The nitrate and the oxide are both valuable in many of these cases, and in judging of their suitability in a given instance, it is not easy, nor is it essential, to draw a definite line between functional and organic disorder. Gastric pain, especially when severe, and coming on some time after food, with tenderness, distension, pyrosis, and vomiting, are sufficient indications. Dr. J. Johnson, one of the earliest observers of this use of the nitrate, found that mental depression, or motor disturbance of convulsive character, furnished additional indications for it ("On Indigestion," 1826). Dr. Symonds recommended it "in nervous irritability with passive or chronic congestion of the stomach." In Dr. Hudson's cases, pain of very acute character and long duration, with distension, thirst, constipation, and vomiting of sour fluid, were relieved within one or two weeks, but he gave the remedy (1/4-gr. doses) with opium (1/4 gr.), and hop (Dublin Journal, May, 1840). Dr. Osborne, a distinguished Dublin physician, found it valuable in gastralgia with "sour vomiting" (1831), and more recently we find Dr. Spender praising it as the "best remedy in pyrosis" (Practitioner, October, 18G8), and Dr. H. Wood, "in vomiting of much yeasty fluid." I should attribute importance to its disinfecting properties in such cases. Dr. Wilson Fox also adds his testimony to the "well-established reputation of the silver salts in chronic gastric catarrh," and places them next to bismuth: he would generally prescribe them, however, with opium, while Frerichs, also a high authority, gave them with belladonna. The absence or the presence of constipation will be a useful guide to the choice of these adjuvants. In gastritis, Dr. A. Fleming obtained very good results from the nitrate, and his mode of using it would seem to obviate, if that be necessary, the objection urged by Brinton,and to some extent by Husemann, viz., that the smallness of the dose, and the dilution and chemical change of the drug, must make it almost inert. Dr. Fleming was accustomed to order 1/2 oz. only of distilled water containing from 1 to 4 gr.

of the salt, to be taken fasting, and in the recumbent position, the patient then to turn himself from side to side, so as to insure contact of the remedy with different parts of the stomach-wall. In some cases he even injected the dose directly into the viscus, with a syringe and perforated tube (Medical Times, i., 1859). Dr. Hartshorn valued the nitrate in chronic gastritis; he gave it in pill (American Journal, July, 1849). My own use of the remedy has been generally in doses of 1/20 to 1/4 gr. every four or six hours in distilled water, and I have certainly observed from it much relief of discomfort and pain, flatulence, heartburn, and pyrosis, yet there is some uncertainty in its action (v. p. 24). Women suffering from the above symptoms, together with severe retching and vomiting of tenacious fluid, and a too frequent and profuse menstruation, are almost always relieved by it, but the maladies in question assume so many phases, and are more or less amenable to so many forms of treatment, that we cannot be surprised at difference of opinion as to the true value of this one.

It has naturally been thought that risk of caustic and irritant effects might be obviated, and equally good curative effects obtained by the use of the oxide of silver instead of the nitrate, and this was brought prominently before the profession by Mr. Lane (Medico - Chirurgical Review, July, 1840-41), and afterward, in a special treatise, by Sir James Eyre. The former records a number of cases with severe but intermittent gas-trodynia, general uneasiness, nausea, and watery eructation, almost all relieved quickly by 1/4 or 1/2-gr. doses of the oxide: nothing is said about diet or other adjuvant treatment. Mr. Lane states further, that if organic mischief have resulted - if the tongue be tumid and cracked, and the pain constant, or the ejected fluid "glairy" (as in Todd's "follicular gastric dyspepsia"), then the remedy is of no service; but it is not necessary to adopt these limitations if other indications for the remedy exist.