in food, beyond the wants of the system and the powers of the stomach, is not only promoted by the state of the appetite, but it is also encouraged by the arts of cookery, and by the stimulus imparted by various wines partaken of during the time of eating. Alimentary matter being thus taken in too great quantity in relation to the digestive energy, the secretion of the gastric juice, and the tonic actions of the stomach itself, are inadequate to the production of the healthy changes which the food should undergo before it passes the pylorus into the duodenum; and hence one of two things must supervene,-either the change of the whole is imperfect, or a part only of the food is converted to healthy chyme, and the rest remains altogether undigested, and ready to undergo those combinations which the chemical affinity of their elements dispose them to enter into when subjected, in a moist or fluid form, to the temperature of the frame. If the former alternative supervene, then an imperfect chyme is formed, which is unfit for the changes which it has to experience in the duodenum and small intestines, when subjected to the operation of the secretions poured into these parts of the intestinal canal; and, consequently, it undergoes those combinations imperfectly and with difficulty, disordering the viscera concerned in the process, and giving rise to an incompletely formed chyle. If the latter alternative take place, that part of the ingesta which is altogether unchanged into healthy chyme, by forming those combinations which the chemical affinities of its elements dispose it to enter into, irritates the internal surface of the stomach, and gives rise to many of those symptoms which constitute the prominent characters of disorder, such as flatulence, acid and rancid eructations, pain and distension of the stomach, cardialgia or heartburn, nausea, vomiting, &c. Such are the more immediate consequences as regards the stomach, when food is taken in too great a quantity for its digestive powers; and these effects continue, or even increase, in proportion as the habit is persevered in. But there frequently arise, even early in the disorder, various morbid phenomena, manifesting themselves in parts remote from its seat. Amongst these, the most deserving of notice are such as supervene in the alimentary canal, and affect its functions. That deranged function of the intestines, and indeed of the adjoining viscera, should accompany, or supervene to, disorder of the stomach, is only what may be expected from the organic connexions of the parts, and the manner in which the healthy action of one organ is dependent upon the due performance of the functions of adinining parts. Thus, we have generally accompanying the

early progress of indigestion, as marked by the symptoms already mentioned, a costive state of the bowels. Indeed, the diminished action of the stomach constituting dyspepsia is seldom confined to this part of the alimentary canal, but extends itself more or less to the whole tube, and to the viscera allied to it in connexion and function. Hence it is that costiveness and a torpid state of the actions of the liver so generally accompany the early periods of the disorder, and, when allowed to continue, increase the original evil.

Diminished function of a secreting organ or surface is generally followed by a viscid, inspissated, or otherwise disordered state of the secretion itself; and hence we find, in cases of indigestion, that the mouth and tongue are foul and clammy, and the latter covered with a whitish or yellowish fur. The intestinal secretions are also not only diminished in quantity, but they also seem, conformably to the general law now alluded to, very materially changed from their healthy character: they become viscid, tenacious, and, owing to the diminished actions of the mucous surface, they accumulate upon and adhere to it, so as to be with difficulty removed, obstructing those actions which are performed in the internal surface of the canal. Even the repeated operation of purgatives fails in removing the accumulated secretions; and it is not until these remedies have been exhibited for a series of days, that the stools assume a healthy appearance.

When the dyspeptic symptoms have continued some time, the bowels become disordered in a still more marked manner. They are generally at first costive; but this state is often followed by the discharge of some offensive and irritating stools of a lax nature, when they again return to their previous condition. This irregularity arises generally from two sources: first, from the acid and irritating matters formed in the digestive canal, from the imperfectly concocted food; and, secondly, from the secretions thrown out upon the mucous surface having undergone some change rendering them more irritating to the adjoining parts, and thus bringing about their discharge. When these conditions of the intestinal secretions and contents are present, the stools are generally extremely irregular, being alternately for many days costive, and for others much relaxed. The stools are also, whether voided voluntarily, or procured by the assistance of medicine, generally very dark, almost black, and frequently very offensive. At other times they assume a greenish brown colour, and exhale an acidulous and disagreeable odour. Occasionally they are pale, often clayey, and

of the consistence of soft putty, and, when broken down, exhibit a variegated appearance. After the operation of a cathartic, they are frequently slimy, and often gelatinous; and sometimes they are of a pale clay colour. The change of colour which thus presents itself has been generally attributed to the state of the bile; and such is doubtless the fact in many cases, but I believe in not so many as is supposed. On the contrary, I have great reason to conclude, that the colour, as well as other appearances of the stools, depend as often upon the morbid state of those secretions which are poured out from the mucous surface itself, together with the changes which the undigested aliments suffer as they pass through the lower parts of the canal, and mix with the mucous secretions in these situations, as upon the condition of the bile itself.

