131 
PATHOLOGY. 
are different in different cafes; pain of different parts, 
and other complaints, of the head, affections of the fight, 
the hearing, fmell, or tafte. The voice and articulation 
are fometimes varioufly affeCled. The patient is diftreffed 
with' fpafms of the trunk or limbs, numbnefs, and even 
temporary lofs of power in the latter; and feelings of 
endlefs variety are defcribed, as fometimes in one part of 
the body, and fometimes in another. 
By a conftant recurrence of fuch attacks without being 
uniformly ill, for the rapidity with which the patient 
rallies is often as great as that with which he is fubdued, 
he is gradually rendered unfit for the aCtive duties of 
life. This preys on his mind, increasing the defpondency 
which makes a part of his difeafe, and which in its turn, 
by further debilitating the digeftive organs, aggravates all 
the fymptoms. Thefe organs being no longer in a proper 
ftate to fupply due nourishment, the body becomes ema¬ 
ciated, and more permanently feeble, the ftrength by de¬ 
grees rallying lefs readily and lefs perfectly after the fre¬ 
quent returns; and what was at firft only a temporary 
depreffion from a debilitating caufe affeCling the nerves 
of the alimentary canal, is gradually changed into real 
debility, the countenance, which is almoft always a fure 
index of what is palling internally, becoming pale and 
haggard. 
The patient, often from an early period of indigeftion, 
feels fome uneafinefs on lying on the left fide; more 
rarely this is the cafe with refpeCt to the right fide. In the 
progrefs of the difeafe, lying on either fide becomes un¬ 
comfortable, and, in its advanced ftages, the only eafy 
pofition is on the back, with the (boulders a little raifed, 
and generally inclined to the right fide. 
The tongue and other parts of the mouth are varioufly 
affeCted from the commencement. Their Secretions be¬ 
come more and more thick and clammy, the former being 
covered with a white or brownifli mucus, which alio 
more or lefs adheres to, and irritates, the fauces. Some¬ 
times all thefe parts are more or lefs parched and ftiff; at 
other times the faliva is morbidly thin and copious, the 
tongue being cleaner, but often of a whitilh and fouden 
appearance. In protra&ed cafes, when the fymptoms 
have been rather obftinate than fevere, and confiderable 
debility has come on, this fymptom is often very trouble- 
fome, the faliva frequently running from the mouth. In 
the advanced ftages of the more fevere cafes, there is often a 
vifcid frothy fecretion from the fauces, while the mouth 
in general is drier than ufual, which forms a very promi¬ 
nent feature of the difeafe. The patient isconftantly hawk¬ 
ing up this matter, particularly after eating, and will tell 
you that all his food turns to phlegm. This difcharge 
is fometimes fo great and haraffing as to prove the moft 
diftrefling fymptom, and feems not a little to add to the 
debility. In fome cafes the tongue, in the more ad¬ 
vanced ftages, becomes clean, ihining, and morbidly 
frnooth, and at length affeCted with aphthae. This ftate 
of it is feldom oblerved except when a confiderable de¬ 
gree of fever has fupervened, which is not uncommon at 
thefe periods. 
The Ikin, in protraCted cafes, often becomes dry, lhri- 
velled, and fometimes, at length, almoft fcaly, and the 
hair is parched and inclined to ftand on end; the whble 
furface is cold, the patient is conftantly hanging over 
the lire, and even experiences frequent fits of chillinefs 
approaching to Ihivering. He bears all extremes of tem¬ 
perature ill, being as much oppreffed by a very high tem¬ 
perature as he is chilled by a low one. Wounds heal 
lefs readily than ufual ; and the Ikin is not unfrequently 
affeCted with a troublefome itching, which often fliifts 
its leat; or with nettle-ralh, herpes, and other fpecies of 
eruptions ; and even ulceration fometimes fupervenes 
without any evident caufe. 
