Nervous diseases, liver and stomach complaints, low spirits, indigestion, gout, asthma and disorders produced by tropical climates ...

Front matter

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Preface

The well-known but ill-humoured observation of Dr. Samuel Johnson, who, in speaking of the profession of physic, exclaims, It is a melancholy attendance upon misery, a mean &ubmission to peevishness, and a continual interruption to pleasure,” was never more capable of being refuted than on the present occasion. I may truly observe, that instead of its being “ the melancholy attendance on misery,” it has borne a most cheerful aspect; in lieu of the “ mean submission to peevishness,” it has resulted in an improved and elevated position ; and “the continual interruption to pleasure” has, instead, been a copious stream of gratifying circumstances.

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In the present enlightened state of mankind, it appears unnecessary for me to expatiate upon the advantages of medical science and its practical benefits to the world at large.

The science of medicine comprehends the perfection of human wisdom ; and the practice inculcates one of the Divine attributes, that of relieving the sufferings of our fellow-creatures.

Since the publication of the Sixth Edition of this Work, several cases of Asthma have come under my notice, and I have deemed it important to introduce a few remarks upon the treatment of that disease.

Although many cases must necessarily occur in my practice where every remedial measure has in vain been adopted, yet, as I feel conscious that such details would not benefit science, but alarm unfortunate nervous invalids, I have purposely abstained from introducing them.

I refer with much satisfaction to some important cases which I have added to this Edition, and to the increasing attention of the Public and the Medical Profession, to Liver and Stomach Diseases, as proofs of the prevalence of these truly distressing maladies, and powerful evidences of the extending and baneful influence they exercise over the comforts and habits of civilized life.

The flattering notice with which “ The Times” honoured this Work, although most gratifying and important to me, yet introduced a misconception as to the period of its publication, by stating that much had been introduced in it already before the public by Dr. Combe and many other Medical Writers.” Without any desire to detract from the well-merited esteem in which those Authors are held, I feel justified in stating that the First Edition of this Work appeared in 1820; a period when neither Dr.

Combe nor any other Medical Writer of the present day had introduced the subject to the Public.

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Indigestion may, indeed, be designated as the fruitful source (the ^^fons et origo ”) of many of the diseases that afflict human nature ; and when the various causes are considered, as involving our contradictory and preternatural modes of life, little doubt can be entertained of the importance of its remedy, not only in the removal of desease, but in the preservation of health.

This Work has been re-written on principles long established before the public : and in addition to its former observations, I have ventured to introduce a few practical remarks on Gout, as calculated, I trust, at least to relieve, if not to remedy, that distressing malady.

My aim has not been to establish new principles in Medical Science, but to express opinions which I rely upon being borne out by the concurrent testimony of the most enlightened men in our Profession.

Another class of diseases has been submitted to my care, viz. those resulting from the effect of tropical climates on European constitutions : indeed the restorative principles of diet, regimen, and the mild alterative system, were never more powerfully evidenced than in the numerous cases of invalided Indian officers that have fallen under my care.

In addition to the former observations of Dr. Beaumont, I have introduced his valuable remarks on dietetic economy ; and I confidently hope that the varied cases which have been added to those of former editions will (however humble) be deemed, by my Medical Brethren, of sufficient importance to claim their attention, and that the public generally will be convinced that some of those formidable maladies, so destructive to human happiness, may to a certain extent be mitigated, if not altogether removed.

I have cautiously abstained from entering too largely into physiological detail, being more anxious to present the public with the results of thirty years' practical observations and experience, although conscious of my fallibility and imperfections.

I feel also much gratification in stating that the principles of treatment I have endeavoured to illustrate, are but the carrying out to a fuller extent those valuable and important measures first promulgated by my great master and lamented friend, the late John Abernethy.

More than twenty years have now elapsed since the first appearance of this Work ; and I can only observe, that an enlarged field having been opened for the suggested treatment of these disorders, of course the opportunities for investigation have increased, and by w^hich I have been led unequivocally to confirm its efl&cacy. This induces me to present another edition, with such amendments and additions as I am enabled to add as the result of these advantages ; and here I may be allowed to mention, with much satisfaction, that since the appearance of this little volume, many of the most eminent men in the Profession (not only in this, hut other countries) have confirmed the principles of treatment it advocates. Of these, Dr. Paris, Dr. Wilson Philip, Dr. J. Johnson, Dr. A. Combe, Dr. Beaumont, of the United States, and Professor Muller, of Berlin, demand particular notice.

