LOCAL WEIGHT, TIGHTNESS, DISTESTIOY, sometimes a feeling expressed as being blown out with wind," while on examination the epigastrium is found not more tumid that that of a healthy person digesting, are modifications of a sensation produced in the nerves of the stomach itself. (1.) 0.—Where it exists alone, unaccompanied by soreness, by pain on pressure, or by decided pain immediately after eating, it is possible to judge of the real meaning of the phenomenon. But in complicated cases the

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... culties presented are very great. Putting then aside for the nonce these latter, and looking only to the simple examples, I have come to the conclusion that it denotes simply the presence of an excessivesecretion of mucus in the stomach. Like other mucous membranes, that of the stomach may be affected acutely or chronically. The first case may be called "gastric catarrh;" the second, "mucous flux." Both are liable to be followed by vomiting, which relieves temporarily the distress, and in the acute form constitutes the ordinary "bilious attack," so called from the bile which the action of the diaphragm in vomiting causes to regurgitate along with the 'contents of the stomach. When not rejected by vomiting, the aliments are so enveloped in mucus, that they cannot be acted upon by the gastric juice, and are passed very little changed into the bowels, where they are liable to ferment, and by their acidity, cause diarrhcea, flatulence, and mucous stools. This latter result is more common in acute than in chronic cases, where the motions are often infrequent and irregular, and exhibit unformed or scybalous fasces. When vomiting occurs, the ejected matters are mixed with so much mucus that there is no difficulty in making the diagnosis ; but where it does not, the case is liable to be mistaken for one of disease of the bowels, on account of the flatulence .and mucous diarrhoea. Certainty of diagnosis can in such cases be obtained only by the administration of an emetic, which brings the source of the evil into the light of day. In acute cases this excess of mucus is often accompanied by very intense headache, but in chronic it seldom goes beyond a feeling of stupidity. Flushing of the face, and heat at the back of the eyes are also nervous symptoms dependent upon the chronic condition, and seem quite independent of any disturbance of the circulation. Bilious attacks, or " acute catarrh of the stomach," is like all other catarrhs, excited by external, and often by epidemic influences. Changes of temperature are its most frequent cause. But still like them the cause must have a special reason in the individual for selecting one mucous membrane rather than another. And since the natural warm position of the stomach, aided by the usual habits of dress, guard it very efficiently against ordinary variations of the weather, the idiosyncrasy of the individual has a preponderating influence in its production, and often leads the others to be overlooked. But in the prevention of the complaint, more is to be done by attending to them, by protecting the stomach against such deleterious agents as the habits of the patient expose it to, than by trying to alter the diathesis of his body. On the other hand, mucous flux, or "chronic catarrh," is much less dependent on external circumstances, and much more on organic changes either in the stomach itself or some other viscus. Tubercular deposits in the lungs, emphysema of the same organs, chronic bronchitis, and enlarged heart, most frequently produce it, and it is usuallv associated with cancerous. tubercular, and iuflammatory affections of neighbouring parts, but alone it is very uncommon. In this it closely resembles bronchial flux, and like it requires more attention to be paid to the causes internal to the body than to external circumstances.* (2.) ) Witla aorcMS. 0)' pressure, (more especially if the soreness exist also when the stomach is empty,) or if accompanied by a decided pain arising from the ingestion of food, it denotes that the secretion of mucus depends on some local inflammation or u.lcerati.on of a chronic chct1'acter, in the maecoics membrane. Where a tumour can be felt, the probability is that it is of a cancerous nature. Where there has been bloody vomiting, the diagnosis of ulcer, cancerous or non-cancerous, is almost certain. In all cases, I am inclined to think that the peculiar sensation here described depends on the general state of the mucous membrane, and not on the local injury to one part or another of the stomach. My reason for thinking so (and it is a reason of practical importance) is, that it is capable of so much relief by medicines, even in patients where the spot anatomically altered is found afterwards to have been gradually progressing. You may very likely remember a man who lay in Albert ward, during the greater part of 1854, with rapidly-growing cancer of the liver and pylorus. In spite of the continual increase of the necessarily fatal tumours, the distention and weight after food diminished, he rarely vomited his meals, and was able to eat largely. His being able to eat a great quantity of nutriment much prolonged his life, and his illness on the whole was not one of much distress. So you see that the treatment of even necessarily fatal cases is capable of adding much to the comfort of our fellow men, and is well worth the thought and attention of a serious mind. It may be observed, that where distention with soreness is dependent on local inflammation of the stomach, the pain is constant, at no time entirely absent, though increased by the ingestion of food. You may see a well-marked case followed out in Case-book xxxix., p. 424, (where the complete cure seems to show that there was no ulceration,) and several others scattered through the books and indexed as "Haematemesis," (where the throwing-up of blood seemed to indicate that lesion) in all of which the discomfort is described as never quite wanting. The excessive secretion of mucus in the stomach, whether arising from ulceration of the membrane, from chronic inflam-