only upon the bladder and kidneys, and is under the ban of fashion. A fashion once set will endure for a long time. Some one will say that Calendula cures all soreness (I believe it is said to be indicated in incised wounds); it has become the fashion; its tincture is sold by the gallon, I presume it is grown in fields and harvested with the mowingmachine, while if its pathogeny be referred to, there is nothing to account for its popularity.* So it is with Baptisia, our commonest pasture weed, once said to be good for typhoid, is now regularly given and sworn by; when neither its pathogeny nor proving indicate any activity of that drug at all, its symptoms bearing on typhoid being the result of the alcohol of the tincture (See N. E. Med. Jour. of Feb., 1891.)

Such is fashion; while medicines whose pathogeny is quite indicative of useful results are left out of sight. Thus Cantharis is one of the remedies which should not be overlooked in certain forms of acute gastritis. For among the effects of Cantharis there appear cutting pains in the stomach and umbilical region and epigastrium; burning pain in the throat and stomach-(usually associated with irritation of genital organs) nausea, vertigo, burning in mouth and throat, violent retching and vomiting-ardent thirst (the kidneys and bladder always primarily affected.) I have found Cantharis most useful in violent attacks of acute gastritis and have, therefore, called attention to this very incisive remedy. It should be given not lower than the 3 and will act high as the fifth and beyond.

I will not say that either of these medicines will supersede Nux vomica. This is always indicated in obstinate retching and vomiting of a cramp-like nature, when the inflammatory process is not so marked as the nervous irritation, chiefly marked by empty ineffectual retching, little or no thirst.

This powerful and most useful polychrest is so well known

* One prover Franz; no information as to dose and repetition, and uncorroborated by others. Hughes, Vol. IV., p. 730.

that I omit its details for the present but shall refer to it again if I have time.

I will not take up too much of your time with acute cases, which are comparatively easy to reach and usually of short duration, but I wish to emphasize the axiom once for all, that no medicinal application is of the slightest value unless the diet is regulated by proper restrictions in the first place. To say this metaphorically, dieting in acute gastritis means to rest the stomach, just as you would rest a broken limb, the least use of which prevents union. In acute digestive disturbances abstain from food as much as possible and return to it slowly.

I still wish to say something about our friends, the chronic dyspeptic. They will be our friends if we can give them relief. If I describe one of them you will recognize them as a class. This patient is generally above middle age, generally somewhat anæmic, anxiously scanning you to see if in your face he can detect the right doctor, whom as yet he has never found. If asked how long he or she has been ailing, the answer will be several months if not years. All food distresses; it seems to lie heavy in the stomach; there are uncomfortable sensations which pass from epigastrium to the back; there may or there may not be nausea, generally there is none; but the symptom the patient dwells most on is "wind or gas in the stomach." The tongue is often not coated and the bowels are usually regular enough. What the patient wants is to get rid of that gas, and he will often proceed to give you an exhibition of the quantity of it in his stomach by a process of eructation (known in horses as a bad habit called cribbing, which they show by a noise they make in their throats while trotting and also in the stalls.) It con sists of swallowing air into the stomach and then ejecting it by eructation. Examination shows the patient's stomach not to be distended at all.

There is no doubt that he has many bad feelings, often voluminous; but when we come to the disentanglement

very

of the whole case we find that the patient has no dyspepsia at all. What food he takes is properly digested, as indicated by the fecal discharges; his appetite is good but he does not dare to eat for fear that the food will hurt him and cause the gas to bloat him.

If in such cases we find constipation, it is simply absence of regular stools from insufficient food which the patient fears. But the stools indicate digested food, and when that is the case, dyspepsia is not present.

cares.

