Among the remedies which are of the most decided benefit in Dyspepsia, next to purgatives, and after they have performed their full effect, we may place the tlibe of stomachics, consisting of the simple bitters, of which perhaps the most efficient are gentian and quassia ; and, of those substances which seem to consist essentially of a bitter and an aromatic, of which we should select ca lomba and cusparia, as the most generally useful. Of the tonics, perhaps the most powerful in strengthening the digestive powers, is the union of one of the stoma chics with iron : for simple pain of the stomach, the ox ide of bismuth has been recommended upon high autho rity ; but we apprehend that the complaint in which this medicine has been found so efficacious, is rather to be considered as a species of Autalgia, than the pain which is symptomatic of Dyspepsia. A very valuable medi cine, and one which is applicable to every form of the dis ease, is the carbonate of potash ; it appears not only to neutralize any acid which may exist in the stomach, but so to regulate the process of digestion, as to prevent its formation ; and it has been found, that it may be taken for months or years if necessary, without producing any kind of injurious effect. An irregular state of the ali mentary canal is almost a constant attendant upon Dys pepsia, and although it generally produces constipation, it occasionally manifests itself in the opposite state of diarrhoea. Except in very protracted cases, or where there is reason to suspect some structural derangement, this symptom generally yields to a cautious exhibition of purgatives, together with a due attention to the state of the diet ; and without any specific treatment the bowels acquire their proper tone, as the system returns to its healthy state. Astringents we conceive to be sel dom necessary, and for the most part injurious ; diapho reties, particularly opium combined with ipecacuanha, are frequently found beneficial, and this may be regard ed as the best form of giving opium, where pain or any other symptom indicates its employment ; it must always be preceded or accompanied by mild purgatives.
Next to Dyspepsia we have placed Pyrosis and Pica in our list of diseases, which depend upon a defect of the digestive organs; the former of them consisting in the eructation of a watery fluid from the stomach, at tended with pain, heart-burn, and flatulence ; the latter in a species of perverted appetite, by which the patient is seized with an almost unconquerable desire of eating indigestible substances, that are not properly articles of food. Although these are usually considered by syste matic nosologists to be distinct diseases, and occasion ally occur almost unconnected with any other symp toms, yet we are induced to regard them as mere modi fications of Dy spepsia ; and, with respect to their treat ment, we have little to offer in the way of general prin ciples that has not been stated in the preceding section. We shall merely remark that Pyrosis is generally sup posed to originate from the habitual use of an indigcst ible diet, which must of course be attended to in the cure, and that Pica is commonly found to be connected with a tot pid state of the uterine system, as well as of the digestive organs.
The next disease which we have placed in this divi sion is Diabetes, an affection of a very peculiar nature, and which, both with respect to its origin, its proximate cause, and its treatment, has given rise to much contro versy. Its most remarkable symptoms are, a great in crease in the quantity of urine, a voracious appetite, a stoppage of the cutaneous perspiration, thirst, emacia tion, and great muscular debility. The urine is tot only prodigiously increased in its quantity, but likewise has its composition completely changed ; the substance named urea, which it contains in the healthy state, is entirely removed, or exists in very small proportion, while in its stead we find a large quantity of a body possessing the physical and chemical properties of su gar. Whether diabetic differs essentially from vege table sugar, is to be regarded more as a chemical ques tion, than as what in any respect influences either our pathology or our practice ; and it has been a subject of controversy whether there be a proper Diabetes insipi dus, that is, a disease attended with the increased dis charge of urine, the voracious appetite, and the morbid state of the skin, but where the urine does not contain sugar. There is much obscurity respecting the origin of Diabetes ; it has been attributed to improper diet, to the use of spiritous liquors, to large quantities of watery fluids, to exposure to cold during perspiration, to violent exercise, and, in short, to any thing which might be sup posed likely to weaken the system generally, or the di gestive organs in particular. It does not, however, ap pear that any of these circumstances so commonly pre cede the disease, as to entitle it to be regarded as the cause, although many of them may contribute to aggra vate it, or bring it into action, when the foundation is laid in the constitution. The proximate has been no less the subject of controversy than the exciting cause, and on this point two hypotheses have divided the opinions of pathologists ; some have ascribed it to a primary affec tion of the stomach and the function of assimilation, and others to a primary disease of the kidney. Upon the whole, we conceive that the former is by far the most probable supposition ; for although the examination of the body after death has detected a morbid state of the kidneys, this we should ascribe to the great alteration in the quantity and quality of the fluid which passes through them, rather than have recourse to the idea, that any change in the secreting vessels of the kidney could produce such a complete perversion of the actions of every part of the system.
