stomach prevails in instances where indigestion is caused only by some particular aliment; or whether there be a debilitated condition of that organ, that incapacitates it from digesting any food demanding considerable powers for its chymification. The mucous membranes of certain stomachs appear to be irritated by particular food, as the skin is known to be by particular coverings; and this is not disease but idiosyncrasy. If, on the contrary, an individual can digest beef or mutton well, but suffers from heartburn, and other unpleasant feelings in the stomach when he eats pork, veal, or fried meat, the right conclusion is that his general powers of digestion are feeble, and easily depressed; and that his stomach is unable to convert into healthy chyme those aliments which require a higher degree of exertion. An healthy stomach, like every other healthy organ, possesses the power of preventing the chemical changes to which its contents would, under different circumstances, be exposed. Hence the food does not ferment there; but if the vital powers of that organ fail, the chemical affinities gain the ascendency, and, after a certain interval, various symptoms arise, which clearly denote the change that has occurred. This is the philosophy of an ordinary attack of indigestion. An uneasiness, and sensation of weight and distension are experienced in the region of the stomach, acidity prevails, eructations of disengaged air distress the patient, and. nausea is felt from an effort of the stomach to eject its indigestible contents. There are chilliness, and a general lassitude, which originate from the sympathy that is produced on the nervous and sanguiferous systems. These effects particularly occur toward the end of chymification; and, in good time, pass off, while the remaining parts of the digestive process are apparently conducted with regularity. But this constitutes only a casual fit of dyspepsia, which may happen to healthy persons, and is remediable by clearing the bowels of any superfluous and crude matter, and avoiding the exciting causes in future. Yet, if an individual retire to rest with an overloaded stomach, he may pass into a comatose state, accompanied with apoplectic stertor, and from which it is not unfrequently difficult to rouse him. This condition springs from the sympathy of the brain with the oppressed stomach; and it is of great importance to distinguish such an affection, purely gastric, from genuine apoplexy, since, if the stomach be not relieved, the stupor will increase, and the sufferer perish. Such attacks are, however, not frequent, and principally occur when the muscular powers of the stomach are so impaired as to prevent the usual efforts which Nature makes to throw off an unmanageable burthen.

Should indigestion continue to recur in the stomach, the paroxysm will assume a more troublesome character; its symptoms will increase in number and extent, and the mischief will speedily involve other functions: but it may be useful to examine the causes to which the origin of the disease is attributable. In every change which the aliment undergoes there is the combined operation of mechanical and chemical agents. When, therefore, the food is introduced into the stomach, it owes its conversion into chyme to such combined actions, viz. the chemical power of the gastric juice, and the mechanical, or, in other words, the muscular movements of the stomach; which, in vernacular language, may aptly be called churning. It is to the failure or imperfect operation of the one or the other of those necessary actions, that indigestion is to be assigned. However perfectly the gastric juice may be secreted, if the mass be not sufficiently churned, it cannot become proper chyme; and the most active motions of the stomach will not compensate for a deficiency in the alimentary solvent. It signifies very little whether the paucity of the gastric liquor be absolute or relative, since, in either case, an indigestion must follow. The quality and quantity of the gastric fluid may be influenced by causes immediately acting upon the stomach, or by those which affect it through the medium of sympathy. Under the first class may be noticed those that produce a direct influence upon the nerves of the stomach, and without whose healthy action no secreting surface can perform its functions with regularity. Among these, the injudicious ingestion of narcotic substances, or of alcohol, deserves a distinguished attention. The languor springing from inanition also brings on a "discontented state of the stomach;" and, under this state, the gastric juice is not secreted in a healthy manner. But all these causes yield in importance when compared with those which act through the medium of sympathy, namely, the various passions of the mind, &c. the very singular and notorious sympathy which prevails between the skin and the stomach; and also of the latter viscus with the urinary organs. We are now to consider the causes that may operate in depressing, or paralysing the muscular powers of the stomach, and by which causes the mechanical process, essential to chymification, is imperfectly performed. Of these, undue distension is perhaps the most common, and, at the same time, the most powerful. This may be proved, not only from ample observation on the stomach, but by the analogy of other cavities; and particularly when the bladder is over-distended with urine, or the rectum by fæces. If this observation

be applied to the stomach, it is easy to comprehend why, in an over-distended state of that viscus, vomiting can scarcely be excited by the most violent emetic; and it is also comprehensible, upon the same principle, how greatly the muscular fibres may become permanently debilitated by the repetition of such an excess. This over-distension is principally ascribable to food which has a tendency to swell from the heat and moisture of the stomach; and, from this circumstance, a person may eat without any sensation of fulness, and yet in the space of an hour he will experience it in a most distressing degree. This generally happens where much new bread has been eaten, or nuts; or from soda water; or, indeed, from any beverage which contains fixed air. There are certain postures of the body, common to shoemakers, taylors, engravers, and clerks at the writing desk, which, by preventing the necessary egress of the contents of the stomach, favour an accumulation in its cavity. In this, and similar ways, indigestion is either caused or exasperated.

2. Imperfect Digestion in the Duodenum. Here the author introduces the opinions of his friend Dr. Yeats, and as these are well known we must refer to the work itself. How far the duodenum deserves to be denominated a "second stomach," we have already discussed ;* and how far the sentiments expressed concerning its pathology, and the conclusions drawn from them, are sound and practical, or visionary and theoretical, let others determine. But it is our duty to call attention to the subjoined extract.

