138 PATHOLOGY. 
experiences Tome uneafinefs in lying on either fide, par¬ 
ticularly on the left, the common derangement of the 
biliary fecretion being rendered more marked with thefe 
fymptoms. The hepatic inflammation thus induced is 
feldom, however, of that adtive kind which requires ge¬ 
neral blood-letting; a fortunate circumftance, as patients 
of this defcription rarely bear lofs of blood well. Thefe 
attacks generally partake of the chronic nature of the 
habitual difeafe, and for the mod part yields to local 
blood-letting and blifters, with the aid of a mild diet and 
faline and aperient medicines. 
The pain is often felt in the left fide, while the ten- 
dernefs on p re flu re is wholly confined to the right; but, 
after the affedlion of the right fide is relieved by evacua¬ 
tions from the tender part, it is not uncommon for the 
left fide to become both full and tender, the inflammatory 
affedlion appearing to attack the fpleen as foon as the 
liver is relieved from it; and it will fometimes, on the 
fulnefs and tendernefs of the left fide being relieved by 
the fame means, return to the liver. This alternation 
often happens more than once before the difeafe fubfides. 
Sometimes, though much more rarely, the fulnefs and 
tendernefs appear in the left fide alone. The pain is then 
more confined to the feat of the tendernefs. 
Whenever the liver becomes thus implicated in the in¬ 
flamed ftate of the ftomach, it leads to a train of fymp¬ 
toms arifing out of hepatic derangement, which demand 
ferious attention. It is not the leaft of thefe, that the 
re-adling difeafe aggravates the gaftric difturbance, a cir¬ 
cumftance which very often perplexes us in the diagnofis. 
But we mull poftpone further refearches till the fubjedt 
of difeafed liver comes before us. 
The connexion of urinary gravel with dyfpepfia is 
worthy of particular notice. We are indebted to Dr. 
Philip for an ingenious fpeculation on this fubjedl. He 
tiiinks that it is not by fympathy alone that indigeftion 
excites urinary gravel. He (hows that in moll cafes of 
dyfpepfia there is a confiderable produdlion of acid in the 
fir ft paflages; and this acid, as appears from his experi¬ 
ments, enters the mafs of blood, and is thrown out of the 
fyftem by the Ikin and kidneys. As all other acids occa- 
fion a precipitation of lithic acid from the urine when 
the adlion of the Ikin is impaired, the one we are fpeak- 
ingof often paffes in fuch quantity by the kidneys as to 
caufe a depolition of lithic acid before the urine leaves 
thefe organs, which there (probably in confequence of 
being agglutinated by a fecretion which its ftimulation 
excites on the internal fur face of the kidney) frequently 
concretes into fmall maffes occafioning fits of gravel. 
A precipitation of lithic acid is often obferved in the 
urine of dyfpeptic patients, after it has Hood for fome 
time ; and that the gravel which afflidls them is only a 
greater degree of this fymptom, appears from the obferva- 
tions of the bed writers on calculous difeafes, who con- 
fider the calculi formed in the kidney to be almoft always 
concretions of lithic acid. 
Dr. Philip feems to confider, that, in difputing that 
the kidneys are affedled by fympathy with the ftomach, 
lie is borne out by the fadl, that while, as we have feen, 
the other inteftinal organs are peculiarly liable to a flume 
the inflammatory ftate of the fecond ftage of indigeftion, 
the kidneys feldom fhow any tendency of this kind. This 
affertion feems, however, by no means confonant with 
experience ; but Dr. Philip obviates the difficulty by 
faying, that, “ it is not uncommon, in indigeftion, for 
the acrid ftate of the urine, arifing from the f'uperabun- 
dance of acid and its other faline contents, occafioned by 
the greater generation of acid in the alimentary canal, 
and the inadlivity of the fkin, fo to irritate the urinary 
paflages as to occafion frequent midlurition, and a fenfe 
of burning, and other painful fenfations in thefe paflages, 
even when no depofition of lithic acid takes place in 
them.” Without attempting to invalidate this theory, 
or even to prove diredt fympathy between the ftomach and 
kidneys, we cannot help thinking, that an indiredl fym¬ 
pathy between the ftomach and kidneys, through the me¬ 
dium of the fkin, would account for the circumftance we 
are confidering in a manner more confonant with general 
principles, and equally capable of demonftration. 