Diabetes has, of late, occupied an unusual share of the attention of medical men, in consequence of the circumstances connected with its treatment appearing to coincide with some pathological doctrines which were fashiftable a few years ago. The remarkable change in the chemical condition of the urine, by which a compound, consisting of hydrogen and car bon is substituted for one into which azote enters as a principal ingredient, led to the idea, that by exclud ing these elements, as much as possible, from the diet of the patient, the morbid state of the fluid might be prevented or corrected. It was accordingly found that, by employing a complete animal diet, the sugar was no longer produced ; and it was announced that, by strictly adhering to this regimen, the disease had been completely cured. Subsequent experience has not, however, confirmed these favourable reports, for al though, while the hydrogen and carbon are no longer present in the digestive organs, the sugar can be no longer generated, yet the diseased action seems to re main without alteration, so that, upon the least devia tion from the animal diet, the saccharine urine is re produced, at the same time that the patient remains nearly in his former state of debility, without any con siderable abatement of the other symptoms ; so that, al though the progress of the complaint be retarded, it does not appear that it ever has, by this means, been ultimately counteracted. A very different mode of treatment has been since proposed, and even adopted in Diabetes. Notwithstanding the apparent failure of the muscular powers, and the different circumstances indicating the extreme of debility, very copious bleed ings have been employed, and if not with much bene fit, at least without that aggravation of the disease which might have been apprehended. The old method of treating the complaint, and the one which is still often had recourse to, is by astringents of various kinds, to which opium is often conjoined; and of the efficacy of this practice we have many flattering accounts, hut, from its total failure on other occasions, we suspect that the alleged cases have either not been proper Diabetes, or that the medical attendants have hastily caught at some flattering appearances of amendment, and mistaken them for a radical cure. Upon the whole, we believe that where the urine was in large quantity and highly saccharine, where Bulimia existed in any considerable degree, and where the cutaneous perspi ration was abolished, no cure has ever been accom plished. With respect to the treatment which may afford the hest chance of success, or which may possibly remove the complaint in its incipient state, we should recommend that a moderate bleeding be premised, and that a diet be employed, of which vegetable matter should form only a small proportion ; at the same time we may administer vegetable tonics, and may endea vour to restore the natural action of the skin by diapho retics and the warm bath.' Gout may be characterized as a disease which recurs in paroxysms, consisting essentially in the pain of one or more of the smaller joints of the hands or feet, most commonly of the great toe, which is attended with fever, and terminates in redness and swelling of the part ; the local affection is preceded by a state of gene ral indisposition, and especially by various dyspeptic symptoms ; and we usually find that, when the inflam mation is established in the extremities, the stomach be comes relieved. The paroxysms come on at uncertain intervals, and frequently without any obvious exciting cause ; but it is generally connected with an hereditary predisposition, and is scarcely ever met with except among persons in the higher ranks of life ; and for the most part, when not hereditary, may be clearly traced to habits of luxury and self-indulgence. \Vhen Gout exists in a well marked form, there is no difficulty in distinguishing it from all other affections ; it is easily recognized by the state of the stomach, the part which is affected, and the nature of the predisposing and ex citing cause ; but in its more irregular forms, it is apt to be confounded with Rheumatism, and it appears, in deed, that the two diseases are sometimes combined in the same patient. In those who are predisposed to Gout, it may be excited by any thing which produces an increased action in the part, as by excessive exercise, by a strain, or a bruise ; but in those who inherit the disease, or who have once suffered severely from it, we often find it impossible to detect any assignable cause for the paroxysm. The fact that Gout never attacks the pool, while even a considerable proportion of the wealthy are more or less subject to it, is known to every one, and has necessarily given rise to much speculation respecting both its predisposing and its proximate cause. It is not very easy to determine to which of the circumstances that attach to the condition of the rich its production is to be attributed ; mere excess in eat ing, although it produces stomach complaints, does not generate that specific state of the digestive organs which gives rise to Gout, nor do we find that the abuse of fer mented or spirituous liquors, which is so common among the lower classes, subjects them to this complaint. It would appear that it depends upon the combined ope ration of luxurious habits of various kinds, of which, in dulgence in the gratifications of the table, and the want of a due quantity of bodily exercise, arc probably the most important.