DUODENAL DYSPEPSIA. 423 



diarrhoea of acute indigestion, familiar to all. At the same 

 time, pain is felt in the abdomen as the result of the powerful 

 impressions on the afferent nerves, attended by a sense of 

 misery and depression. Primary acute duodenal dyspepsia 

 closely resembles the disorder just described, except that it is 

 not preceded by gastric symptoms, and constitutes another form 

 of diarrhoea. As in the case of the stomach, the chief cause of 

 the derangement is improper feeding, including excess of those 

 principles which tax the activity of the liver and pancreas, 

 namely, fats, sugars, and, in infants, starchy materials. In 

 other instances, the bile may be deficient. The flow of pan- 

 creatic juice is sometimes diminished by nausea and vomiting, 

 as well as by other circumstances. Nervous and mental de- 

 pression also interfere with the action of the secreting glands, 

 and may lead to indigestion and diarrhosa. 



In chronic cases disturbance of the natural relations between 

 the duodenal juices and the chyme produces less urgent symptoms, 

 but leads to more serious impairment of nutrition. Pain, 

 " heart-burn," and depression, come on within a few hours 

 after meals. The bowels are irregularly moved; and the 

 motions are apt to be pale and foul, and may contain undigested 

 fat and milk. The same symptoms in an aggravated form 

 accompany organic disease of the duodenum, liver, and pancreas. 

 Disorders and diseases of the liver have, however, an interest 

 much beyond their bearing on digestion, and will be separately 

 discussed. 



IV. NATURAL EECOVERY. 



Little requires to be said under this head. Diarrhoea is 

 manifestly a natural provision for relieving the duodenum of 

 unsuitable contents, as vomiting relieves the stomach. Even if 

 this be excessive, and give rise to general disturbance, the 

 duodenal function soon becomes normal, when the cause of dis- 

 order has been removed. A thorough appreciation of all the 

 facts of the case manifestly suggests that the province of the 

 therapeutist is not to prevent or check these salutary efforts 

 unless excessive; and to help Nature to recover herself more 

 speedily and more surely than she might otherwise be able 

 to do. 



V. THERAPEUTICS. 



As in the stomach, the rational treatment of disorder of the 

 duodenum is either preventive or immediate. Duodenal dyspepsia 

 may be prevented from returning in persons predisposed to it by 

 careful regulation of the quality, quantity, and preparation of 

 the food. The patient must be ordered to eat sparingly of 

 fatty, sweet, and starchy foods, and to avoid richly-cooked 



