PATHOLOGY. 187 
edlyfeenj in an exhaufted conftitution, the face become 
fuddenly pale, and all power loft, the patient falling 
down infenfible, and the countenance continuing to in- 
creafe in palenefs till it a/Turned a cadaverous hue ; and 
yet this patient has been immediately reftored to the ufe 
of his faculties, the palenefs of his countenance at the 
fame time abating, by the lofs of blood; and there is 
every reafon to believe would have died without it. For 
it is evident that the apoplexy we are coniidering is of a 
different nature from detention of the veflels of the en¬ 
cephalon arifing from general fulnefs; and therefore lofs 
of blood from the head, and that only to fuch an extent 
as relieves the fymptoms, is alone proper; the incautious 
ufe of general blood-letting in fuch a cafe being alfo fol¬ 
lowed by a degree of debility which further difpofes to 
returns of the attack, as well as to other difeafes.” 
The effeft of the gaftric irritation in debilitating the 
veflels of the head, might be illuftrated by many faffs : 
it is enough to mention the flufhing of the face which 
occurs to dyfpeptics after dinner. 
Of the nature of epilepfy fo little is known, that any 
attempt to trace its connexion with indigeftion nuift be 
futile ; nor indeed does there appear any real difference 
in the difeafe, let it arife from what caufe it may. 
The moft chronic and inveterate form in which the 
brain is affeffed through the gaftric media, is that of hy- 
pochondriafis. We fhall referve our fpeculations as to 
the nature of this complaint till we come to the clafs 
Neurotica, in which we fhall take up the fubjeft of ner¬ 
vous irritations arifing from indigeftion on a more ex¬ 
tended fcale. It will be fufficient at prefent to ftate, that 
in confidering the mutual aftion of one part of the fyftem 
on another, the ftate of the mind deferves particular at¬ 
tention in indigeftion. The difeafe itfelf w'e have feen 
feldom fails to render it anxious, irritable, and apprehen- 
five ; and this ftate of mind, which we have found ranked 
among its caufes, cannot fail to influence its fymptoms. 
The affections of the mufcular fyftem which fuperVene 
on this ftage of indigeftion, are of a gouty or a rheuma¬ 
tic nature ; and, like other inflammatory affeCions, they 
prefent lefs indication of plethora when dependent on 
gaftric difturbance, than when they arife from other caufes. 
It muft not be forgotten, that an ill ftate of the abdo¬ 
minal vifcera is always connected with chronic rheuma- 
tifm ; a circumftance which induces us to defer tracing 
theconnexion, or noticing the peculiarities, of that dyf- 
peptic variety in this place. We fhall remark, how'ever, 
that, where a tendency to gout exifts, difeafe may be 
induced by any caufe that produces, and for a certain 
time keeps up, indigeftion. In fome the difpofiticn to 
gout is fo great, that it appears without being preceded 
by fymptoms of derangement in the firft paflages ; but 
in the majority of cafes it is preceded by thefe fymptoms, 
and the tendency to them feems to conftitute a con/idera- 
ble part of the hereditary difpofition' to gout. 
The regular forms of this difeafe, not affecting a vital 
part, tend lefs to derange the fyftem in general, and give 
more relief to the primary difeafe, than moft of the other 
fymptomatic affections which have been enumerated, the 
patient often remaining well for fome time after; and, 
the more cautious be is in preferving the vigour of the 
digeftive organs, the longer interval he enjoys. Hence 
appears the danger which attends interrupting the regu¬ 
lar fits of gout: the fympathetic difeafe, being prevented 
from taking the courfe which the difpofition to affeclion 
of the extremities gives it, feizes on the part, generally 
an’ internal one, which nex.t to thefe is moft liable to 
difeafe; and, on the other hand, if any thing fo aftefts 
any of the vital parts during a fit of gout as to render it 
confiderably the weakeft part, the fympathetic difeafe 
fometimes leaves the joints and feizes on the internal 
part, producing what is called retrocedent gout. It is 
evident that the rifle of both thefe accidents will be 
greateft, where the powers of the fyftem are moft im¬ 
paired. 
