonalis, bronchitis, erysipelas, latent pneumonia, or perhaps disease of the liver, and consequent dropsy; consequence of a casual attack of fever or other disease, perhaps altogether unconnected with the original affection, but which, from the impaired condition of the coùstitutional powers, speedily destroys life. In some cases, but especially in those connected with habits of intemperance, after suffering an indefinite length of time from symptoms of chronic gastritis, a patient is suddenly seized with faintness, giddiness, and sickness, and presently vomits a large quantity of dark blood, either in a fluid state, or partly fluid and partly coagulated. The quantity of blood thus vomited varies much in different cases, being occasionally only a few ounces, at other times amounting to the enormous quantity of several pints. When the quantity is large, as is very commonly the case, the patient either speedily expires, or is left exceedingly pale, cold, and faint. In general, however, he sooner or later rallies, when it is found that the pain and tenderness of the scrobiculus cordis, previously complained of, has either ceased entirely, or is considerably diminished. Part of the blood thus poured into the stomach passes off by stool; and as it undergoes a change in its passage through the bowels, it is found to render the alvine discharges, for perhaps two or three days afterwards, almost as black as pitch; indeed it occasionally happens that very little or even no part of the blood is vomited, but continues to pass altogether through the bowels, when it may escape observation, unless care be taken to examine the patient's stools. When the disease occurs in delicate, nervous, and hysterical females, which is by no means unusual, it is apt to assume a more decided and active character; and the symptoms, though the same in kind, prove much more distressing; the tenderness is greater, and the pain on pressure |