treated with Mercury; spasmodic wrenching in the stomach and pit of the stomach, ascending to the chest and oppressing the breathing.

Castoreum.-Bitter, sour regurgitations after a meal; sickness at the stomach, ptyalism, tightness and weight in the stomach; contractive pain under the sternum; ulcerative pain in the pit of the stomach, flatulent distention of the abdomen, constipation, urgings to stool ineffectual. Lobelia-inflata.-Pressing constrictive sensation in the pit of the stomach after a meal, especially at night, extending to the back and inter-scapular region; bilious vomiting, oppression, and anguish in the chest, and in the small of the back. Nervous agitation.

Natrum-muriaticum.-Contractive cramp in the stomach, commencing after dinner, and continuing till evening; feeling of coldness in the back of the stomach.

Alumina.-Cardialgia with constipation.

Carb.-baryta. Scrofulous subjects; fullness after slight meal; hardness of the stomach perceptible externally; pressure and weight; disorganization of the stomach.

Sepia.-Delicate nervous females, with fine skin, and liable to get angry; oppression and weight, with cramp in the stomach; sour eructations, indifference to life, occasional nausea, constipation, amenorrhoea. Nerves deranged by onanism.

9. GASTRALGIA.

Increased irritability of the nerves of the stomach, inducing spas

modic contraction of the muscular fibres.

Diagnosis.-General symptoms: neuralgic pain in the epigastrium extending to the hypochondria. The pain occurs in paroxysms, varying in intensity, and subsides partially or completely in the intervals. It is peculiar in its character, violently constrictive, twisting, turning, cutting, tearing, gnawing, or beating; and it is often most severe in the locality of the right or pyloric orifice of the stomach, at other times the pain is greatest at the cardiac orifice. Sometimes it extends from the pit of the stomach to the back, breast or scapula, though in others it is confined to the epigastrium. As the disease is usually not inflammatory, the pain is frequently relieved by external pressure, as by pressing the stomach against hard bodies; though in many cases slight pressure cannot be borne. The attacks last from a quarter of an hour to a full hour, and subside soonest when the parAs the disease advances the paroxysms oxysms are most severe. increase in intensity, and occur more frequently, and often last a whole day; or returning from trifling causes, such as light food that easily sours in the stomach, fatigue or change of weather. We have observed the exacerbations worse when the stomach was empty, as

before eating; they are considered worse in the afternoon; and they generally subside more completely during sleep.

Sympathetic Symptoms.-Pain in the region of the last dorsal vertebra of the spine, extending to the scapula; spasmodic action of the gastric muscular fibres, causing vomiting, or ineffectual muscular efforts; eructations, gnawing, spasmodic contraction of the abdominal muscles, or diaphragm. The pit of the stomach is drawn inward toward the spine; hiccough, obstinate constipation, strangury, feeling of excessive anguish, palpitation of the heart, constriction of the fauces; loss of voice; the stomach is distended by flatulence, which rises toward the throat, and is there arrested by spasmodic contraction of the œsophagus, forming the "globus hystericus." In some cases the stomach is relieved by the raising of green bile, or an acrid-sour or slimy mucous secretion from the mucous membrane. The pulse is small and contracted, and the skin cold. The vomiting, though it gives great distress at the time, is generally followed by relief; the sweat breaks out as the pains abate, and the pulse rises.

In the most severe paroxysms the pain may terminate for the time in spasmodic fainting, tremor, delirium, extreme debility, convulsions, or tetanus. (Hartmann, Vol. IV., p. 69.)

A prominent feature, in which gastralgia surpasses almost every other form of physical suffering, is the terrible gloom and feeling of despair that accompanies it in all its severe paroxysms. The sufferer from real gastralgia not only endures a degree of actual pain equal, at least, to that of tic-doloreux, but is weighed down by a feeling of despondency so terrible, that life, with all its accompaniments, is only regarded as a burden and a curse, instead of a blessing. The mental agony pervades the whole being, and poisons with bitterness all the fountains of health and peace and happiness on earth.

