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ON

DISEASES OF THE STOMACH.

The Varieties Of Dyspepsia: Their Diagnosis And
Treatment.

Although nearly every year new works have appeared on diseases of the stomach, still the maladies affecting this organ are so numerous, and of a character so diversified, that there is ample scope for the records of individual experience. It is not my intention to enter into the scientific and pathological bearings of gastric disease; this I have already done to a great extent in my former work on 'Diseases of the Abdomen.' My object in the following pages is rather to direct attention to the practical consideration of the subject, and to those divisions of a common disease which are brought under the daily notice of the physician. The opinions advanced are based upon facts educed in the clinical study of disease; and, if it had been thought desirable numerous instances might have been appended in support of every statement: we have preferred simply

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recording the result of our own experience, leaving each one to test by individual practice the correctness of our deductions.

The organisation of the human frame is so nicely and ! delicately adjusted that every part maintains its harmonious relation to the whole; and, if the attention is called at any time to the performance of any of its functions, we may rest assured that the healthy state is disturbed, and that disease in some form, however mild, has already commenced, and demands the attention of the physician. Healthy digestion is performed unconsciously; and the physical movements, the chemical solution, and the subsequent absorption produce no sensory phenomena. The replenishment of the natural wants of the system excites a consciousness of healthy vigour, and of capacity for new exertion; and, as exercise produces waste, the demand for fresh material, by which the deficiency may be restored, is expressed by a healthy hunger, and by a thirst which is soon satisfied.

It is the function of the stomach to carry on the work of digestion; therefore, when indigestion arises we must trace it to some cause by which, this natural process is impeded. To enumerate all the causes of dyspepsia we must trace the daily life of an individual from earliest years to advanced age; and not only must we note the external and physical conditions, but the subtle workings of the mind amidst its joys and sorrows, its gratifications and disappointments, its corroding cares and its seasons of buoyant happiness, its thirst for sensual enjoyment, as well as its highly intellectual pursuits. Were we to depict all the varieties of dyspepsia, we must comprehend every form from the trifling malady, which may scarcely be regarded, to those which are so severe as to rob life of its enjoyment; and even the same symptoms may in the one case be a mere temporary disturbance, and in the other they may indicate the commencement of serious organic disease: and, still further, the measures available in the treatment of these multifarious complaints are even more comprehensive than the symptoms; and were we to enter upon a minute detail of the whole subject, we must include the rules of hygiene, as well as those of therapeutical practice; for the diet and the clothing, the exercise and rest, the air we breathe and the water we drink are most important; and not less essential are mental rest and discipline in their effects on the physical organism. A full description of these remedial measures would lead us beyond our intended space, and we must content ourselves with general indications concerning them, still bearing in mind the fact, that they should never be placed in a position subordinate to the mere administration of medicinal substances.

As dysphagia indicates impaired action of the oesophagus, so dyspepsia is a term applied to corresponding defect in the stomach; and as the varieties of dysphagia comprise the diseases of the oesophagus, so the forms of dyspepsia include the maladies of the stomach. The want of gastric power cannot however always be designated dyspepsia, for during the paroxysms of fever, as well as in the exhaustion of chronic disease, the stomach fails in common with every other part, and the local sign is almost disregarded in the general affection. We are fully aware of the danger attached to the special study of one class of disease; and we must ever be on our guard, lest in directing attention to the local symptoms we overlook the constitutional character of the malady.

In my former work on 'Diseases of the Abdomen' I arranged these affections of the stomach according to the physiological divisions, by referring to the various parts implicated, and then considered them in the following order:—1st. The dyspepsia arising from disorder of the mucous membrane of the stomach and its secretion; 2nd. That arising from the muscular movements of the stomach being impeded; 3rd. From an abnormal state of the vascular supply; 4th. From changes in the condition of the nervous system; and lastly from improper diet, or from chemical decomposition taking place during the digestive process. My present intention is to enter into a more minute consideration of the varieties of the disease as observed in daily practice.

The first that we shall notice is dyspepsia from

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