130 PATHOLOGY 
duces difordered funftion of the collatitious vifcera; and a 
change takes place which marks an important Hep in the 
progrefs of the malady. The alvine difcharge begins to 
deviate from the healthy appearance: it fometimes con¬ 
tains uncombined bile, fometimes it chiefly confifts of 
bile; its colour at other times is too light, more fre¬ 
quently too dark ; and occafionally, at length, almolfc 
black. At different times it afl'umes various hues, fome- 
times inclining to green, fometimes to blue; and fome¬ 
times it is mixed with, and now-and-then almoft wholly 
confifts of, undigefted bits of food. When there is much 
draining, it often contain^ mucus in diftinft maffes, and 
not unfrequently fubftances refembling bits of membrane. 
It frequently (eparates from the canal with more diffi¬ 
culty than ufual, and leaves a feeling of the bowels not 
having been completely emptied. We have reafon to 
believe that the above change and variety of colour arife 
chiefly from the ftateof the bile, to which the alvine dif¬ 
charge owes its natural tinge, being quite white when no 
bile flows into the bowels. It would appear that the 
properties of the bile are fometimes changed without 
change of colour; but this is comparatively l'o rare, that, 
if the colour of the alvine difcharge be natural, we may 
generally infer that the function of the liver is duly per¬ 
formed. 
Many conceive that the changes of colour in the al¬ 
vine difcharge are often to be alcribed more to circum- 
ftances in diet, and changes which the contents of the 
bowels undergo in their paflage through this canal, than 
to the ftate of toe bile ; and we have no doubt thefe 
caufes operate to a greater or lefs extent. The long de¬ 
lay of their contents in the bowels generally darkens the 
colour; a milk-diet produces a difcharge of a lighter co¬ 
lour than one conflfting chiefly of animal food, and fome 
vegetables and medicines communicate a certain tinge 
to the difcharge. With a little attention on the part of 
the pradlirioner, this circumftance will feldom miflead 
him. It mull always be kept in view, that the appear¬ 
ance of the difcharge often changes when it has remained 
for fome time out of the body. 
The difeafe has hitherto been what is called ftomach- 
complaint. It is now, from the various appearances of 
the vitiated bile, and the various fymptoms which arife 
from the irritation it occafions in the alimentary canal, 
what is called bilious and nervous complaint. The 
former of the two laft appellations has alfo arifen from 
the bile, of which there is fometimes a fuperabundant fe- 
cretion, being occafionally, in confequence of the in¬ 
verted a£tion of the duodenum, thrown into the fto- 
inach ; and there exciting naufea, headache, and bilious 
vomiting. 
The urine alfo deviates from the healthy ftate. In its 
tnoft healthy ftate, it is perfeffly tranfparent when palled, 
and remains fo after it is cool, its colour being more or 
lefs deep in proportion to the degree in which its con- 
tentsarediluted. But it is fometimes covered withavery 
thin oily film, which appears to arife from an imperfeit 
ftate of the affimilating procefs. Sometimes alfo it is lim¬ 
pid, and parted in unufually large quantities, more fre¬ 
quently fcanty and too highly coloured. It is then moll 
apt, as we ftiould ft priori expert, to depofit fediment, 
unlefs fome degree of fever prevail, when it often either 
depofits nothing, or a little of the red fediment. 
A remarkable fympathy between the ftate of the kid¬ 
neys and inteftines is often obferved in indigeftion ; the 
urine remaining fcanty and high-coloured, when the 
bowels are conftipated ; and flowing freely, and of a 
paler colour, as loon as a free difcharge from them has 
been obtained. Even in thofe dropfical affections which 
fupervene on this difeafe, it is common for all diuretics 
to fail, when the bowels are conftipated, and for the ope¬ 
ration of cathartics alone to be followed by a free dif¬ 
charge from the kidneys. 
