INDIGESTION. 



be cured by reftoring the tone of the ftomach, and by 

 remedies firft applied to this organ. 



On the other hand, however, it is not to be omitted, 

 that the ilomach, from its extenfive fympathy, by which 

 it is often a partaker of morbid initation feated in other 

 organs, occafionally difplays fymptoms of derangement fo 

 violent, and apparently fo confined to itfelf, as to make 

 the primary and proper foiirce of the derangement be alto- 

 gether overlooked. Many inftances might be quoted of 

 the fuccefsful treatment of feemingly idiopathic dyfpepfia, 

 by remedies which manifeftly and chiefly operate upon other 

 organs, and exert little or no immediate beneficial influence 

 on the ilomach. The vifcera, more immediately concerned 

 in the fnnftion of digeflion, efpecially the liver, and the 

 alimentary canal, are often the feat of the original irrita- 

 tion in fuch cafes ; the kidnies and the uterus occafionally 

 produce fimilar eftefts. 



Treatment of Indigejllon. — In attempting to cure this (late 

 of the ftomach, we may confider the following indications 

 as the principal points to be purfued : Jirjl, to avoid, or re- 

 move, or, as far as may be, to regulate thofe things which 

 have been enumerated above as the ordinary exciting caufes 

 of the difeafe ; fccondly, to palliate or remove thofe urgent 

 fymptoms, which efpecially contribute to aggravate and con- 

 tinue the ilifeafe ; and thirdly, to reftore the tone and vigour 

 of the fl:omach, and of the fyftem at large. 



The propriety and neceflity of the firfl; indication is fuffi- 

 ciently evident, as the continued application, or frequent re- 

 petition of thofe caufes, muft neceffarily tend to continue the 

 difeafe, to defeat the efficacy of remedies, or to occafionthe 

 recurrence of the diforder in fpite of the operation of thefc. 

 Dr CuUen juftly remarks, that it is commonly owing to the 

 neglett of this indication, that this difeafe is fo frequently 

 obftinate in its duration. Tt would be fuperfluous to enu- 

 merate the various modes of fulfilhng this indication, which 

 will be fufficiently obvious from the confideratiou of the fe- 

 veral eaufes : but this circumftance evinces the importance 

 of minutely inveftigating the origin of the diforder, previous 

 to the adminiftration of remedies, and of afcertaining whether 

 the dyfpepfia be conftitutional or acquired, vi'hether idiopathic 

 or fymptomatic, whether owing to any organic derangement 

 of the ftomach, fuch as tumour, ulcer, or fcirrhofity, or 

 whether arifing merely from errors in diet,, or other extrinfic 

 agents. It muft be obferved, however, that the accom- 

 plifliment of this firft indication is often exceedingly diffi- 

 cult : for, in many cafes, the circumftances of the patient 

 will not admit of any material change ; his avocations 

 themfelves, upon which his fubfiftence depends, compre- 

 hend, perhaps, the principal caufe of the mifchief. More 

 frequently, the obftacles arife from the difficulty of inducing 

 men to break in upon eftabliflicd habits, or to renounce the 

 purfuit of pleafure ; and efpecially, to perfuade them 

 that thofe praftices, which they have often repeated, and 

 feen others repeat, with fceming impunity, are in reality pre- 

 judicial. 



Some allowance, indeed, is neceffary to be made for the 

 influence of habit, in all changes that relate to the animal 

 economy, and efpecially where thcfe habits have been carried 

 to the extreme. For if the ftomach have been long accuftomed 

 to exceffive xlimuli, whether from condiments or fpirituous 

 liquors, the total abftraclion of thefe from the diet might 

 occafion a direft debility, under which the powers of life 

 might fink. Under fuch circumftances, therefore, fome de- 

 gree of the accuftomed ftimulus muft be for fome time in- 

 dulged in, or fome lefs prejudicial one fubftituted. But the 

 apprehenfions of danger, from great changes in the habits 

 of life, which are generally entertained, are carried to an 



extent which experience does not juftify. Almoft aii iii<' 

 general rules which can be laid down, in refpeft to tlr, 

 wholefomenefs of certain articles of diet, admit of exception a 

 from peculiarities of conftitution in particular individuals. 

