§ 42. Gastric fevers; saburral, gastric, bilious fever. We have alluded to the precursory symptoms of Carbo animalis is an excellent remedy for sour stomach, with scalding sensation in the throat.

* There are other symptoms, and also other remedies, for gastric affections, which Hartmann has not mentioned. We recommend Calcarea carb., Carbo veg., China, Capsicum, for acidity of the stomach and heartburn, each of those remedies to be chosen in accordance with the symptoms.

Lycopodium for acid risings from the stomach, constipation, cuttings from the liver to the epigastrium.

Arsenic for burnings in the pit of the stomach, oesophagus and pharynx, with constrictive or suffocative sensation in the throat, and constant thirst; or for sensation as if the stomach were torn to pieces.

Digitalis for excessive debility in the region of the stomach as if this would die; accompanied by irregular pulse.

Ignatia for great weakness in the epigastric region, with a burning pricking.

Spigelia for a strange sensation of weak soreness in the pit of the stomach; the patient cannot bear the pressure of the clothes; this pain is frequently accompanied with soreness of one eye-ball, and pain on turning it or looking down; twitchings in the lid, sensitiveness to light.

Lachesis for excessive rolling of wind from the stomach upwards.

Nux vomica for gastric derangement arising from abuse of coffee or spirituous drinks.

Merc, for soreness as of an abscess in the pit of the stomach. - Hempei..

Those fevers in the preceding paragraphs. If the precursory symptoms be not relieved, and the gastric fever become fully developed, then the fulness and pressure in the region of the stomach increase, that region becomes distended, although it remains soft and is not sensitive to pressure; it is filled with gas, as may be ascertained by percussion, accompanied with inclination to vomit, rising of fetid air, sometimes vomiting of food and tenacious, bile-coloured mucus; the tongue is covered with a thick crust of dingy-yellow mucus, the abdomen is soft, the bowels are either constipated or else the patient discharges a quantity of fetid stool,, consisting of badly-digested food. A peculiar kind of headache is almost always present, a sort of pressure in the forehead, commencing in the frontal sinus and thence spreading over the orbital region; general feeling of debility; wretched, disfigured appearance, with yellow tinge of the whites of the eyes; the chilliness is more or less violent, succeeded by heat and dryness of the skin; the pulse is irritated, quick, soft, sometimes intermittent, or at any rate unequal, the urine is turbid, smells like horse-urine.

If the bilious symptoms be particularly prominent (in which case the fever is called febris biliosa, or in the language of the older physicians, causus) all the symptoms are then generally more violent, the heat is very great, there is great burning and turgescence of the skin, the restlessness and the thirst are great, the patient has a great desire for sour drinks, and the prevalence of the bilious symptoms is visible all over. The tongue has a lemon-coloured coating, which becomes gradually brown, taste and eructations are bitter, the patient vomits a greenish, bilious matter, the bowels are confined, or else there are yellowish, green or brown discharges from the bowels, the countenance looks livid, and somewhat jaundiced; these symptoms are sometimes accompanied by sensitiveness, hardness, tension, warmth, burning in the region of the liver and stomach; the urine is dark-brown, tinged with the colouring matter of bile, the pulse is frequent, full, intermittent or double-beating.

§ 43. The gastric fever is liable to be confounded with typhus, from which it is distinguished by the absence of all nervous symptoms (which may exist, however, when the fever is of a torpid character), and of the aching pain in the occiput; nor are the senses of sight and hearing disturbed with illusions; in typhus the region of the stomach is not distended, but is painful to the touch; there is no pain in the region of the coecum, which is a constant characteristic of typhus; the characteristic typhus evacuations from the bowels are likewise wanting in gastric fever, nor is the spleen enlarged.

Individuals with weak stomachs, suffering with dyspepsia and great irritation of the mucus membrane of the stomach, are particularly predisposed to gastric fever. Cold and wet weather in the summer-season favours the occurrence of gastric fevers, which are even epidemic at such periods; they may be likewise occasioned by injurious and heavy food, stimulating medicines and bitters, overloading the stomach, by chagrin, anger, cold on the stomach. Epidemic bilious fever is sometimes developed out of an epidemic fever and ague.

The course of the disease is sometimes very rapid, twenty-four or seventy-two hours, sometimes it lasts fourteen or twenty-one days. A successful termination of the disease is generally accompanied with profuse evacuations of some kind, either vomiting of badly tasting, bilious substances, or fetid stools, profuse sweats, clear urine, with earthy, flocculent sediment; in a few cases miliary eruption makes its appearance upon the skin in the region of the abdomen; an eruption upon the lips is frequently present. The fever may leave chronic derangements in the digestive system, or may pass into typhus or intermittent fever. If the so-called typhoid symptoms supervene during the course of the gastric fever, the abdomen becomes distended, meteorism sets in, a constant sensation of pressure is experienced in the region of the stomach, there is a constant inclination to vomit, the coating of the tongue is browner than usual, the tongue is dry, the extremities are cold, the pulse is frequent, wiry, small, the urine is brown, decomposed, emitting a strong am-moniacal odour, the patient becomes delirious; involuntary discharges of faeces and urine, sopor, and the usual typhoid symptoms set in. Death rarely takes place by local disorganizations, inflammation and ulceration of the mucous membrane of the stomach; death is more frequent by the gastric fever passing into typhus, and paralysis taking place in consequence. Should a chronic inflammation and subsequent suppuration of the mucous membrane of the stomach set in, the physician's attention will necessarily be directed, by the obstinate duration of the gastric symptoms, to such a process of disorganization having commenced; and he will find that the fever, which gradually increases again, has become a slow, chronic, secondary affection, depending upon the incipient degeneration.