The copious flow of urine which fometimes attends 
indigeftion, feems frequently to arife from a failure in the 
aCtion of the Ikin, as appears from fome of the experi¬ 
ments juft referred to. The kidneys and Ikin feparate 
the fame fluid from the blood, and a failure of fecretion 
from the latter is often compenfated by an increafe of 
that from the former, if they have not by fympathy par¬ 
taken too much of the ftate of the Ikin. Thus, in dyf- 
peptics, an unufual application of cold to the furface, 
when the powers of the lyftem are not able fo to re-aCt as 
to fupport the due aCtion of the Ikin under it, frequently 
occafions an increafed flow of urine. The fame caufe 
often occafions a greater difcharge from the bowels. It 
particularly demands attention in this difeafe, that, al¬ 
though the increafed difcharge from the bowels in the 
inllance before us is of a watery nature, when the Ikin has, 
from the ftate of that difeafe, become uniformly languid, 
the increafe is often in the folid, as well as liquid, con¬ 
tents of the bowels. On the fame principle, the quantity 
which paffes from the bowels of delicate children when 
the Ikin has become dry and Ihrivelled, is often aftoniffi- 
ing, and that even when little nourilhment is received; 
as if not only what ought to have parted by the Ikin, but 
a great deal of what had been inhaled by this organ, were 
depofited in a folid form in the alimentary canal. 
What is here faid is well illuftrated by the cafes which 
we detailed of very great eaters, in whom the alvine dif¬ 
charge was no greater than in other people, but the fe¬ 
cretion by the (kin was found much more copious. 
The fenfible change in the appearance of the alvine fe- 
cretions in indigeftion, is generally attended with fome 
change in the other fymptoms. The ftomach is more apt 
to be oppreffed after eating, the patient often obferving 
that he feels as if there were not room for what he had 
taken. The bowels are more frequently variable, diar¬ 
rhoea often fupervening without any evident caufe, almoft 
uniformly followed by fits of conftipation. Thefe, the 
patient finds, cannot now be removed by the Ample me¬ 
dicines which at firft reftored due action to the bowels ; 
larger dofes or more active medicines are necertary, and 
their effeft correfponds with the previous ftate of the 
bowels. The difcharge is generally unfatisfa&ory, 
fomething feeming to be retained. It is very often wa¬ 
tery or iemi-fluid, mixed with mucus, and fometimes 
ftreaked with blood ; and, after it has been repeated, 
often chiefly confifts of mucus and a little blood, the paf- 
fing of which is attended with much gripingand bearing- 
down, and followed by a conftant defire of further eva¬ 
cuation. The patient takes more medicine with the hopes 
of a freer eft'eft; but he thus often increafes the {training 
more than the difcharge. 
After this ftate of irritation has continued to recur for 
a great length of time, a degree of permanent fpafmodic 
ftridfure fometimes appears, which gives a tape-like ap¬ 
pearance to the alvine difcharge. In the mean time the 
patient is haraffed with a variety of other fymptoms, arif- 
ing from the irritation occafioned by the morbid con¬ 
tents of the alimentary canal; increafing languor, pains of 
the ftomach, more frequently of the bowels, and parti¬ 
cularly of the lower part of the bowels, fometimes conti¬ 
nued, generally of the griping kind ; a fenfe of heat, or, 
as the patient often calls it, burning, referred to the 
ftomach, and now-and-then extending to the bowels, 
(which fometimes proves the molt obftinate and diftreff- 
ing fymptom of the difeafe;) or of weight in the right hy- 
pochondrium or lower part of the abdomen, with unufual 
diftenfion of the former, fometimes difappearing in a day 
or two, particularly after freer evacuations, and return¬ 
ing again, at other times more ftationary; a more foul 
and clammy tongue, naufea, more rarely vomiting, a de- 
preffion of llrength, which fometimes, particularly after 
the unfatisfa&ory operation of cathartics, almoft amounts 
to fyncope, and a defpondency that is hardly equalled in 
any other difeafe. 
As thefe fymptoms proceed, others, the confequence of 
the fympathy which exifts between the ftomach and other 
parts of the fyftem, gradually ftiow themfelves. Thefe 
are 