In profecuting further the groups of fymptoms which 
a rife from dyfpepfia, cachedic diforders will hold a promi¬ 
nent rank. The marafmus both of infants and adults is. 
often diredlly traceable to the undigefted ftate of the pa- 
bula vitae, even where no affedlion of the abforbents of 
the mefentery exifts; fo that tabes, atrophia, &c. will 
(as we (hall endeavour to fhow when thefe are on the 
tapis) often gain relief from the treatment of dyfpepfia. 
There is, however, one fpecies of cachedlic diforder which 
we mu ft notice here for want of a more, fit place in our 
nomenclature : vve allude to a ftate which has been de- 
feribed by Dr. Hall as a variety of (what he calls) th« 
Mimofis acuta; and which appears an analogous diftem- 
per to that noticed by many authors under the terms 
purpura, Jcorbutus, &c. This affedlion is indicated by all 
thofe fymptoms which we fhould naturally infer from a 
morbid condition of the circulating fluids; for inflance, 
by deficient adtion of the mufcular fibres, manifefted in 
its larger ftrudlures ; by languor, indolence, and debility; 
and, in its Irnaller ones, by various topical congeftions, 
and by haemorrhage ; and thefe latter are peculiarly re¬ 
markable on the (kin and the nervous expanfions. The 
fkin, being prefled or otherwife injured, betrays extra¬ 
ordinary marks of want of tone, or of the refinance to, 
and recovery from, unnatural agents, which healthy 
ftrudlures fo remarkably difplay; and it is fometimes af¬ 
fedled with a continued though variable ftate of fallow- 
nefs, of yellownefs, or idlerode hue; of darknefs, or of 
a wan, fqualid, or fordid, palenefs of complexion ; or a 
ring of darknefs furrounding the eyes, and extending a 
little perhaps towards the temples and cheeks, and fo mu¬ 
tinies encircling the mouth ; and the gums, throat, &c. 
are peculiarly liable to fall into ulcerations, haemorrha¬ 
ges, &c. Pains in the bones are often felt. We feledl a 
cafe from Dr. Hall, which, though it does not exemplify 
this complaint in its word form, yet is worthy of per¬ 
manent record, becaufe it ferves to trace the difeafe very 
conclufively to a dyfpeptic origin. 
“ E. M. aged"35, a framework-knitter, tall, flout, and 
healthy, was employed, in 1815, in the moll a drive and 
laborious manner, in hay-making; he was expofed to 
great heat, underwent much fatigue, perfpired profufely, 
and drank copioufly of beer and ale. He became affedled 
with weaknefs, liltleffnefs, lofs of flelh, nodturnal perfpi- 
ration, head-ache and vertigo, lofs of apetite, and idlertis, 
with pale-coloured (tools and deep-coloured urine. He 
recovered from thefe complaints; but in the year 1816 
had the misfortune to break his leg. In confequence of 
this accident and the fubfequent confinement, he became 
and remained indifpofed ; he gradually loft flefh, and 
from i4ftone, weighed between 12 and 13 only; and ex¬ 
perienced, on taking cold, a lofs of apetite and flrength, 
with an inability to work, not known before. In No¬ 
vember 1817, he underwent much bodily exertion, and 
remained expofed to the cold and damp. He took cold, 
and became affedled with hoarfenefs, fore throat, a net 
cough, with oedema of the ankles. Thefe fymptoms 
ceafed, except the oedema, which receded however gra¬ 
dually ; but he was ftill affedled with the following com¬ 
plaints, which are copied from his own account of them: 
Lofs of flefh, and of flrength; a feeling of internal weak¬ 
nefs ; feverifhnefs, a parched and dry Hate of the throat, 
and fometimes of the tongue; fenfibility to cold, chilli- 
nefs, tendency to perfpiration, efpecially in the night; 
head-ache ; fleepineis; dulnefs of fpirits ; nervoufnefs j 
fluttering at the heart and about the ftomach; cough-; 
dyfpncea; a clammy tongue and mouth, and foetid 
breath ; lofs of appetite, fenfe of load at the ftomach, 
occafional rejedlion of food, conflipation, and pain in the 
chondiliac regions. This patient became much better 
from the ufe of gentle purgatives of calomel, rhubarb, and 
Epfom 