Befides the more tranfitory fymptoms in the head, 
which have been mentioned, there are often marks of an 
habitual undue determination of blood to the brain, pro- 
yoi. XIX. No. 129s. 
ducing languid inflammation of the eyelids, tinnitus au- 
rium, and occafionally throbbing of the temples. Some 
are oppreffed with drowfinefs, almoft approaching to ftu- 
por; others with almoft conftant pain more or lefs fevere, 
fometimes in the back of the head, more frequently in 
the fore part; others are fubjeCt to giddinefs, and fome 
even to fudden fits of infenfibility. The thoracic vifeera 
are often particularly affeCted; not unfrequently dyfp- 
ncea fupervenes, and the patient is fometimes haraffed by 
a dry and irritating cough, or with fits of palpitation. 
When expectoration attends the cough, it is generally 
difficult, but brings confiderable temporary relief. It 
deferves notice, that, in this ftage of the difeafe, he more 
frequently complains of pain in the left than in the right 
fide; but the feat of the pain is very various; not un- 
ffequently it is-chiefly in the back, about the Ihoulders, 
fometimes attended with itching, and in the limbs, more 
frequently in the legs than the arms. Irregularity of 
pulfe and fyncope are not unufual fymptoms; and are 
much to be feared when combined with other charaCter- 
iftics of angina pedoris, as they fometimes produce, in the 
fecond ftage of indigeftion, organic difeafe of the heart. 
Pain and tendernefs of the mufcles of the cheft is alfo 
frequent; and, when this occurs, the patient feems worfe 
at night, and turns in bed with difficulty and pain. 
The above hiftory of the firft fymptoms of indigeftion 
we have borrowed from the accurate work of Dr. Wilfon 
Philip. It remains to trace the fympathetic derange¬ 
ments which grow out of this ftage. 
It is to be premifed, that, when nerves are irritated, 
and fympatheticaliy affeCt diftant parts, the latter, how¬ 
ever influenced, return to their natural ftate when the 
nervous excitement is removed. Ofcqurfe, as the altered 
ftate of the nervous influence will accelerate or impede 
the contraftile powers of veffels, the phenomena of in¬ 
flammation may occur, and the fame excitement conti¬ 
nued may produce the confequence of inflammation. It 
follows therefore, that, if the nervous expanfion of the 
ftomach be irritated, and caufe diftant diforders, we may 
cure thofe by removing that irritation : but if, from its 
long continuance, or from the nature of the affeCled 
ftruChire, irritation degenerates into inflammation, we 
have further indications to fulfil. Of this fact experience 
convinces us every day. We have to correct the morbid 
ftate of the fecondarily-affeCled part, as well to remove 
the firft caufe. 
The firft derangements are what we have to confider 
at prefent. The fubjeCt has been ably treated of by Dr. 
Marlhall Hall, in his Effay on the Mimoses ; a name 
which, as its origin implies, defignates a ftate which mi¬ 
mics, or refembles, other difeafes. 
The above-mentioned author has however ufed this 
term in a very extended fenfe; he has included in it 
many difeafes where idiopathic diforder had become efta- 
blifhed. For our own part, we (hall reftriCt the term to 
thofe affeClions which are propagated by nervous in¬ 
fluence, which do not implicate permanently the vafeu- 
lar ftruCture, and which fubfide on the removal of indi¬ 
geftion. Ufed in this fenfe, it charaCterifes the affeCtion 
in queftion with great force and faithfulnefs ; and con¬ 
veys a clear idea of the difference which we find in the 
mere fympathetic diforder, and thofe more ferious af¬ 
fections which, arifing from longer-continued or feverer 
forms of dyfpepfia, or from thefe and the morbid predif- 
pofitions of their own feats, require mixed methods of 
treatment : i. e. fuch as immediately influence the circu¬ 
lating as well as the digeftive funCtion. But, ere we 
enter on this branch, we mull again remind our readers, 
that we confider Difpr.pfia, in all its immediate as well as 
remote fymptoms, as a difeafe incapable of regular ar¬ 
rangement. In proportion as one or other of its nume¬ 
rous caufes are applied, in proportion as the remedial in¬ 
dications are wrong or mifplaced, will it appear in the 
marked and fevere characters of the fecond ftage, without 
Mm exhibiting 
