228 On Chro7jic Debility 



tion, appears probable from the altered nature of the se- 

 cretions. On this subject I cannot now enlarge, without 

 anticipating what I have to say elsewhere. In vessels so 

 small as the arterial and secreting vessels of the stomach, 

 and removed at some distance in consequence of their 

 minute ramifications, from the propelling power of the 

 heart, is it not reasonable to suppose, that the force of the 

 circulation depends considerably on the contractile power 

 of the arteries, and that as the coats are debilitated, the 

 contractile power of the arteries will be lessened? An in- 

 creased local action in the blood vessels, and an increas- 

 ed circulation of blood takes place in every phlegmon. 

 Why may not the contrary phenomenon occur ? 



To all these arguments, analogy lends some aid. That 

 a local nervous debility takes place in some instances in 

 other parts of the body, without affecting the rest of the 

 system, unless by sympathy, will not, I suppose, be dis- 

 puted. That a similar muscular debility also takes place, 

 will probably be admitted. That a languid circulation 

 of the blood may take place locally, while the general 

 circulation is regular, seems to be admitted, with respect 

 to the liver ; why may they not all take place in the stom- 

 ach? 



Several respectable physicians, with whom I have con- 

 versed, have believed that the disease, commonly passing 

 under the names Dyspepsia and Hypocondriasis, has its 

 seat in the liver ; or, in other words, that a morbid state 

 of that viscus is the cause of it. This opinion appears to 

 have been admitted without sufficient evidence, and 

 chiefly, or solely, as I suppose, on the authority of some 

 great names. In hot climates a schirrous liver is said to 

 be a frequent complaint, as is also an acute and chronic 

 inflammation of the same viscus ; and in temperate cli- 

 mates very luxurious living sometimes occasions a mor- 

 bid state of the liver. But these causes do not operate, 

 except in a small degree, in this part of the United States. 

 Among almost all the cases of Chronic Debility of the 

 Stomach which I have sedn, and they have been pretty 

 numerous, there has not appeared to me any reason to be- 

 lieve that the liver was affected at all, except in conse- 

 quence of the morbid state of the stomach, and from sym- 



