DYSPEPSIA. 



765 



mixed with umlissolved fragments of the fibres of-the 

 alimentary substance. When food is masticated, 

 and macerated for a few hours hi simple saliva, he 

 has found it to present exactly the same appearances 

 as the chyme of the stomach. The digestion of the 

 stomach, he infers from his experiments, is not a de- 

 composition of the alimentary matter, but is a simple 

 disintegration or reduction of it into its component 

 molecules, the animal character remaining unchanged. 

 The chyme, having passed into the duodenum, meets 

 with tlie pancreatic liquor and the bile. What are 

 the positive changes induced by these fluids, cer- 

 tainly is not accurately known. The acids of the 

 chymous mass are neutralized by the alkaline princi- 

 ples of the bile, the picromel and colouring matter of 

 wliich appear to coalesce with the unassimilable 

 principles of the food, and assist in their conversion 

 into faeces. A chemical modification hi some of the 

 alimentary elements may also be effected. It is cer- 

 tain that chyle, or the nutritive principles of which 

 blood is formed, does not appear in the lacteals until 

 after the action of the bile and pancreatic fluid on 

 the chyme, the product of the stomachic digestion. 

 The action of the stomach on the food is that usually 

 designated as digestion, and it is the derangement of 

 this process that is usually expressed by the term 

 dyspepsia. The process accomplished in the duode- 

 clum is also a true digestion, and the symptoms arising 

 from its disordered state are confounded with those 

 of the stomachic digestion, hi the general accounts 

 of dyspepsia. 



From this sketch of the function of digestion, it is 

 evident, that its most important agents are, 1st, the 

 secreted fluids collected hi the stomach ; 2d, the con- 

 tractile movements of the stomach, keeping the ali- 

 mentary mass hi constant agitation, mixing it with the 

 fluids as they are secreted, and removing the portion 

 digested or reduced into chyme ; 3d, the application 

 of the biliary and pancreatic fluids to the chyme in 

 the duodenum ; and, 4th, the contractile movements 

 of this viscus. Most of the derangements of the di- 

 gestive functions may be traced immediately to a 

 departure from a natural state of some one or more 

 of the above requisites of digestion. But this devia- 

 tion from the natural order is, itself, an effect. The 

 secretions are products of organs, and all excitement 

 of the secretory organ, beyond the range of healthy 

 action, causes vitiation of the secretion, or its total 

 suspension. The action of the organ, diminished be- 

 low the physiological range, is attended with other 

 vitiations of the fluid, or the cessation of its secretion. 

 Indigestion or dyspepsia is a consequence of both 

 these conditions of the organs furnishing the fluids of 

 digestion. Digestion is a very stimulating process. 

 All functional actions are exciting. The increased 

 demand for secreted fluids renders an augmented ac- 

 tion, and increase of blood in the furnishing organ, 

 necessary for their production. The presence of the 

 food, drinks, &c. , in the stomach, add to the stimula- 

 tion of digestion. If the stomach of an animal be 

 examined in the act of digestion, the mucous mem- 

 brane is found of a diffused scarlet colour. The 

 movements of the stomach essential to digestion de- 

 pend on its nervous communications, and especially 

 on the integrity of the eighth pair of nerves. When 

 these are divided, the stomach and oesophagus are 

 paralyzed ; the food is no longer agitated and mixed 

 up with the digestive fluids, and it often regurgitates 

 from the stomach into the oesophagus. This experi- 

 ment proves the influence of the contractile motion of 

 the stomach in the act of digestion. The ganglion ic 

 nerves are not less important, though their specific 

 influence cannot as readily be determined. But in 

 many cases of disease of these ganglions, vomiting, 

 eructations, pain in the gastric region, and unpaired 



digestion, are accompanying symptoms. Through 

 the nervous system, the function of digestion is ex- 

 posed to numerous disorders from moral impressions, 

 especially those of an agitating character. 



From the preceding principles, it is evident that 

 dyspepsia or indigestion is not, properly speaking, a 

 disease, but rather a symptom, attached to diseases 

 of the apparatus of digestion, of very various and 

 even opposite character. No specific treatment can, 

 therefore, be laid down for the cure of dyspepsia, but 

 each case requires to be managed according to its 

 peculiar cause and nature. The organ of the digestive 

 apparatus the most frequently productive of dyspeptic 

 symptoms is the stomach, and the most usual cause of 

 dyspepsia is its irritation and inflammation. The 

 stomach is more liable than any other organ to these 

 states, from its direct exposure to so many irritating 

 aggressions, and its intimate sympathetic communi- 

 cations, which make it participate in the irritations 

 of almost every other organ. The sub-acute and 

 chronic forms of gastric irritation and inflammation, 

 the signs of which have only of late been fully appre- 

 ciated, are the disorders that, in seven or eight cases 

 out of ten, are termed dyspepsia. Hence dyspepsia 

 so frequently succeeds to febrile diseases, especially 

 when treated by emetics, drastics, and the improper 

 use of tonics and stimulants, which, although the 

 patient escapes the fever, leave him a martyr to the 

 chronic, disorganizing, and perturbating irritations of 

 the gastric mucous membrane. Hence, too, dyspep- 

 sia almost inevitably follows continued abuse ot the 

 digestive functions, from too highly seasoned or too 

 abundant food, and stimulant drinks. The constant 

 stimulation of the stomach finally becomes pathologi- 

 cal or morbid. The simple prolongation of the func- 

 tional excitement essential to digestion, continued 

 from meal to meal, without permitting the stomach to 

 revert to a state of repose, is sufficient to constitute 

 a morbid state. All functions, for their perfect per- 

 formance, require alternate periods of repose and 

 activity. Incessant action irritates, inflames, and 

 finally disorganizes the structure of the organs. 



A second condition of the stomach, productive of 

 dyspepsia, is the congestion of its mucous tissue. 

 This may be confined to the stomach alone, succeed- 

 ing to an attack of acute gastritis, or following on its 

 protracted irritation ; or it may be an attendant on a 

 general congestion of the whole portal system involv- 

 ing most of the abdominal viscera. Every irritation 

 is attended with an afflux of the circulating fluids 

 into the structure where it is seated, proportioned to 

 its intensity and the vascularity of the structure. This 

 gorged state often continues after the subsidence of 

 the irritation that provoked it, and prevents the re- 

 sumption of the healthy functions. It is a state of 

 passive congestion, and often exists in the mucous 

 membrane of the stomach, after attacks of inflamma- 

 tion or acute irritation, and embarrasses its digestive 

 operations. In all the extensive irritations of the 

 alimentary canal, especially when attended with fever, 

 having a paroxysmal character, the great portal sys- 

 tem of the abdomen becomes loaded with blood, and 

 congestion of its radical vessels ensues The func- 

 tions of the viscera are then disordered, the secretions 

 are defective, and indigestion, costiveness, and their 

 attendant nervous affections, are the necessary conse- 

 quences of this condition. 



A third state of the stomach, a cause of dyspeptic 

 symptoms, is precisely the reverse of the preceding. 

 Asthenia, or diminution of vitality and actions below 

 the healthy degree, occasionally takes possession of 

 the stomach. Its circulation is then deficient, its 

 secreted fluids are defective hi quantity or quality, its 

 sensibility is impaired, and digestion is imperfect. It 

 is not probable that gastric asthenia is ever primitive. 