As this Work aims at nothing but merely the

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laying down a regular and decided method of cure of the hypochondriac and dyspeptic diseases (assisted by the concentrated opinions of the most eminent men in the Profession), little more than practical hints can be expected to be offered.

In submitting the following Work to the inspection of the Public, as well as of the Profession, it is not my intention to assume a knowledge superior to that of other medical practitioners, or to subvert the most approved systems of treatment of these prevalent maladies ; but merely to communicate the result of long and continued application, in the investigation of these particular diseases, in this and other climates.

The experience which my practice, in several parts of the world, afforded, first induced me minutely to inspect the nature and progress of such frequent complaints ; and therefore the following remarks are offered to the public, with a view of impressing more fully on the minds of practitioners in general the necessity of the greatest regard and attention to all the minutiae of them ; and also of giving an admonition to the unfortunate invalid, to avoid the use of spirituous liquors to excess ; and to check the great desire, usually indulged in, of employing every empirical nostrum, daily offered as a specific remedy.

I have adverted to some of the singular sympathies and connexions in many of the important organs of the animal economy ; but such is the obscurity of the operations of nature, that many of them are unaccounted for, and are only known to exist ; yet it is highly essential, in the management of disease, that medical practitioners should be apprised of the certainty of these phenomena, although their causes cannot be ascertained. Sufficit si quid fiat mtelligamus etiamsi quomodo quidque fiat ignoramus. — Cicero.

With a view of defining the different modes of treatment, in the hypochondriac and dyspeptic diseases, I have availed myself of that plan which I conceived most calculated to exhibit the various and insidious forms which they assume, by the enumeration of cases selected as most likely to answer the intention.

In detailing the diet and regimen to be observed, I have dwelt most particularly upon the advantages accruing from regular and temperate modes . of life, and which must be regarded as the grand coadjutors to the enjoyment of health, as well as to the annihilation of diseases principally occasioned by their negligence, and which, viewed either in a moral or physiological light, will carry with them a conviction of their rectitude.

I have eagerly availed myself of the valuable and important experiments of Dr. Beaumont in the elucidation of the digestive process ; and I rejoice that the labours of that distinguished philosopher have been so beneficial in establishing a dietetic system which must remove many prejudices, and secure to the invalid a plan well calculated to promote his restoration to health.

ON

NERVOUS DISEASES,

SfC. SjC,

CHAPTER I. Low Spirits

The connexion existing between bilious and nervous diseases, with the generally received opinions of their dependence on each other, renders any observations on such prevalent maladies always highly interesting; if they were merely to excite the attention of others in the profession, more capable of explaining the nature of their several diseases, and, consequently, tending to a discovery of the most proper remedies. Happily for mankind, since the appearance of these observations (twenty years ago) many l(j

valuable and important investigations have taken jdace*; disease has been much mitigated, the formidable train of symptoms ameliorated, and its hitherto too frequent and fatal results considerably averted.

The term “nervous” may be applied, in a general point of view, to every disease the human body is subject to, being more or less dependent on nervous excitability; but, in the modern professional acceptation of the word, it is intended to convey the meaning of that class of diseases in which the nervous system is immediately and principally interested.

Now, as all nervous energy must be supposed to originate in the regular and healthy formation of blood, which the great sympathy between the nervous and sanguiferous system evidently denotes, it is fair to infer that those organs, principally interested in the assimilation of food, must be considered as the incipient causes of vitiated nervous sensibility; it will, therefore.

* Vide Dr. Wilson Philip ; Dr. Paris ; Dr. J. Johnson ; Dr. Combe; Dr. Beaumont, of the United States, &c. &c.

1/ be my aim to select such instances which physiological and practical observations will amply justify and clearly demonstrate.

The influence of the stomach in the animal ceconomy is greater than is perhaps generally imagined. It not only contributes to the digestion of the aliment, but the whole system is either invigorated or affected with a languor, according to the different dispositions of the nerves. By proper food the nerves of the stomach are gratefully stimulated, and the whole body is thence enlivened and strengthened : so that, beside its use for nutrition, food in the stomach becomes, on account of its stimulus, altogether necessary in some delicate nervous people for keeping up the strength of the body and the due exercise of all its functions : and hence it is that such persons become faintish as soon as the greatest part of the food has passed into the intestines

The sudden eflPects from mental impressions are evinced by the fact, that certain fears or affections excited in the mind are frequently

* Whytt on Nervous Diseases, p 255.