The mufcularfyftem is likewife afFefted in fome cafes by 
a permanent and gradual debility, by tremor, and by 
lofs of fubftance. The latter circumftance is much 
dwelt upon by Dr. Hall, who weighed feveral of his pa¬ 
tients, with a view to more correct information on the 
fubjeft. It will be found, however, that fome dyfpeptic 
patients retain their embonpoint, notwithftanding much 
functional difturbance. 
The patients/of indigeftion are ufually aflefled with 
great tremor, obferved fometimes in a quivering of the 
lip, or dimpling of the chin, but more ufually, on hold¬ 
ing out the hand, or in carrying a cup of tea, for iriftan.ee, 
to the mouth, on attempting to Hand ereft or walk, or 
on being fatigued or hurried. The tremor, in fome pro- 
trafted cafes, has formed the moft remarkable feature of 
the affeCtion ; in others, it has been much lefs obferved, 
but it is rarely, if ever, entirely abfent. 
The debility which now comes on is, as we have be¬ 
fore obferved, of a different nature from that merely- 
nerv.ous inaCtion which happens in the early ltages of the 
complaint. The latter is the mere want of nervous fti- 
mulation, while the former feems to be a change in the 
contractile power of the mufcular fibre, probably derived 
from the morbid ftate of the blood, and indicating much 
danger. 
The heart is often affeCted in the fecond ftage of indi¬ 
geftion, in various and fevere modes. The palpitation 
which in the firft ftage was merely nervous, in fome in- 
ftances now becomes fo obftinate, as to affume the form 
of angina peCtoris, carditis, See. and, being accompanied 
with an increafed hardnefs of pulfe, can only be relieved 
by lofs of blood. 
Dr. Philip has noticed a connexion between rheurna- 
tifm and this fort of carditis. He fays, “It is a common 
obfervation, that carditis is apt to fuperverie after re¬ 
peated attacks of rheumatic pains of the limbs. I believe 
from many cafes which have fallen under my obfervation, 
that it will generally be found, in fuch inftances,.that the 
rheumatic pains had been combined with, and in a 
greater or lefs degree dependent on, diforder of the di¬ 
geftive organs.” The pain of the limbs arifing from this 
caufe, often aflume the form of idiopathic rheumatifm, 
and become very obftinate, if the caufe which fupports 
them be overlooked; which is the more likely to happen, 
as cold is very often the immediate exciting caufe. Dr. 
Philip has feen fevere pains of the limbs, which had long 
relilted the means ufually fuccefsful in rheumatic cafes, 
wholly removed by combining with thefe means the treat¬ 
ment adapted to the fecond ftage of indigeftion ; and it is 
well known to furgeons, that the fwelling of the knee- 
joint which fometimes accompanies the rheumatic con- 
ftitution, is only cured by the fame indication. 
On turning our attention to the other vifcera, we fee 
the fpafmodic contractions of the bowels, and their oc- 
cafional difturbance of function, developed in the early 
periods of indigeftion, now terminating in inflammation, 
ftri/ture, adhelions, piles, &c. The figmoid flexure of the 
colon appears to be a part very liable to be aftedled with 
inflammation, probably from the contents lodging there 
longer than in other parts of the large inteftines. It is 
not uncommon in protracted cafes, to find a confiderable 
degree of tendernefs in the feat of this part, which is 
fometimes at length affected with ulceration. It is alfo 
common to find tendernefs on preflure in the feat of the 
ccecum. 
The liver, too, aftumes an inflammatory appearance. 
We often find, when the patient takes cold, orisexpoled 
to other caufes of inflammation, or the dylpeplia is ag¬ 
gravated, the greater part of the right hypochondrium 
becomes full and tender on preflure, with a fenfe of op- 
preflion and an increafed hardnefs of pulfe, often accom¬ 
panied with fome degree of dylpncea, and a dry teafing 
cough. He fometimes complains of pain in the right, 
not unfrequently in the left, hypochondrium, or in the 
pit of the ltoinach, or in the right or left fiioulder; and 
experiences 
4 