That the biliary functions and the constitution of the bile become disordered early in the diseases of warm climates, cannot be denied. Proofs of the fact are too common and too important to be overlooked; but we should not impute effects to wrong causes, or to fewer causes than actually exist, and still less should we fail of endeavouring to connect effect with its efficient antecedent. The same causes which produce indigestion, such as have been before alluded to*, will most directly tend to disorder the actions of the liver, and the constitution of the biliary secretion. Indeed, so immediately will these causes act upon this important organ, when assisted more especially by a high temperature and indolence, that it will be difficult for the patient himself to feel, and for the practitioner to ascertain, whether the stomach or the liver be the primary seat of disorder. In the majority of cases, however, the stomach evinces the earliest signs of disorder, when the testimony it affords is inquired into, or properly listened to. But in many instances the symptoms are so slight, and, even when important, so little attended to, that they pass unregarded until the actions of the liver become deranged, and heighten the primary disorder. When this extension of disease takes place, the state of the bowels and the appearance of the stools are matters of great moment, and should undergo the most careful scrutiny of the practitioner.

In the advanced stages of indigestion, the bowels are frequently disordered in the manner already pointed out; and the stools present those appearances previously noticed, in a more marked degree, with all the characters usually denoting morbid states of the bile. Sometimes the bile seems unmixed with the rest of the alimen

See sect. vi.

tary contents and fæces, as if it had been suddenly poured out from the gall-bladder, and, from the irritation it had occasioned, been quickly propelled along the intestinal tube, and discharged. At other times, owing to its admixture with the various matters taken in the way of food, drink, or medicine, and with the secretions of the mucous surface of the alimentary canal, it tinges the stools of every shade of colour. Occasionally, when the digestive power of the stomach is much impaired, and is connected with a lax state of the bowels, owing to the irritating combinations which the alimentary matters form in the intestines, pieces of undigested food may be observed amongst the fæces. In this more advanced form of disorder, distension after full meals is frequently severe, and is often attended with a sense of weight and oppression at the pit of the stomach and right hypochondrium, and with obstinate costiveness, followed by numerous loose motions, occasioning much smarting and tenesmus at stool; the motions being at first chiefly hardened and broken-down fæces, and afterwards a dark-brown or greenish-brown fluid, containing pieces of fæces of a lighter colour, and tenacious, putty-like consistence, and sometimes lumps of viscid mucus. The symptoms in such cases evidently depend upon the diminished power of the digestive process, having extended itself to the whole intestinal canal, occasioning inaction of the colon, and distension of it by the flatus given off from its contents; and likewise to the liver, impeding its actions and locking up its secretions, until, by the re-action of the vital energy upon the sources of irritation thus accumulated, and offending it, the amassed secretions and excretions are at last discharged, occasioning a temporary disturbance of the system, in proportion to the morbid changes which have taken place in them during the period of their undue retention.

In those cases of indigestion which are attended with loss of appetite and occasional nausea, although the patient becomes sooner alarmed, and the pathological condition may be more important, than in such cases as are attended with undue appetite and frequent craving for food; yet the disorder is often sooner removed. For where there is loss of appetite and nausea, there is usually much mental apprehension; hence the patient sooner seeks assistance, and more closely abides by the advice given him. Food, also, being but sparingly indulged in, and that which is taken under such circumstances being generally of a mild quality, the disorder is not perpetuated by indulgence in its chief cause; nor are the functions of the liver and bowels deranged by unduly concocted chyme, and by the irritating materials formed from undigested

aliment. When nausea, however, is a sympton of dyspepsia, and still more especially if the nausea is productive of retching and vomiting, the practitioner should then be watchful, and take care to examine fully into the state of the patient. The pulse should receive attention; for if it be quicker than natural, independently of the influence of retching upon it; if there be pain at the stomach or right hypochondrium, either upon pressure or without it, then the following pathological states are to be dreaded:namely, the indigestion has gone on to produce an inflammatory state of the mucous coat of the stomach, or to occasion inflammation about the concave surface of the liver, or about the duodenum, or the gall-bladder and biliary ducts. It should, however, be recollected, that sickness at stomach, with pain and accelerated pulse, may sometimes be present without resulting from inflammation in the situations now pointed out; for these symptoms sometimes supervene, in the advanced stage of indigestion, from altered sensibility of the nerves of the stomach, independently of inflammatory action, although more frequently they proceed from this cause. That either condition may exist, more particularly that accompanied by inflammation, should be borne in mind by the prac titioner, when the various circumstances of the case, and the aggregate of the symptoms, will guide him in forming his conclusions as to what actually is the proximate cause of disorder.

It is chiefly in weakened and nervous constitutions-in hysterical females and in gouty subjects-that we observe nausea, retching, and pain at the pit of the stomach, unattended by inflammation in some one of the parts already mentioned. The mode of living in warm climates is generally such as is productive of inflammatory action in these viscera; and therefore, when these symptoms supervene in the progress of indigestion, this consequence should be dreaded and guarded against. It should also be remarked, that the signs now noticed may be the consequence of the irritation of biliary calculi, either in the gall-bladder itself, or in the gall-ducts. When such is the case, the state of the pulse, and the seat and kind of pain, together with the appearance of the stools, and sometimes the character of the countenance and surface of the body, will inform the attentive practitioner. In all instances, the kind of pain or uneasiness complained of should be a point of interest: even when it is most urgent, the effect of pressure on the pained part should be tried; and even when it is not present, its non-existence should be proved by firm pressure, the practitioner causing the patient to make a full inspiration at the time when pressure is being made