H accompanied by corresponding sensations in the body : as the seeing another vomit will often cause the same effect on the spectator; the recital of tales of misery and woe will stimulate the laehrymal glands to pour out tears in greater abundance ; and it was even observed by HippoerateSj that the unexpected sight of a serpent immediately causes the countenance to turn pale *. And among other instances of this peculiar species of sympathy, is that of yawning being so generally communicated to persons in the same society ; therefore, these are to be attributed to the changes made on the sensorium commune^ by the mind or sentient principle.

When the stomach is disordered, languor, debility, restlessness, and impatience are the consequences ; and the great sympathy between

* Lib. de Humoribus.

f “ The stomach being rnisaffected, which he calls the King of the Belly, because, if he be distempered, all the rest suffer with him, as being deprived of their nutriment, or fed with bad nourishment ; by means of which come crudities, obstructions, winde, rumbling, griping, —Burton' s Anatomy of Melancholy, Part I. sec. 2. memb. 5. sub. iv.

that organ and the skin is manifested by the eating of shell-fish, which will, in some peculiar habits, produce a violent eruption ; and the external application of cold in fevers occasionally excites vomiting ; also worms lodging in the coats of the stomach, by their irritating powers on its nervous sensibility, cause convulsions in the whole frame.

Nothing makes more surprising changes on the body than the affections of the mind ; and when it is considered that the action of the heart is greatly accelerated, or nervous energy preternaturally diffused by fits of anger, the unity of action between the arterial and nervous systems is clearly demonstrated. It is but reasonable, therefore, to suppose, when the circulation is languid, that universal debility will be the result, and the contrary when stimulated.

The contractile state of the pupil of the eye, when light is unexpectedly and offensively admitted; the increased secretion from the lachrymal glands, when any irritating substance is applied to the eyes, are decided and manifest convictions of that principle of self-preservation,

B 2 which is so conspicuous in all the functions of the animal economy, by getting rid of something prejudicial to the due performance of its office, and must be attributed to that connexion between the mind, or sentient principle, and body, which animates our whole frame ; yet even, in some instances, these efforts to prevent the accumulation of morbific matter, are productive of serious and fatal consequences, by their impetuous and irritating powers on the constitution, although the great utility of these efforts must be apparent, as we should often cherish such substances in our habits as would ultimately tend to the destruction of life.

The peculiar sensation of hunger is among those phenomena of nature, which are as yet unaccounted for. “ The cause which excites appetite is an impression made on the nerves of the stomach ; but the feeling itself is experienced in the brain, to which that impression is conveyed * and by way of illustrating the influence which the nervous or living principle has, in counteracting the corrosive qualities of the

* Combe.

secretion of the stomach, the following wellauthenticated case might be mentioned*. A criminal, immediately before his execution, had eaten a hearty meal. On dissection, when the abdominal viscera came under examination, it was found that the stomach itself had undergone the same changes as its contents ; clearly proving that this potent secretion (for the purpose of digesting the alimentary matter contained in the stomach) had been excited, but, by the vital destruction of the organ, it was deprived of that mysterious protector, which would seem to indicate, thus far shalt thou go, but no farther.” — My impression is that the sensation of hunger is produced by a distension of the gastric vessels, or that apparatus, whether vascular or glandular, which secretes the gastric juice, and is believed to be the effect of repletion by this fluid

The singular sympathies and connexions in the animal formation, as well as the wonderful faculties of reason, memory, imagination, reflec-

Observations of John Hunter and Spallanzani,

t Dr. Beaumont’s Theory of liung'er, page 47.

B 3 tion, judgment, &c., so intuitive in man, and by which he is so eminently distinguished from the brute creation, must be referred to the brain, as being the medium or instrument by which they emanate ; but the manner in which the will is conveyed to the brain, or how sensations are excited in different parts of the body, remain involved in the greatest obscurity * ; yet contemplation on this grand and sublime mystery, duly and seriously devoted, will surely preponderate over the hypothetical opinions, which materialists adduce of the non-existence of a Supreme Being; and however hidden it may at present remain, yet future ages may perhaps develope the awful and omnipotent source.