The whole condition is caused first by a hereditary predisposition traceable to a hypochondria of a parent or two. If not this, to overwork, mental anxiety and business and family I do not know which are the most difficult to treat. First comes the question of diet; the patient must be persuaded to eat, and not abstain too long from food. "But it will hurt me and cause gas," will be his reply. It is now that the doctor must resort to argument adapted to the patient's understanding, to the effect that he must put up with a certain degree of pain, for there is every evidence that the food digests; that he must not allow his stomach to dominate, but give it the work to do, by taking moderate quantities of food rather oftener than three times a day. After regulating this matter, comes the selection of the appropriate medicine. I need not look far in my note book to find a case. October 24, J. A. was here two years ago for headache, gas, etc., was benefitted and wants to be again. His case now is: Gas after eating. Headache in the morning, dull, heavy, does not want to rise; bad taste in mouth; sedentary work, no exercise. Last time Nux vomica 3x cured him; he has the same again with strict injunction to saw wood, or ride a wheel, or walk an hour every day.

October 23d, Th., Mrs.30: Neurasthenic and hypochondriacal to prostration; could write page after page of distressing symptoms most of which she refers to abdomen; claims to have terrible distress there from diarrhoea. Feels as if her head, her eyes, her heart were all affected; spends

most of her time in bed, fearing diarrhoea. This is the only positive symptom she has, and amounts to two or three rather loose stools a day, with some tenesmus and mucous discharge. She has had Mercurius v., 3x, one tablet every three hours, and is now much better of her bowel trouble, but quite as disconsolate as before. She continues Mercurius v., but has to be much encouraged and made hopeful.

I will not weary you with cases of this kind, but refer briefly to a few remedies which, after encouragement, are applicable in neurotic cases. There are three species of neurosis which are very often associated with what the patient calls dyspepsia — flatulence, pressure, fear of food, while stools, etc., show digestion to go on properly. These forms are Hypochondria, Hysteria and Neurasthenia. The hypochondriacal man or woman dwells on his or her disease; thinks of it, tries to find its cause; is sometimes melancholic but usually dyspeptic. Hysteria is characterized by lack of self control; Neurasthenia by want of muscular and mental endurance, tiredness.

These forms are often associated with each other. The hypochondriacal woman is generally neurasthenic; men sometimes but rarely; or she is apt also to be hysterical; but all these forms, combined or uncombined are in a majority of cases associated with neurotic dyspepsia, but our remedy should be directed mostly toward the symptoms presented by the nervous system, of which the semblance of dyspepsia. is only a part. It is in our case the most prominent part, and the most prominent symptom which should guide us in seeking for its remedy.

In an article written six years ago I have endeavored to point out the class of remedies to choose from in cases of neurasthenia, including hypochondria and hysteria, without reference to dyspepsia. Now the same class of remedies has a very strong bearing on cases of neurotic dyspepsia.

In this as in my former lectures on the study of the *Therapeutics of Neurasthenia, N. E. Med. Jour., Dec., 1894.

materia medica, I still adhere to the principle that medicines should be studied according to their botanical and chemical groups, which resembling each other in this respect, will also resemble each other toxicologically.

At the head of the list stand Nux vomica and Ignatia (belonging to the order of Loganiaceae). It is certainly unnecessary to enumerate the indications for either, especially for the former. I can only briefly give the indications upon which I prescribe Nux vomica: Great worry about patient's condition; he is anxious and wants to know the cause of this or that sensation; ascribes it all to his stomach which feels to him as if "bloated with gas," thinks he can't digest his food because the gas in his stomach causes so much pressure. He eats little, and has irregular stools. So in addition there is nausea, costiveness, headache in the morning with coated tongue, why, then, the case is clear enough.

Conium Maculatum is strongly indicated in the symptom of gas in the stomach where there is no gas; but where the patient has loud and long eructations often cultivated by habit, and the mental conjecture that he must get rid of that gas. Constipation associated with hypochondriacal introspection, or hysterical loss of self control and nervous palpitation.

The relationship of Conium to certain forms of nervous dyspepsia might lead us to think that Cicuta would also be indicated here; but this is so strongly related to the spasmproducing drugs, decided epileptic form attacks being frequent among its effects, that we find no place for it in nervous dyspepsia.

Helleborus comes very near to it (in the class of Helleborineæ). It is a remedy to which I owe much gratitude. Its severe cerebral symptoms, approaching actual meningitis, point out its sphere of action, not only in its relation to the cerebral membranes, but to the cerebrum itself. I use it in cases where there is melancholic depression, dullness of the senses; where patients complain of great pressure upon the