Treatment. In the treatment of this disease in all its forms, homoopathy has gained many of its grandest triumphs; "it offers," says Meyer, "amidst the frequent uncertainties of diagnosis, the great advantage of contending with the disease with tolerably certain weapons. This becomes more apparent, if we glance at the miserable therapeutic apparatus of the old school, and see how uniformly it tries one after another, in every case of spasm in the stomach, the same two or three remedies. that have once or twice been of use; and when at last even the Opium panacea will do no good it stands helplessly by, and in order to conceal its ignominious defeat, declares the case to be incurable."

No where is the necessity and utility of accurate individualization more clearly shown, no where is allopathy taught the uselessness of its pottering minuteness in reference to the diagnosis of diseases, while neglecting the much more important diagnosis of medicines, than in our treatment of cardialgia."

Remedies--Nux-vomica.-The many-sided action of Nux-vomica on the ganglionic system, and especially on that portion of it which influences the functions of the stomach, explains the frequency of its success in spasms of the stomach. So frequently has it succeeded, that it is too often relied upon alone on the ground that it is the specific for every form of cardialgia. On this point Böenninghausen says: "that Nux-vomica is often improperly used, and powers are attributed to it, which, from its sphere of action, it cannot possess." It is, however, true that the gastralgia which presents the parallel of Nux-vomica is that most often met with. It exibits:

Aching pain in the stomach, commencing with tension and increasing to a squeezing, pinching pain, which occurs after any heavy meal, or even after taking the slightest quantity of food. The pain then frequently spreads over the whole extent of the stomach, and occasionally implicates the cardia, where there is felt a sensation of constriction, and as if the food had to be forced through the orifice; often, however, the pains extend far above the epigastrium, and give rise to oppression of the breathing. An objective symptom thereupon. presents itself, viz.: the stomach is distended, and the scrobiculus cordis is arched forwards. As a consequence of this abnormal irritation and inordinate pressure upon the muscles and nerves, there occurs tenderness of the external coverings of the stomach, which is increased by slight pressure, but diminished by strong pressure. "This physiological sign is quite characteristic of Nux-vomica, and is yet more distinctly expressed by the fact, that the pains are momentarily relieved by bending the body forward, i. e., by strongly compressing the stomach. The effort of nature to get rid of this abnormal state, is especially shown in the process of elimination. It has often occurred to me that the essential nature of most so-called nervous cardialgias consists in a spasmodic closure of the pylorus, which impedes or obstructs the passage of food into the intestines. The stomach, filled with wind, is first freed of its excess of ballast by eructation, which is either tasteless or accompanied by the taste of the food, or when there is at the time catarrh of the stomach, it may be sourish or putrid. Occasionally the attempts to eructate are at first ineffectual or painful, in consequence of the spasmodically constricted cardia through which the wind has to pass; but at the same time the eructations give transient relief to the cardialgic pains. It often happens that by the eructations, after they have lasted some time, and have pretty well evacuated the stomach of its gaseous contents, a fluid tasting of the food, is propelled into the œsophagus or mouth, by a kind of regurgitation. Nausea soon sets in, with or without flow of water into the mouth. After more or less severe retching, whereby at first only (sour) mucus is brought up, the contents of the stomach are emptied by vomiting

which recurs again and again, until the last morsel of food is rejected from the stomach, whereupon the pains go quite away. Except during the actual paroxysm the patient has no pain, except perhaps that there may remain some tenderness of the external coverings of the stomach or scrobiculus." The spasm of the stomach for which Nux is suitable is not of a regularly intermitting character, for it is only caused by partaking of solid food. Liquids do not, as a rule, cause it, but it is worthy of observation that coffee may occasion or increase not only the exciting cause, but when taken in excess or in too weak infusion, the disposition to the disease. The cardialgia curable by Nux seldom occurs in the morning before eating, and hence this condition, which is generally characteristic of the medicine in question, is only deserving of attention in this disease where the other symptoms point to Nux. After a late supper the attacks may occur in the night also, for, as a rule, the pains do not come on until some time after eating. It is not necessary that the cardialgia for which Nux is suitable. should be conjoined with gastric states, on the contrary we generally find the tongue clean and the appetite good. The bowels may also be in a normal state, although habitual or accessary constipation, which often accompanies spasm of the stomach, gives an indication the more for Nux-vomica. The gastric complication is most frequently observed in the spasm of the stomach of drunkards, where Nux, unless there exists some important contra-indication, is generally the appropriate remedy. The reflex phenomena sometimes arising from cardialgia, as headache, vertigo, &c., are only important for the choice of Nux, when, in addition to accompanying the other symptoms, they show peculiarities corresponding to those of the drug.

