Flatulence is often a very distressing disease; it sometimes is associated with acidity, but frequently is the only symptom which indicates an imperfect digestion. Whether the gas, with which the intestines are inflated, be a product of fermentation, or a secretion from their vessels, is a question which has given origin to some discussion. It may probably arise from either of these causes, although it is generally attributable to the former. In some cases, it appears to contain sulphuretted hydrogen gas, and eructations take place which are characterised by the smell of rotten eggs. Where this occurs, we may infer the existence of great alimentary disturbance; the natural affinities, by which the digestive changes are produced, appear to be subverted, and a new chain of compositions and decompositions established. The albumen would seem to be the substance from which this compound is generated; and in several cases which have fallen under my notice, relief has been obtained by confining the patient to a strictly farinaceous diet.

Ordinary cases of flatus, however, are of a different nature; the air appears to be the product of fermentation, and by avoiding such vegetables as are known to be susceptible of it, the disease has been removed, n certain states of the alimentary canal, a sense of distention may be felt, without any morbid increase in the quantity of intestinal gas; an undue sensibility or irritability of the bowels may occasion such a feeling. This fact has been well illustrated by Dr. Parry1: he observes, that "there is often considerable variation in the degree of inconvenience resulting from the use of food or drinks which disagree." "Sometimes," says he, " if I take acids, as considerable quantities of fruit, and immediately afterwards eight or ten scruples of kali at a dose, in saturated aqua kali carb., I feel no distention of the stomach, and bring up no carbonic acid gas: several hours afterwards there is a great uneasiness in the colon, which is not relieved till a great quantity of wind passes downwards. In this case it was absolutely necessary that the wind should have existed in the stomach, because an acid and an aerated kali were mixed there.

But no dyspepsia, or what is called wind, was produced by it, because the stomach itself was not thrown into a spasmodic state from being over-irritable. Afterwards, however, when the same wind passed into the colon, that bowel being in a state of morbid irritability, the uneasiness from the wind was produced there till the wind was expelled." Although the terms in which this fact is expressed may not be consonant with those of modern science, the fact itself, as well as the explanation of it, are of great practical value. It is not the presence of gas in the intestinal canal, but the irritability of the intestines, which renders them impatient of the slightest stimulus of distention, that occasions the distress so common to dyspeptic invalids. In different forms of dyspepsia different parts of the alimentary canal have their sensibilities excited: I have a patient, who, from the slightest error of diet suffers from flatulency, but he never feels the distress but in the sigmoid flexure of the colon. A person in robust health may, from various accidental circumstances connected with the nature of his food, experience an unusual intestinal distention; but it will not occasion distress, for the reasons above stated.

The practice to be founded upon such observations is evident: we shall obtain more advantage from calming the irritability of the bowels, than by dispelling the flatus by carminatives. I have found small doses of the extract of hyoscyamus, combined with two grains of ipecacuan, produce relief in attacks of flatulence which have resisted the ordinary methods of cure.

1 Collections from the Unpublished Medical Writings of the late Caleb Hillier Parry, 1825.

360. Some dyspeptics, in consequence probably of an uneasy sensation at the cardia of the stomach, acquire the habit of swallowing a quantity of air, and of again expelling it. I have seen a patient who, for a considerable period, has thus appeared to bring up torrents of wind from his stomach, whereas in truth he merely suffered the air to return into the mouth which he had previously forced through the pharynx. I do not intend to insinuate that this is a voluntary deception; it is evidently a habit originally acquired from a spasmodic effort to relieve a painful sensation.

361. Dr. Parry considers that dyspepsia consists in such a state of the villous coat of the stomach or intestines, or both, as subjects them to be morbidly susceptible of irritation from certain kinds of food, or certain changes of the food, which are not perceived, or produce no uneasiness in healthy stomachs; and that this affection of the villous coat, throughout all its degrees, up to inflammation itself, is apt to be followed by sympathetic or symptomatic affections of the secretory arteries or glands seated in it, and often of the muscular coat of the alimentary canal itself. I believe that such an affection is the general consequence, although not the cause of dyspepsia. In the treatment, therefore, of this complaint, we may frequently interpose sedatives with advantage. Protracted dyspepsia not unfrequently depends upon a morbid condition of the alimentary surfaces; the mucous membrane becomes affected, and the disorder is not removed until measures have been adopted to restore its healthy secretions.

A fretful state of the intestinal discharges is generally associated with such a disturbance, and I have found the administration of a lenient aperient every morning, with small doses of the vinum colchici, repeated twice a day, eminently successful in such cases.

362. Where the dyspeptic disease is connected with duodenal irritation, I know of no medicine more useful than the vinum colchici; taking care to accompany its exhibition with that of occasional laxatives. Purgatives that act with violence are always followed with an aggravation of the symptoms. Dr. Yeats speaks in high terms of commendation of the sulphate of potass: "It appears to me," says he, "to have a more specific effect upon the duodenum than the sulphate of magnesia. I give Эj. of it twice a day in the infusion of quassia. If much feverish irritation prevails, arising, as I imagine, from some slight inflammatory action in the duodenum, the saline draught, in a state of effervescence, is substituted, with the sulphate of potass, for the bitter infusion, with the happiest effects." This is very excellent practice: I am satisfied that nothing is more mischievous than active purgation in every stage of dyspepsia. Drastic doses of calomel, to which some practitioners resort, are calculated to increase the morbid irritability by which the disease is kept alive. In cases even of loaded bowels, it will be more prudent to excite their peristaltic action by a gentle but continued stimulant, than to irritate by active purges.