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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 during fever, whether intermittent, or continued, or during the febrile state of symptomatic fever. In these conditions the stomach is affected in common with the whole system, all the glandular organs have their action retarded, the blood is modified, and the whole organism is disordered. The furred state of the tongue is often expressive of a general condition, rather than a mere local indication of the state of the digestive mucous membrane.

With sympathies so widely pervading the whole system, it is not surprising that gastric disease should present most varied indications in the disturbance of other organs; and, in like manner, that gastric phenomena of an abnormal kind should result from irritation, far removed from the stomach itself. The closest circumspection is required to discriminate between sympathetic affections, and those of a strictly local origin.

CHAPTER III.

ON THE SYMTOMS OF DISEASE OF THE STOMACH.

If we were to judge alone by the severity of the symptoms in diseases of the stomach, constant mistakes would be the result, especially in the earlier stages of disease; for in functional maladies, that is to say, those in which no structural change can be detected, the symptoms are often extremely urgent. The irritability of the stomach may be excessive, so that every portion of food is at once rejected, the pain may be severe, and the general distress constant, although the ailment is curable, and of a comparatively slight character.

It will be well to consider seriatim, the symptoms which are present in diseases of the stomach, and their relative value. The two symptoms which are regarded as of especial diagnotic value are vomiting and pain* in the region of the stomach. We have already referred to the intimate connection of the nerves of the sympathetic plexus with all the abdominal viscera, and with the spinal nerves; and this connection serves to explain the uncertain indications of these symptoms.

* The remarks on pain and vomiting are in great measure taken from my larger work on 'Abdominal Disease.'

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