"In some cases (of duodenal indigestion) a severe pain is felt in the back, especially in the region of the right kidney; and Dr. Yeats states a symptom, which I have also noticed on such occasions-a faint and fluttering pulse, occasioned by the pressure of the vena cava against the spine by the distended intestine." 226.

Is it come to this?—A faint and fluttering pulse, in duodenal indigestion, is occasioned by the pressure of the vena cava against the spine by the distended intestine! Is an assertion like this to be tolerated by a profession boasting, and justly boasting, of extended views, accurate observation, and rigid induction from proven facts? What is it calculated for but to deceive the unsuspecting, and to mislead the ignorant? What is it but to supply the want of knowledge by bold conjectures only, and to pretend to a perspicacity which is beyond humanity? Be it for ever borne in mind, and let it for ever

* New Series, No. 8, April 1826, p. 422.

stand as a monument of mortal vanity, that the assertion, now so deservedly reprobated, is made with all the confidence of demonstration; yet is it undeniable that no man can determine such a point, or render it even plausible, by sophistry. We call upon Dr. Paris and Dr. Yeats to explain to the public how they know that" a faint and fluttering pulse is occasioned by the pressure of the vena cava against the spine by the distended intestine;" for we do most unequivocally declare that the al leged circumstance is physically impossible from the anatomical construction of the parts. But admitting the possibility of such a pressure, what proof is there that it could produce "a faint and fluttering pulse ?" as if such a pulse could not, and did not often, arise from various other, and more likely causes than a passive and polite vena cava permitting a rude and distended intestine to press it against the spine.*

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3. Of Head-aches which arise from Indigestion. From the intimate sympathy which subsists between the nerves of the stomach and the brain, it is not extraordinary that any casual derangement of the digestive process should communicate its influence to the head. Dr. Warrent states, that there are two forms of dyspeptic head-aches; the one he refers to a fault in the stomach, the other to a defective action of the upper bowels. The former is distinguished by a languid and feeble, but not an unnaturally frequent pulse; the tongue is whitish and slightly coated; the edges are of a pale red colour. There exist a mistiness before the eyes, and general indistinctness of vision, also a dull pain or weight in the head, with some confusion, slight giddiness, and an apprehension of falling. These symptoms are attended with slight nausea, or an uneasiness and sense of irritation in the stomach; and often likewise by a

* Besides, we ask Dr. Paris and Dr. Yeats, in what possible way pressure on the cava inferior, which only partly supplies the right chambers of the heart, can cause a weak and fluttering pulse in the arteries arising from the left ventricle, after the blood has made the round of the short circulation in the lungs ? In the whole course of our reading we never remember to have seen so strange a statement from any medical writer, or one so entirely untenable. If the heart of a man consisted of a single ventricle, and the distended duodenum could mechanically interrupt the flow of blood into that ventricle, there might be some colour for such an assertion. But such is not the case. Every man of clinical observation, and especially every man who has ever experienced dyspepsia, well knows, how much the action of the heart is influenced by any source of irritation in the stomach, duodenum, small intestines, and even the colon, without having recourse to such a clumsy mechanical explanation as pressure on the vena cava.—Rev.

† Medical Transactions, vol. iv. p. 233.

feeling of constriction about the fauces, accompanied with a watery secretion. Coldness and slight stiffness, or numbness of the fingers are sometimes present. The other parts of the system are, in general, affected with a great degree of nervous sensibility. The second species of headach, or that depending upon irritation of the bowels, probably in the duodenum, is remarkable for the appearance of brilliant ocular spectra, which distress the patient; there is chilliness of the body, and coldness and dampness of the hands and feet. The pain in the head is very severe, attended with a sensation of coldness and tightness of the scalp, slight giddiness, weight, distension, and stiffness of the eye-balls. In some cases, as these symptoms increase, they are accompanied by tingling and numbness of the fingers and hand. The tongue is commonly covered with a yellowish-white fur, and is often very considerably coated with it. The pulse is of the natural frequency, but languid; nausea is oftentimes present, yet seldom amounting to vomiting. There are usually flatulency, and a seeming dryness and inactivity of the bowels. This last symptom is pathognomonic; the sufferer feels as if his intestines had lost their sensibility, and were unable to propel their contents, which occasions a peculiar sensation of weight and obstruction. The appearance of the alvine discharges varies very much, yet they are always of an unhealthy kind. Generally, bile shews itself in too large quantity; sometimes of various colours, and of different degrees of viscidity; occasionally the evacuations have a natural look, but display portions of undigested food. At other times, the stools are of a faint yellow colour; and, floating upon water, they give an odour like that of saliva. A very common appearance, especially where there has been great dejection of spirits, is a loose discharge, of a dark greenish-brown colour, which smells like the grounds of sour beer.

The stomach headach generally occurs in the earlier stage of digestion;-that which may be termed the duodenal* takes place when the food has passed into the intestine. The former

In our opinion this is purely conjectural. How is it possible for Dr. Paris to know, except by mere supposition, that there is a duodenal headach, which, with singular good breeding, appears after the food has entered into the duodenum, lest it might previously have spoiled the appetite and interfered with chymification. Alas! diseases are not imbued with politeness; and it is apparently impossible for any physician to pronounce, with confidence, as this author does, that one headach occurs in the earlier stage of digestion," and the other arises "when the food has passed into the duodewwm;" for, as we shall attempt to prove in the next note, such headachs most generally develop themselves when the stomach is, and has long been empty, and in a state of atony.—Rev.

VOL VI. No. 11.

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