The nerves are subject to the same diseases as other parts of the body ; they may become inflamed or irritated, and their sentient powers may become either too acute, obtuse, depraved, or entirely deficient, as in cases of Paralysis,

* “ The Author of Nature is perfect in all His works; and although we may not understand all the operations of His hands, we are compelled to acknowledge their wisdom, propriety, and beauty.” — Beaumont^ p. 47.

Hydrophobia, Hemiplegia, &c. ; but as I intend to confine myself particularly to those species of nervous disease, which are denominated Hypochondriasis or Low Spirits, and Dyspepsia or Indigestion, I shall forbear to make any remarks on others, as the subject would require a much greater latitude than the present work is intended to comprise.

In describing the symptoms of Hypochondriasis, or as it is usually termed. Vapours, or Low Spirits, I shall not enter into an enumeration of all the morbid changes, but content myself with the most common and remarkable ; for, as the learned Sydenham remarks, the variations of the hypochondriac and hysteric diseases are only to be equalled by the shapes of Proteus, or the colours of the Chamelion * ; in fact, in a greater or less degree, they become intermixed with almost every chronic disease the human body is subject to ; and, as the celebrated Dr. Mead has justly observed, “ Non imam sedem hahet, sed morhits totius corporis est

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The following are among its most common indications. Want of appetite, indigestion, debility, faintness, and sense of great sinking, and fulness at the stomach ; flatulence in the intestines, acid eructations of wind, nausea, and frequent vomiting of dark fetid liquor ; pain and spasms extending across the epigastric region ; great depression of spirits, impatience and anxiety ; clay-coloured evacuations from the bowels, sometimes in a relaxed, at others in a costive state ; hoemorrhoids or piles, and frequent discharges of blood; flushings of heat, and cold shiverings over the whole body ; pains in the back and shoulders, spasmodic affections of the muscles ; tremblingly alive to a sense of danger* ; restlessness and want of sleep, sudden startings on the slightest unexpected noise ; frequent sighing, a sense of great oppression about

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the region of the heart, with violent palpitations ; the skin is dry and constricted ; tongue furred, and an unpleasant taste in the mouth ; foetor of the breath ; tremors, more particularly when the stomach is empty, with frequent yawning; pains in the head, with frightful dreams and hallucinations; pulse irregular and intermitting; giddiness and confused noises in the ears ; vision frequently obstructed and imperfect ; impaired memory, wandering and unconnected thoughts, want of resolution, considerable difficulty in being roused to either mental or corporeal exertion ; former occupations which were regarded with pleasure and satisfaction, now become tedious and irksome ; and many other symptoms which it would be tedious here to enumerate.

There are but few patients, after having been afflicted with these symptoms, and long continued so, but fall into a state of melancholy, madness, apoplexy, dropsy, phthisis pulmonalis, or some other fatal disease, unless timely aid is had recourse to, and which, in the early stage of the disease, is generally to be attained by that mode of treatment I shall hereafter refer to.

The leading causes of Hypochondriasis will next come under consideration : these are various, but the general ones must be attributed to morbid derangements of the liver* and stomachglandular obstructions of the alimentary canal ; intense study ; mental disquietude ; immoderate and luxurious living ; sedentary and inactive occupations ; inebriety frequently indulged in ; and in lihidine venerid excessus.

These conjoined, in a habit predisposed to nervous excitement, which is strongly indicated by a peculiar melancholic temperament, sallow complexion, thick impending eyebrows, coarse moist hair, are to be denominated as the primi-

* “The weakness of the liver and his obstruction, a cause facultatem, debilem jecinoris, which he calls the mineral of melancholy.”— Anatomy, Part I. sec. 2. memb. 5. sub. iv.

f “ There is no doubt that low spirits, melancholy, and disturbed sleep, often proceed from a disordered state of the stomach.” — Whytt on Nervous Disorders, page 318.

2/ tive and most potent symptoms of this afflicting malady.

And here I can but refer to the numerous list of patients which have occurred to my notice amongst gentlemen of the legal profession ; clearly evidencing that, where corporeal exercise has not been used as a principal auxiliary to stem the morbid effects of an overstretched mind, the most formidable attack of Hypochondriasis is too frequently the result.