In such cases as embraced the above characteristics, Dr. Meyer says he had persevered with Nux even when improvement did not immediately appear. The improvement was perhaps delayed in many of the earlier cases by the using of low dilutions and their too frequent repetition; whereas the proper potencies given at longer intervals effected more rapid and more permanent cures.

Arsenicum.-The cardialgia suitable for Arsenicum must have reached a great height. The pains are excessively severe, sometimes so much so as to cause despair, in rare cases fainting. The salient quality of the pains is burning, often as if from red hot coals; but the burning often passes into gnawing and cutting, or it is combined with aching, which latter sometimes, though more rarely, occurs alone. Along with these torments there is external coldness and violent thirst, but only small quantities of liquid can be drank without increasing the pains. The stomach seems to be distended and enlarged; from it the pain may extend upwards, when it causes great anxiety, or downwards into the abdomen, or backwards, when some of the vertebræ may some

times be tender. There is sensitiveness of the gastric region to slight and also to strong pressure. "Vomiting is a constant Arsenic symptom in gastralgia; it occurs either early or with great effort, and consists either of the food taken, or of thick, yellowish green, gelatinous looking mucus. The vomiting does not completely relieve the pains as happens in those cases for which Nux is the remedy, on the contrary, they persist a considerable time after the vomiting, in a greater or less degree. The eructation that sometimes precedes the vomiting is generally very loud, and sometimes becomes hiccough. The cardialgic symptoms occur either immediately after eating and drinking, or in rarer cases not till a few hours thereafter. Frequently, however, the pains and the whole paroxysm occur without ascertainable cause, as often happens after midnight. If this kind of gastralgia has already lasted some time, the patient gets a cachectic look, at the same time there gradually occurs a chronic catarrh of the stomach, often attended by occasional diarrhoea, which reduces the patient's strength. Under such circumstances we may easily suspect that the malady is caused and kept up by some organic disease (round ulcer, scirrhus), but this suspicion should not contra-indicate Arsenicum. In the above enumerated cases of this character, I found Arsenicum very useful."

Phosphorus.-When there is reason to believe that a perforating ulcer of the stomach is the cause of the cardialgia. There is occasional show of blood in the ejected matter; painless intervals brief; the emaciation and anæmia favor the suspicion of perforating ulcer.

If, however, there is no reason to presume upon organic lesion, Phosphorus is indicated by: excessive formation of acidity (the heartburn, sour eructation, sour vomiting, when, also, the vomiting occurred soon, often immediately after a meal, or rather of the nature of regurgitation of food, and the patient can not retain in the stomach a morsel of food. The thirst is not great and tormenting as in the cases corresponding to Arsenic, but yet the pains are aggravated by drinking. If the pains are of a gnawing character, and sometimes extended to the back,-if the gastric region is very sensitive to the touch,-if this sensitiveness is increased by walking,-Phosphorus was found by Meyer "a most successful remedy."

Colocynth.-The spasm of the stomach begins from two to three hours, or more, after a meal, especially if the meal consisted largely of sweets. The cutting pain is slight at first, but gradually increases, until it attains the greatest intensity. It now extends to the bowels, where the patient feels as if he were being cut with knives, and into the back, which seems to him to be broken. The patient feels as if he must vomit, without being able to do so at first; it is not until the lapse of considerable time that vomiting occurs, and then only of the food that has been taken. After the stomach is completely emptied,