PATHOLOGY. 
moils urgens; or, by waiting, Tome fuch fymptoms may 
occur to develope the myftery. The cafe is fometimes 
fo urgent as apparently to demand an operation to pre¬ 
vent an impending fuffocation. We quote the following 
cafe: “ In a young woman, aged fifteen, the firft fymp- 
tom which arrefted the attention was a ftridulous found 
of the refpiration ; and circumftances conduced to render 
an attack of an inflammatory nature probable. She had 
been conveyed through the cold air, and appeared to be 
livid from cold. On being feen in bed, however, the 
nature of the difeafe became obvious, from the prefence, 
then, of globus; from the hiftory, by which it was alcer- 
tained that other fymptoms of the Mimofis urgens had oc¬ 
curred; and from the abfence of any affection of the 
pulfe. The patient was fpeedily relieved by the opera¬ 
tion of a purgative medicine.” Hall, 177. 
The pain of the abdomen in the Mimofis urgens is at¬ 
tended with great urgency of complaint; much anxiety 
and fuffering; an extreme tendernefs to the flighted: 
touch, rather than under p re flu re ; an hurried and irre¬ 
gular ftate of breathing, &c. The countenance is ex- 
prefiive of an urgent anxiety 5 the patient is reftlefs, im¬ 
patient, and irafcible, and pulhes the hand, although 
gently applied to the abdomen, rudely away; the gene¬ 
ral furface, and the pulfe are, at the fame time, little af- 
fefted ; there is fometimes vomiting, or a fort of retch¬ 
ing; the bowels are generally cGnftipated. The hic¬ 
cough or the retching is fometimes of the moll violent 
kind, and is apt to be long continued. Dyfury, or re¬ 
tention of urine, is alfo common as a form of the Mimofis 
urgens. Its duration is ufually (hort. But it has conti¬ 
nued occafionally for a long period. It is diftinguilhed 
by being combined with other fymptoms of this affection. 
It mu ft not be forgotten that the ftomach, when its 
contents irritate the nervous expanfions, and the irrita¬ 
tion is propagated to the brain, that organ re-ads on the 
Itomach, and produces pain and fpafm in various parts 
of the alimentary canal, which are not topically difeafed : 
as for inftance a flight contradion of the return, of the 
oefophagus, fpafm of the gall-dud, mtelena hasmatenefis, 
See. But thefe are generally fo obvioufly connected with 
the prefence of dyfpeptic lymptoms, that we need not 
take particular notice of them. 
Of the Second Stage of Difpepjia .—The firft ftage of in- 
digeftion having continued for fome time, or an erethe- 
matic inflammation of the ftomach, or any of the various 
caufes capable of inducing inflammation, being prefent; 
the fecond ftage of indigeftion makes its appearance. 
The palling of the firft ftage into this is denoted by va¬ 
rious figns ; fome taken from the nature of the gaftric 
or inteftinal derangements, but chiefly from the nature 
of the fympathetic irritations. With refped to the 
former, the ftomach betrays fymptoms of chronic in¬ 
flammation; and the inteftinal excretions, hitherto irre¬ 
gular, for the mod part affume deficiency of colour or 
confidence of a more permanent kind. The ftate of ner¬ 
vous excitation, in which fympathizing parts have been 
long retained, brings on a more permanent change in 
the fanguineous ftrudure, or fecretion becomes difturbed 
in the fame continued manner in particular parts. The 
topical affections are lefs changeable and varying. The 
mind, lofing the petulant nervoufnefs of the firft ftage, 
feels all the imaginary hurry and the anxiety of hypo- 
chondriafis; the fymptoms are lefs under the control of 
medical treatment; every thing, in a word, afl'umes a 
more fixed and continued form. The great pathogno¬ 
monic fign confiftsin a permanent tendernefs, on preflure, 
of the foft parts clofe to the edge of the cartilages of the 
falfe ribs on the right fide, after they have turned up¬ 
wards to be joined to the fternum. This fpot is often 
very circumfcribed, and always lies about half-way be¬ 
tween the end of the fternum and the place at which the 
loweft of the cartilages begins to afeend ; and the carti¬ 
lage itfelf near the tender part often becomes very tender, 
not unfrequently indeed much more fo than the foft parts. 