 Some indications on this point, however, may be obtained 

 by attending to the obvious prevailing ftate of the ftomach, 

 as evinced by the acid or nidorous eruftations, &c. The acid 

 ftate of the ftomach implies the neceffity of diminiftiing the 

 proportion of vegetable food ; while the nidorous condition 

 may be benefited by augmenting that part of the diet, and 

 lefl'ening the quantity of animal food. It is of much im- 

 portance that the whole quantity of food fiiould be fuch as 

 not to overload the ftomach, or occafiou confiderable diften- 

 tion. There is a common precept, under which great errors 

 are fometimes committed, in the way of overloading the 

 ftomach, or at leaft of exhaufting its digeftive powers, 

 namely, that of eating little and often, fo that long fafting 

 may be avoided on the one hand, and too much repletion 

 on the other. With the view of fulfilling this precept, 

 an almoft inceflant fupply of aliment is fometimes thrown 

 into the ftomach ; fo that the digeilion of one portion 

 is never completed, before another is combined with it in a 

 crude ftate, thus aggravating the crudities which the 

 difeafe itfelf produces, or preventing their more effe&ual 

 affimilation. 



In fulfiUi]ig the ficond indication, of removing urgent 

 fymptoms, one of the firft objects purfued by fome prafti- 

 tioners, is that of removing the crudities of the ftomach 

 produced by the difeafe, by means of emetics : Dr CuUen 

 himfelf appears to be the advocate of this practice. ( Firft 

 Lines, par. 1204.) Neverthelefs, as thefe crudities are 

 commonly the effeft of the difeafe, and not the caufe, the 

 expulfion of them from the ftomach by vomiting can afford 

 but a brief and temporary relief ; and the fame uneafinefs will 

 recur after the firft or fecond meal. And, moreover, experi- 

 ence has (hewn us, that frequent vomiting, however excited, 

 tends to weaken the ftomach, to diminifli its powers of digef- 

 tion, and to render it lefs able to retain what is thrown into 

 it, and therefore ultimately to aggravate the fymptoms which 

 it was intended to relieve. " They are unhappy,'' fays the 

 fame phyfician in another place, " who trull to this mode 

 of relief, and have frequent recourfe to it ; for I am certain, 

 from much experience, that frequent vomiting hurts the tone 

 of the ftomach, and often makes the fymptoms of digeftion 

 recur more frequently and fooner than they otherwife would 

 have done." (Cullen on Mater. Medica, vol. ii. p. 465. 

 See alfo Emetics.) We haveftated under that article, the 

 circumftances which have led to the erroneous fuppofitioo, 

 that the indigeftion and its concomitant fymptoms originate 

 in the prefence of bile and other extraneous fluids in the fto- 

 mach ; and explained how the difcharge of bilious and mu- 

 cous matters from the ftomach, under the operation of an 

 emetic, may be the effecl of the vomiting, although they 

 miglit not previoufly have been lodged there. In fliort, there 

 are few inftances of dyfpepfia in which the ufe of emetics can 

 be deemed beneficial. 



Of the other urgent fymptoms, which require to be pal- 

 liated, the principal are acidity, and its frequent concomitant, 

 heart-burn, — pain in the ftomach, — the ejedion of a copious 

 and clear fluid, or •watcr-hrajh (as it is termed in Scotland), 

 — and conjlipation of the bowels. It will not be neceflary for 

 us to dilate upon the method of treating thefe fymptoms 

 here, fince they will be found amply difcuffed under their 

 proper heads ; as they are often fo peculiarly diftreffing to 

 the patients, as to be confidcred themfelves the principal 

 difcafes, and to be the principal fubjcft of complaint. We 

 may briefly obferve, that the prefence of acid in the ftomach 



