1. The first object is to discover the origin and seat of the disease (322).

2. If it arise from a debilitated state of the stomach, in which either the secretions are deficient or depraved, or the muscular powers of that organ have lost then-vigour, we have first to remove, as far as we are able, the remote causes which may have produced the disorder. The alimentary canal must be cleared of all foul congestions, and their future accumulation prevented, first, by a strict adherence to a diet most likely to insure the digestion of the food; and, secondly, by the careful exhibition of laxatives, which may carry off the superfluous parts. The functions of the skin must be restored, and a general vigour imparted to the body, by remedies which are calculated to strengthen the nervous system.

3. If the dyspeptic disease has continued long, and we have reason to suspect an inflammatory state of the gastric membranes, we must employ antiphlogistic means for its cure (366).

4. If the duodenum be the seat of the disorder (292), we must carefully insure, by appropriate diet, the complete chymification of the food, so that it shall not be irritated by the contact of half-digested food; the secretions which enter its cavity must be regulated and improved, by small doses of mercury; and colchicum may be administered in the manner above directed (361).

Above all, the colon must be carefully preserved from feculent accumulations.

5. If the bowels be distressed with flatus, we must ascertain whether the feeling arises from an increased quantity of air present in the canal, or a morbid sensibility of the membranes, which renders the ordinary quantity of elastic matter burthensome. In the former case the treatment must be regulated by such measures as may prevent fermentation (359); in the latter, the irritability of the intestines must be appeased by sedatives.

6. If acidity prevails, we have to inquire whether it arises from- the nature of the food, or the morbid state of the gastric juice, and regulate our measures accordingly (353).

7. Where disease exists in the bowels, and the appearance of the stools indicates a dysenteric affection, we may infer that the mucous membrane is in a state of disease.

8. The administration of tonics and aromatic stimulants will always be attended with mischief, where a phlogistic condition of the mucous membranes exists: mild aperients and light diet are to be prescribed under such circumstances (368).

9. When there exists a languor in the muscular powers of the alimentary canal, and a torpor in the secreting membranes, bitters, aromatics, and other stimulants, such as mustard-seed, etc. may be safely administered.

10. The dietetic code of the dyspeptic patient may be summarily included under the following precepts:

A. Precepts In Relation To The Quality Of Food

A. Animal food is more digestible, but at the same time more stimulant and less flatulent, than vegetable diet. A dyspeptic invalid may be restricted to meat and bread with advantage, until his digestive powers have gained sufficient energy to enable him to convert vegetable matter into healthy chyle (129), after which a due mixture of both species of aliment will be essential (131).

B. The wholesome quality of food depends as much, or even more, upon its mechanical condition, as upon its chemical composition (171); and as this is influenced by various circumstances under our own control, we may render food, naturally indigestible, of easy digestion (174). The digestibility of any species of aliment, as well as its nutritive qualities, are influenced by the different modes of cookery (177). The addition of condiments is also capable of producing the same effects (183). The practitioner will be enabled to direct that species of food, which is best calculated to fulfil the indications of the case, by an attentive perusal of those remarks which are introduced in the body of this work And he will also find ample directions for his guidance in the selection of liquids for drink.

B. Precepts In Relation To The Quantity Of Food

This must, in every case, be regulated by the feelings of the patient: let him eat slowly, masticate thoroughly, and, on the first feeling of satiety, dismiss his plate, and he will not have occasion for any artificial standard of weight and measure. But he must, in such a case, restrict himself to one dish; an indulgence in variety provokes an artificial appetite which he may not readily distinguish from that natural feeling which is the only true indication.

C. Precepts With Regard To The Periods Best Adapted For Meals, And On The Intervals Which Should Elapse Between Each

I have, upon every occasion, endeavoured to impress upon the practitioner the high importance of these considerations. In every situation of life, we too frequently pass unheeded objects of real importance, in an over-anxiety to pursue others of more apparent but of far less intrinsic value; so is it with the dyspeptic invalid in search of health: What shall I eat? Is this, or that species of food indigestible? - are the constant queries which he addresses to his physician. He will religiously abstain from whatever medical opinion, or even popular prejudice has decried as unwholesome; and yet the period at which he takes his meal is a matter of comparative indifference with him: although he will refuse to taste a dish that contains an atom of vinegar with as much pertinacity as if it held arsenic in solution, he will allow the most trifling engagement to postpone his dinner for an hour. So important and serious an error do I consider such irregularities, that I have frequently said to a patient labouring under indigestion, "I will waive all my objections to the quality and quantity of your food, if I were sure that such a sacrifice of opinion would insure regularity in the periods of your meals".

a. The principal solid meal should be taken in the middle of the day.

b. Four hours after which a liquid meal should be indulged in.

c. The digestion of one meal should be always completed before fresh labour is imposed upon the stomach.

d. The intervals at which food is to be taken must be regulated by-the digestive powers of the individual, and the rapidity with which they are performed.

e. The patient should never take his meal in a state of fatigue. f. Exercise, if practicable, should always be taken three or four hours after dinner.

Conclusion

I have now fulfilled the objects, which I proposed to myself in the composition of the present Work. I have attempted to establish the general principle upon which the digestibility and nutritive powers of different aliments depend; and I have endeavoured to point out the circumstances which may render any species of food indigestible and noxious; but, after all, it is impossible that any standing orders, however judicious can be made applicable to every case; nor can any work be written which shall embrace every modification of so proteiform a disease; I therefore trust that the practitioner will make a liberal allowance for the defects of the present treatise, and not like the country fellow, in Aristophanes, pick a quarrel with the map, because he could not find a particular farm in it. It only remains for me to relate a few Cases in illustration of the views I have offered, with regard to the causes and nature of dyspepsia, and in confirmation of the utility of that medicinal and dietetic treatment which has been developed in the preceding pages.