INDIGESTION, OR DYSPEPSIA. 357 



alternating with diarrhoea, acidity, a furred tongue, and offensive breath. In 

 addition there may be dull headache, giddiness, and disinclination for exertion. All 

 these symptoms need not, of course, be present in every case, but some of them are 

 sure to be. 



The appetite in dyspeptics is very variable. In some it remains but little 

 affected, there being simply a distaste for certain articles of food, whilst in others 

 there is an absolute repugnance to all forms and varieties of food. It occasionally 

 happens that the appetite is absolutely increased, whilst in many instances a persis- 

 tent sense of uneasiness or emptiness, with constant craving for food, is experienced. 

 More rarely the appetite becomes depraved, the patient not merely craving for 

 aliments of an unwholesome character, but swallowing earth, co'als, chalk, and other 

 substances which are not only void of nutritive properties, but are disgusting and 

 even absolutely injurious. Thirst is usually absent, at least, to any abnormal degree. 

 Sometimes there is positively a dislike for fluids, which not unfrequently, especially 

 when taken at meals, aggravate the dyspeptic symptoms. 



A sensation of pain or uneasiness in the chest or stomach is a very frequent 

 symptom of dyspepsia. In some cases it comes on mainly when the stomach is 

 empty, and disappears under the influence of a meal ; in others it comes on only after 

 food. Sometimes it is more or less persistent, being present when the stomach is 

 empty, and increasing in severity after eating. Sometimes it is experienced 

 immediately after a meal, but it may be delayed for two, three, or even four hours. 



Respecting flatulence, or wind, we shall have more to say presently. It is 

 usually a prominent symptom of dyspepsia, and eructation may be for a time almost 

 continuous. 



The nausea and sickness of dyspepsia are often extremely distressing. Vomiting 

 may ensue when the stomach is empty, but more frequently it occurs soon after a 

 meal ; occasionally it is delayed for an hour or more. The vomited matter may 

 consist of food, almost unaltered; or of a clear watery fluid, having many of the 

 characters of saliva. Between these two extremes there are all kinds of gradations. 

 The quantity also varies very much, there being in some cases only a few tea-spoon- 

 fuls, whilst in others the whole contents of the stomach are forcibly ejected. 



Pyrosis, or water-brash, is of frequent occurrence in connection with dyspepsia. 

 It is characterised by " heartburn," or a burning sensation in the stomach, followed 

 by the vomiting, or rather eructation, of a thin watery liquid resembling saliva, some- 

 times sourish, but usually insipid and tasteless. The quantity of fluid rejected at 

 one time may vary from a mouthful to a pint or more. 



The tongue in dyspepsia varies considerably in character, but it seldom or never 

 presents an entirely healthy appearance. When it is habitually clean and moist, 

 neither too florid nor yet too pale, and of natural size, you may be pretty sure that 

 digestion is efficiently performed. When, on the contrary, the tongue is furred, with 

 excessive redness of the tip and sides, or when the whole organ is swollen, flabby, 

 and indented at the edges, there is some interference with the functions of the 

 stomach. 



Costiveness is a very frequent concomitant of gastric affections, and this sluggish 

 state of the bowels often aggravates, if it does not produce, dyspepsia. The evacua- 



