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Another instance of this sympathetic connection between the brain and the stomach is shewn in mental disturbance and anxieties. Bad news will entirely destroy the appetite, and great mental distress places the digestive process almost in complete abeyance. In mania the appetite is changed, digestion altered, the bowels confined, and sometimes the strangest substances swallowed.

The connection of the stomach with the lungs and heart may be regarded in a threefold aspect :

1st. As it regards the entrance of nutriment into the system if, from irritability or inability to receive the supply required for the maintenance of health and strength, the blood becomes 'impoverished, then a low organised product is more likely to form in the lungs or glands, as strumous tubercle, thus leading secondarily to phthisis.

2nd. In reference to the nerve supply to these several parts: the pneumogastric, one of the most important nerves in the body, from the character of the organs to which it is directed, is largely distributed, both to the stomach, the lungs, and the heart; and in addition to this, the connection of the large semilunar ganglia, which sends branches to the stomach and abdominal viscera, is a very intimate one with the pulmonary and cardiac ganglia of the vaso-motor nerve.

3rd. The action of these important structures, the lungs and heart, in the circulation of the blood, has a

direct effect on the function of digestion; for, if the course of the blood be impeded by disease of the lungs or heart, the portal system of vessels becomes necessarily congested, the secretion from the mucous membrane is changed, and digestion is embarrassed.

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From one or other of these reasons we find that there is a very close sympathy of the stomach with the lungs and heart; thus indigestion frequently produces hurried breathing and dyspnoea, with dry cough; and as to the heart, the symptoms are often so distinctive, that it is difficult to convince patients that they are not suffering from organic disease; palpitation of the heart is thus induced, and irregularity, which greatly alarms the patient, and even faintness or actual syncope, if the heart be feeble. The converse symptoms are equally important, and early disease of the lungs, especially from peripheral irritation of the branches of the pneumogastric by miliary tubercles at the apex of the lung, is often accompanied by excessive irritability of the stomach, so that the practitioner may suppose that the stomach is at fault; the diminished nourishment increases the constitutional weakness, and thus leads to a rapid increase in the original disease; too often the mistake is made, "that it is all stomach," and many of the so-called cases of gastric phthisis are of this kind. In whooping-cough a similar connection between the stomach and the lungs is noticed, and the former becomes almost as irritable as the latter;

the spasmodic cough is very often accompanied by actual vomiting.

In chronic bronchitis, and in obstructive disease of the heart, whether from the state of the valves or the muscular tissue of the heart, gastric symptoms arise from the third cause mentioned, namely, from interference with the free circuit of the blood, and the consequent distension of the gastric veins. The capillaries of the stomach thus become intensely injected, a thick layer of catarrhal mucus is secreted, and digestion is greatly hindered.

In acute disease of the heart and of the pericardium the stomach sometimes becomes irritable.

The stomach is so closely connected with the liver in the function of digestion, that one organ can scarcely be seriously disordered, without the other becoming more or less implicated; but there are other conditions which shew the closest sympathy, independent of their functional connection. The violent vomiting that is induced by the passage of a gall stone is due, not only to the direct transmission of spasmodic contraction from the involuntary fibres of the duct to those of the stomach, but it also arises from the connection of the hepatic and gastric filaments by means of the pneumogastric and vaso-motor nerves.

In diseases of the kidney the gastric disturbance is susceptible of a two-fold explanation; in some forms of acute renal disease, as calculus, the violent vomiting is

from the connection of the renal nerves with the gastric; but in chronic Bright's disease of the kidney it has been shewn, that the secretions of the stomach become unusually irritating from the presence of urea.

In Addison's disease of the supra-renal capsules (melasma supra renale) irritability of the stomach is often present; and although, after death local irritation and superficial ulceration of the mucous membrane have often been detected, we regard the direct nervous connection as having the more important causative relation.

The sympathy of the stomach with the urino-genital organs is so well known that it scarcely needs comment; and this is due to the same nerve union, namely, the hypogastric plexus with the semilunar ganglia. Diseases of the bladder and prostate are often associated with gastric and general symptoms, due to the vasomotor nerve, as rigors, irritability of stomach, hiccough, &c.; and the changes in the uterus and ovaries are often marked by characteristic irritability; sometimes the extreme sensibility of the stomach continues during the whole period of utero-gestation, whilst in other cases digestion is performed more comfortably and effectively during gestation than at any other period. We have known all the symptoms of dyspepsia disappear as soon as conception has taken place, and they have remained in entire abeyance until parturition has been completed.

The lining membrane of the alimentary tract is continuous with the skin, and in one sense it is external to the living organism, so that the stomach and other parts of the intestinal canal have been spoken of as inversions of the external investment; the intimacy of their connection bears out that form of expression, although the union between the stomach and the skin does not require continuous irritation to explain the phenomena.

At the onset of nearly all the exanthems the stomach sympathizes, and vomiting is a common symptom. Thus the commencement of erysipelas, of small pox, of scarlet fever also, is often thus indicated; and equally distinct is the sympathy in chronic forms of cutaneous disease. How often do we find in lichen and in eczema that the gastric symptoms increase when the irritation of the surface is lessened; and in other conditions, disturbance of the stomach will greatly increase the cutaneous malady, thus in children, strophulus, lichen, and eczema are greatly aggravated by gastric irritation, and by muco-enterite.

In the forms of nettle rash from the crustacea, &c., it might be said, that the irritation on the skin is due to the absorption into the blood of irritating extraneous material.

We can scarcely designate by the term sympathy, in the sense in which we have hitherto used it, the anorexia, and the inability to digest food, which occur

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