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performed. Abdominal tumours, whether carcinomatous, hydatid, or of any other kind, sometimes exert pressure upon the stomach, and thus mechanically interfere with its healthy action.

3. As regards the changes in the coats of the stomach, they belong so exclusively to organic diseases that we shall not enter upon the consideration of them here; but it may be mentioned, that in fibroid disease of the pylorus, the stomach sometimes attains enormous proportions, so that with the pyloric valve close to the pubes, the viscus fills nearly the whole of the abdomen ; and that without such valvular obstruction, the muscular coat becomes sometimes atrophied, and the cavity enormously distended, so that it is unable to contract upon its contents. In this latter case, the principal symptom is the tympanitic distension of the abdomen, with feebleness of digestion. We shall have again to refer to distension of the stomach in speaking of fermentative changes.

CHAPTER XIII.

SYMPATHETIC DYSPEPSI A.

The extensive connection of the stomach with other parts of the system, by means of its supply of nerve filaments, leads to frequent disturbance of its function from disorder in other parts; and an intimate acquaintance with these sympathetic maladies is of the utmost importance ; for without this knowledge, not only is the true source of disturbance overlooked, but, as a necessary sequence, the treatment is ineffective, because applied in a wrong direction.

It is not our intention to describe the nerves that supply the stomach, but only to state that this supply is from two sources, 1st, from the large branches of the vaso-motor nerve of the semi-lunar ganglia of the abdomen, by which it is connected, not only with the adjoining viscera in the abdomen, but with nearly every part of the body; this connection gives rise to disturbances of sight and hearing, and of the intellectual and sensory centres generally; the 2nd source is from the pneumogastric nerve, which also supplies the lungs and the heart.

Perhaps the most important form of sympathetic disturbance of the stomach is that connected with disease of the brain ; and the consideration of this is the more necessary, because in such cases the true nature of the malady is often overlooked. There are some peculiarities, however, which serve to distinguish this form of malady ; in one class the subjects are young, of an active mind, intelligent, and precocious. There may be some headache, and temporary disturbance of vision, grinding of the teeth, disturbed nights, and restless activity of mind during the day; they are generally precocious children, of bright and joyous disposition ; and, without any very apparent cause, vomiting is set up, and the illness is regarded as a “ bilious attack.” This may soon be followed by more marked symptoms of cerebral disturbance, by severe headache, convulsion, and gradually increasing coma, in fact, by all the symptoms of acute hydrocephalus; or there may be a succession of such attacks, each slight in itself, but, as the mind is allowed to rest, and the irritation of the brain is diminished, the diseased state gradually subsides. This repeated disturbance of the brain favours the deposition of tubercular deposit in the membranes, and at length acute hydrocephalus is developed to the inexpressible anguish of the relatives of the child. Sometimes the symptoms of cerebral affection are preceded by those of gastric remittent fever, and then it is difficult without careful investigation to decide, whether the disease is really wholly abdominal in its character, and whether the brain disease is not secondary rather than primary.

In another class of cases, the patient is more advanced in life, it may be in early manhood, when severe pain in the head, and vomiting without any real gastrie disturbance, usher in most serious and fatal disease.

The same sympathetic connection is witnessed after concussion of the brain; as the patient begins to rally from the first effects of the blow, vomiting is a frequent result; and, if local inflammation of the membranes of the brain takes place, the irritability of the stomach is sometimes excessive, especially if the disease extend to the origin of the pneumogastric nerves.

These cases are often set down as “bilious attacks,” which is the most serious mistake that could be made, for the sole attention is then directed to the stomach and the liver; the nature of the malady is overlooked, and the treatment misdirected. In the diagnosis of these cases, where irritation of the brain is the cause, the head is hot, the pupils generally small, the tongue clean, the abdomen contracted, and the bowels confined.

Another cause of sympathetic disturbance of the stomach is disease of the spinal cord; but although irritability of the stomach is sometimes to be traced to this source, more frequently the pain at the scrobiculus cordis, and flatulent distension of the stomach and

abdomen, are really signs, the one of irritation at the peripheral extremity of the spinal nerves, the other of paralysis, which prevents the muscles forming the abdominal parietes, and the involuntary muscular fibre of the intestine from contracting in their normal manner.

In disease of the lungs, especially of a tubercular kind, the implication of peripheral branches of the pneumogastric nerves in the morbid action sets up reflex disturbance of the stomach; we find delicate strumous subjects thus affected with such extreme sensibility of the stomach, that food of almost every kind is at once rejected; no cough may be present, but on examining carefully the apices of the lungs, some difference in the resonance on percussion will be found, and the respiratory murmur will be heard more feeble than natural, or irregular, or the expiratory murmur coarse and prolonged, even if more advanced indications of organic change do not exist. This state of sympathetic gastric disturbance sometimes subsides as the phthisical condition becomes fully developed, or it may continue to harass the patient throughout the whole course of the complaint.

It may be argued by some, that the gastric altogether precedes the pulmonary mischief, and that in the weakness from the impaired power of digestion we have the cause of the low organised deposit in the cell structure of the lungs. If such were the case, the gastric disease would continue at least pari passû with

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