Vol. XIX. No. 1193. 
135 
The patient in general is not aware of this tendernefs till 
it is pointed out by the phyfician. There is often, we 
have feen, a degree of fullnefs in the right hypochon- 
drium at earlier periods ; but it is then more tranfitory, 
being generally relieved and fometimes removed by the 
effeCls of cathartics, and, not unfrequently, fpontaneoufly 
difappearing and returning again. The tendernefs above 
mentioned never exifts long and to any confiderable de¬ 
gree without the pulfe becoming hard, and it often at 
the fame time becomes rather more frequent than in 
health. 
Sometimes the hardnefs of the pulfe is fo well marked 
that it is eafily diftinguilhed, but more frequently tire 
hardnefs is only to be diftinClly perceived by examining 
the pulfe with the utmoft care. See our remarks on the 
manner of diltinguilhing the hardnefs of the pulfe, in the 
prefent article, p. 9/p. The tendernefs of the epigaftrium, 
after it has lafted for fome time, generally begins to be 
attended with fome degree of fulnefs in the part, and to 
extend downwards along the edge of the cartilages, till 
at length there is a degree of fulnefs, and fometimes ten¬ 
dernefs, throughout the right hypochondrium, which 
feels firmer than the left; but the tendernefs is feldom fo 
great as in the part of the epigaftrium above deferibed. 
Sometimes the preflure, both there and in the hypochon¬ 
drium, rather produces a fenfe of oppreflion, affeding 
the breathing, than pain. Sometimes, particularly in 
the epigaftrium, it occafions pain palling through the 
body towards the back, fometimes quite to the back, at 
other times a fixed pain or fenfe of oppreflion under the 
fternum, and, in fome cafes, a pain extending to the left 
fide. 
The tendernefs of the epigaftrium, as well as the hard¬ 
nefs of the pulfe, are perceived molt clearly when the 
patient has been taking exercife; mufcular aCtion, as 
might be expeCted, increafing the phenomena of inflam¬ 
mation. We mull not forget to remark, with refped to 
exercife, that its performance is often attended with much 
uneafinefs, all motion except of thepaflive kind produc¬ 
ing an infupportable degree of languor. This obtains 
chiefly, however, in the more fevere forms of the affec¬ 
tion, the flighter ones being ufually free from it. 
Thefe fymptoms are generally accompanied with others 
indicating fome degree of feverilhnefs. The chillinefs of 
which the patient has long complained is now fometimes, 
and independently of any change of temperature in the 
furrounding medium, interrupted by languid and op- 
preflive fits of heat; and the hands and feet, inftead of 
being uniformly cold, as in the earlier ftages, often burn, 
particularly during the firft part of the night, while at 
other times they are more obftinately cold. The thirftalfo 
often increafes ; and fometimes there is a tendency to 
partial fweats in the morning, efpecially if the patient 
lie longer than ufual; and thefe fymptoms are generally 
attended with an increafe in fome of thofe of the firft 
ftage. 
The inflammatory ftate of the ftomach proceeding un- 
fubdued, organic changes are foon induced, and thick¬ 
ening of its coats; ulcers, feirrhus, and a variety of 
ftrudural derangements, occur. More frequently, how¬ 
ever, the inflamed ftate of the ftomach and bowels fub- 
fides, while the organs to which its difturbance has been 
propagated undergoes the ftrudural diforganization. 
The liver, lungs, fpleen, pancreas, lower bowels, mefen- 
teric glands, heart, and brain, are faid to be moft obnox¬ 
ious to this occurrence ; but it cannot be queftioned that 
every part of the body is liable to . the lame changes, 
and from the fame caufes. Sometimes one of thefe parts 
is aft'eded, fometimes many; and it is to be remarked, 
that, in eonfonance with the known laws of pathology, 
when difeafe eftablilhes itfelf firmly in a fecond part, the 
firft is relieved from it. Indeed there feems this further 
difference between the mere nervous excitement which 
fupervenes to the firft ftage of Dyfpepfia and the inflam¬ 
matory affedions we are now treating of, that, while tire 
N n former 