In pointing out the most efficient remedies, it will be necessary to state the objects which they are intended to accomplish ; and the following rules are to be adopted as the most rational principles of cure, which I shall define the mental and corporeal :

1st. The nervous system, being deprived of its energy, requires a powerful stimulus to remove the consequent torpor and gloomy state of the mind.

2d. The constant indolent and morbific action of the gastric and biliary organs, demands the greatest exertions to promote a due and healthy performance of their various functions.

In order to accomplish the first of these objects, the following are to be recommended : change of air and exercise*, cheerful society, travelling, indulgence in some favourite sport, as hunting, coursing, shooting, gardening, a sea voyage, or any employment that will withdraw the invalid’s attention from that proneness of mind which is cherished in contemplating the danger arising from the disorder. The management of the mind is to be regarded as of the greatest consequence ; and every attempt to persuade the unhappy sufferers that their apprehensions are imaginary or unfounded, must be avoided ; therefore, compassion and kindness, with every possible attention to their feelings or wants, must be substituted for ridicule or reasoning.

* “ Many people who are extremely irritable and hypochondriacal, and are obliged to take medicines to regulate their bowels whilst they live an inactive life, no longer suffer from nervous irritation, or require aperient medicines, w'hen they use exercise to a degree that would be excessive in ordinary constitutions.” — Ahernethy s Surgical Works, vol. i. page 91.

In laying down modes of cure^ general rules can only be advanced, as the various symptoms in this, as well as other diseases, prevent the suggestion of specific ones ; and having stated those mental remedies, I shall next proceed to consider the corporeal.

The sympathy between the stomach and brain which has been noticed, as well as the important changes the digestive organs have to effect in the decomposition and assimilation of nutritious matter, and the too general indulgence in the luxuries of the table, serve as fair reasons to suppose, that the seat of this disease must, in some measure, be referred to the vitiated secretion and imperfect functions of the stomach*, and that particular attention ought to be paid to the matter conveyed into it. Light animal food must be preferred to vegetable t, as being likely

* “ When the stomach is in a sound state, and digestion is properly performed, the spirits are good, and the body is light and easy ; but when that organ is out of order, a languor, debility, melancholy, watchfulness or troublesome dreams, the nightmare, &c. are the consequences.” — Whytt on Nervous Diseases^ page 1 1 .

f “ As a general rule, animal food is more easily and to occasion less acidity, milk, as requiring less digestion, boiled fish, or white-fleshed poultry, custards, bread puddings made with eggs, boiled rice, light French bread, avoiding every substance containing fatty or oily matter, as butter, rich soups, &c. The drink should consist of light French wines, in small quantities ; the good effects of wine thus used seem not altogether to have been unknown to Celsus, who tells us, Si quis vero stomacho lahorat non aquam sed vinum hihere jejunus dehet^'’ Wine in general is preferable to malt liquors, as being lighter, less apt to ferment, and less flatulent ; tea and spirituous liquors must be avoided.

Haller, in his Physiological Lectures, observes “ never use milk, soups, beer, or other liquors made hot, for this is preternatural to man, as well as to all other animals, and by relaxing the nerves of the stomach, heart, diaphragm, and

speedily digested, and contains a greater quantity of nutri" ment in a given bulk, than either herbaceous or farinaceous food.” — Dr. Beaumont's Experiments^ page 301.

* De Medicina, lib. 1. cap. viii.

f Vol. ii. page 341, Mihles’ translation.

Other adjacent viscera, is productive of numerous diseases in those who have them already weak ; much less scalding tea, which many drink hot enough to fetch the skin off a delicate finger.”

Now, as this disease may be considered as arising from deranged condition of the stomach, rather than that of debility, any measures likely to improve the former, without adding to the latter, are to be regarded as among the most beneficial. Immersing the body in cold water, and afterwards rubbing it dry with flannels ; early rising, and the hours of bed-time gradually reduced ; more particularly if the patient does not sleep. The situation for residence should be selected as being high, or hilly, on a chalky or gravelly soil.

Having thus far considered (though briefly) the mental and dietetic treatment of this disease, I shall next proceed to the discussion of the benefits to be derived from the medical, and endeavour to point out that particular mode of treatment which I conceive is best adapted to the cure, of course being influenced by the various exciting causes. First, I beg to observe, that, as it is generally in the power of medicine to relieve, so it is frequently inefficient in annihilating this disease altogether, although it may admit of the greatest palliation ; and, under the most favourable circumstances, no permanent benefit can be expected to be derived, without a steady perseverance in a course of diet, medicines, and exercise.

