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but the same susceptibility, though less energetic, is manifested at a later period. We have often found young persons, between the ages of eighteen and twenty-five, affected with vague nervous and dyspeptic symptoms during the passage of the wisdom teeth through the gums; the mind is oppressed, so that there is an incapacity for directing fixed attention to any subject, and slight disorder of the gastric function is associated, irregular appetite, occasional nausea, &c.; and in some instances we have known severe epileptiform attacks come on.

These states of sympathetic dyspepsia, with nervous irritation, require attention. The bowels should be freely acted upon, so as to unload the colon; and the diet should be sustaining without being of a stimulant character. If there be any direct pressure upon the gum, free incision should be made; but what is of still greater importance is the general treatment of the patient: the mind must have rest from close application; exercise in the open air is desirable, especially horse exercise; hot rooms and exciting pleasures should be avoided; and when it can be attained, several months of travel and change of scene is greatly conducive to complete restoration of health.

Less severe, but more distressing, is the dyspepsia in hypochondriasis. We might have spoken of it in connection with atonic dyspepsia, for there is great feebleness in the vaso-motor nerve, leading, it may be, to a

deficient secretion of gastric juice; or we might have described a very similar state as being produced by gouty dyspepsia; or, lastly, as arising from an overworked mind and body. In these instances the whole attention is occupied with the diet; the mind is depressed and its energies enfeebled; one change after another is tried, but pain and discomfort equally follow; the stomach is sometimes exceedingly irritable, the bowels are over-anxiously watched, the sleep is unrefreshing, and life rendered miserable. To tell the patient nothing is the matter, would be to drive him to some one who would give an opinion more in unison with his feelings.

By carefully regulating the diet and the bowels, by cold sponging, by taking frequent exercise, either walking or on horseback, or a pedestrian tour when it is possible; by keeping the mind free from anxiety, and by cheerful society and occupation, all the symptoms may be greatly relieved. Such patients often take too spare a diet, leaving off one thing after another as unsuitable; and considerable improvement follows a more generous diet, especially when the mind is encouraged and cheered by the prospect of restored health.

CHAPTER XIV.

FERMENTATIVE DYSPEPSIA.

THE chemistry of digestion is a subject full of interest, and one that has received considerable elucidation from the researches of later years. The food begins to undergo change as soon as it is brought into contact with the secretion from the salivary glands, and passės through the process of mastication, although this is especially the case with starchy and farinaceous substances, which are converted into sugar. The saliva is naturally alkaline in its reaction, and contains a substance to which the name of ptyalin has been applied; this chemical substance resembles diastace. It induces a rearrangement of the elements of the starch, so that saccharine principle is produced; the saliva also contains sulphocyanides and a large quantity of saline material. Thus, thorough mastication serves a double purpose, not only to break down the solid portions of food, so that they may more readily undergo solution by the gastric juice, but to incorporate the salivary fluid, so that it also may be brought into contact and exert its energy upon the starchy elements. This metamorphosis

is extremely rapid, and it continues throughout the whole of the masticatory movements, during deglutition, and till the food reaches the stomach; and even then, it is not checked, although more important reactions take place by means of the gastric juice. In the duodenum and small intestine the same action persists as was commenced in the mouth, but with less energy. It is of great importance, therefore, that mastication should be thoroughly and efficiently executed, and the defect in this process is the first step towards the abnormal fermentative changes in the form of dyspepsia, which we have now before us.

In the stomach a different set of glands, peculiar to itself, secretes an acid fluid, known familiarly as the gastric juice; this secretion contains a nitrogenous substance, pepsin, and an acid, variously regarded by chemists as hydrochloric or as lactic acid, besides saline materials and water. The pepsin acts upon fibrinous substances, causing their solution, without itself entering into combination or becoming decomposed; the fluid that is formed, although fibrinous or albuminous, possesses different properties from a mere solution of a protein compound, for it is not coagulable by heat; the term peptone has been applied to it, and the whole solution has been designated chyme.

The chemical solution of the nitrogenous portions of food by the pepsin is limited, but it is greatly increased by the presence of the acid of the gastric juice, and by

the heat of the stomach and churning movements of the muscular walls. The food rotates along the lesser, and then from right to left backwards by the greater curvature; as the chymous fluid is formed, it passes by the pyloric valve into the duodenum, when it is mixed with the bile, and with the pancreatic secretion before it reaches the small intestine, and is absorbed into the system by the capillary veins and the lacteal processes.

This process of solution or digestion requires, according to the nature of the food, from two to four or five hours; and many substances that are taken cannot be dissolved at all, but pass in their crude state into the intestine; and although the solvent powers exerted by the gastric juice are especially upon the protein compounds,—the nitrogenous elements,-still the changes upon the starchy portions commenced in the mouth are not entirely checked; the oleaginous elements are more thoroughly divided, and the saline and aqueous constituents are diffused completely through the semi-fluid aliment. In a normal state the solution should be completed after a certain time, and as one part after another passes into the duodenum or becomes absorbed, the stomach is left in a quiescent state. But, far different are the conditions found in dyspepsia of the kind we are considering; when, either from improper food, or from insufficient secretion of gastric juice, or because the fluid when formed is unable to pass from the stomach, fermentative changes take place.

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