The remedies which my experience confirms to be the most proper will, perhaps, be illustrated by an enumeration of the following Cases.

CASE I.

A Gentleman, aged 32, of a melancholy temperament, was attacked with, violent pains in his head ; difficulty of respiration, and sense of fulness about the region of the stomach; which had continued at intervals for several months. When he applied to me, in the autumn of 1813, his appetite was much impaired;

tongue furred, with an unpleasant taste in his mouth, particularly in the morning ; an uncommon sense of heat, or cold, in different parts of the body, sometimes suddenly succeeding each other ; great despondency ; wind in the stomach and intestines, with sour belchings ; nausea and frequent vomiting of black fetid matter ; a sudden and great flow of pale urine during the night ; pulse quick and full ; restless and disturbed in his sleep, with violent palpitations of the heart. I ascertained that the evacuations from his bowels were sometimes black, at others clay-coloured. Considering that his disease originated from the imperfect secretion of bile, and the general derangement of the chylopoetic viscera, I directed my attention to what I imagined to be the most important object, viz. that of endeavouring to obtain a due and healthy .action of the digestive organs : I therefore immediately prescribed a dose of mercury, and an aperient draught.

The discharge from the bowels, by the operation of these medicines, was composed of slimy clay-coloured matter, without the appearance of c bile, accompanied with a considerable degree of tenesmus. I then prescribed small and undebilitating doses of mercury, with gentle aperients, recommending the most plain and simple diet, with plenty of air and exercise; and, as the secretion from the bowels became more and more tinged with a proper admixture of bile, I found the symptoms gradually disappear, and, in a few weeks, he was perfectly restored.

About the same time, in the year 1816, he was attacked with a recurrence of the preceding symptoms, although in a much less degree; but, by a regular and persevering attention to a similar plan, was again perfectly re-established in his health.

A review of the above case clearly demonstrates the unity of action between the secretions of the animal economy ; as a derangement of any of them evidently produces the same affection in the others. The furred state of the tongue and impaired appetite, the appearance of the motions and black vomiting, were convincing proofs that morbid derangement existed in the alimentary canal : whilst the despondency of mind, and profuse discharges of pale urine, evinced that the nervous system was labouring under extreme agitation, and that the secretory vessels of the kidneys were thrown into stronger and quicker alternate contractions ; and moreover, as perspiration is generally impeded by the operations of the mind, the aqueous part of the blood was determined more to the kidneys. The medicines, by gradually removing the glandular obstructions from the prima via^ and inducing a due performance of their various functions, prevented those parts sympathising with them in their morbid sensibility ; and consequently effected the cure.

CASE II.

A MIDDLE-AGED Gentleman, who had been subject for several years to many of the distressing symptoms of Hypochondriasis, as severe head-aches, indescribable anxiety of mind, trembling and palpitations on the least exertion, and who, in vain, had tried many approved remedies, made application to me in the year 1816. His case was truly pitiable. He had made use of various empiric remedies which are daily offered to the public as infallible, and innocent in their composition, although they contain drugs of the most pernicious nature, and so far from being an antidote, become a powerful auxiliary to the rapid progress of that disease they are w^arranted to cure. By these, his symptoms were not only augmented, but others of a still more alarming nature were induced ; the stomach was rendered so irritable, as to reject almost everything taken into it, and on examination of the right hypochondrium, I found a considerable enlargement and induration of the liver ; his despondency was so apparent in his countenance, that his friends were apprehensive for his safety. With giddiness there was great dimness of sight (without any apparent defect in the organs of vision), and determination of blood to the head ; considerable oppression in the region of the heart, accompanied with frequent sighing. This was his melancholy condition when I was requested to take him under my care. I immediately direeted him to abstain from tea, and other enervating liquids ; and prescribed leeches to the epigastric region, and saline medicines, with gentle deobstruents, which moderated the violence of the urgent symptoms, and rendered ^the stomach capable of retaining light food, &c. I then recommended the same plan as was pursued in the case before mentioned ; by which his mental perturbation was allayed, his appetite improved, his tongue beeame clean, and his bowels regular, their secretions gradually assuming a more healthy appearance ; so that, after vigilant attention, I had the pleasure of finding all the distressing symptoms he complained of yield to the remedies which had been suggested.