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rience of every additional year excepting to the most determined has made him more sensible of caviller. the importance of examining the We shall not, however, we situation of the pylorus and duo- trust, be deemed by the author denum, since here there is most to participate in a spirit of hyfrequently a morbid tenderness, percriticism, when we say, that which, unless submitted to local though what he has stated is in a treatment, invariably maintains great measure correct, it is not and aggravates the dyspeptic altogether so; but that the pain symptoms. We believe that all and tenderness in the right side who will attentively and candidly may proceed from affection of the consider their own experience, colon, as well as of the pylorus will agree in this opinion. In the and duodenum. It is true that second stage of indigestion, it is Dr. Philip has mentioned at some never enough to recur merely to length the affection of the bowel, the general indications, the local when the pain is in the region of affection will always require lo- the stomach or of the sigmoid cal treatment.
flexure of the intestine ; but he When pain is experienced in has not referred to it as being the the region alluded to, there is in site of tenderness in the ascending general also much fulness, and branch, or as it turns to form the the right side is more prominent transverse arch. In both these and firmer than the left. This, situations, however, we have had as Dr. Philip remarks, has been frequent reason to suspect dis100 frequently referred to an af- ease ; and some of the most disfection of the liver; and the mode tressing cases of indigestion that of cure pursued has been directed have fallen under our care, have,as on this supposition. We have had it appeared to us, had their prinoccasion to know, that with many cipal seat in this part of the alipractitioners this kind of liver mentary canal. For the means disease, which in truth is no dis- of distinguishing affections of the ease of the liver at all, is a very stomach from those of the colon, frequent occurrence, and mercu- Dr. Philip mentions the ry in all its forms is most liberal- complete performance of the early administered.
It need scarce- lier part of the process of digesly be said that such treatment is tion, and the more or less perfect most wretchedly unsuccessful, relief afforded by evacuations, the diagnosis is incorrect, and which are generally preceded by
can happen only by an increase of tenderness. It chance. That to the duodenum will, however, often happen, that this fulness and tenderness is in a the stomach and the colon shall great measure to be attributed, be affected simultaneously, and our own experience would have thus the diagnosis will be renderinclined us to believe, without ed more difficult than when either the testimony of Dr. Pbilip ; but is disordered separately. Under the facts he has brought forward, these circumstances, it will be and the satisfactory manner in frequently possible to arrive at which he has described thein, so tolerable accuracy by tracing the concordant with daily experience, course of the bowel, and ascerscarcely leaves room to doubt, taining whether the pain extends
in its direction; and sometimes either the caput coli and its imwhere there is much borboryg. mediate neighborhood, or the sigmus, the pain is observed to moid flexure of the same inteschange its situation as the differ- tine. We have most commonly ent parts of the bowel undergo met with it in dressmakers, contraction. In this last case, some of whom have been comhowever, it may be said that the pelled to leave their occupations pain is entirely spasmodic, and on account of it. When the pain different therefore from the in- is confined to the right side, they flammatory irritation mentioned often experience a sense of dragby Dr. Philip. To a certain ex- ging, and complain of inconvetent, this is undoubtedly true ; nience, occasionally arising even but at the same time, some one to pain, on moving the arm. Frepoint will be always more readily quently, also, there is pain at the affected than another, and be re base of the scapula. The counferred to as the principal seat of tenance is seldom much affected; disease, from which the general nor have we ever noticed a jauntenderness is derived. With this diced state of the skin, or any state of tenderness, whether con- other symptom that would lead fined to the stomach, the duode- to the suspicion of hepatic disease. num, or the colon, the author of In many cases, there is not the the present treatise appears dis- slightest fulness of the abdomen posed to maintain, that a certain in any one point; and in one of the tightness of the pulse is conjoined, most obstinate cases that has indicating the presence of an in- fallen under our notice, the bowflammatory action. To this doc- els were so empty that by a very trine we are inclined only partial- little pressure the vertebræ could ly to assent ; for we feel con- be perceived. vinced that there are many cases The duration of this painful of local pains in the abdomen at state is very uncertain ; but setending on indigestion, which are veral instances have occurred to neither accompanied by a sharp us in which it had been more or nor tight pulse, nor curable by less experienced for three years. common antiphlogistic measures. Hitberto we can only confess It is true, that in the very great our ignorance of a successful memajority of cases, the fact is as it thod of treating it. Leeches and has been stated by Dr. Philip ; blisters have frequently increased and local bleeding will suffice to the constitutional derangement, subdue or to relieve it. There without affording the slightest reis, however, a state of irritation lief to the local affection ; and of the colon which exhibits no- purgatives invariably aggravate thing inflammatory in its nature, tenderness of the intestine. and which has often appeared to The second essay is entitled, us rather aggravated than re of the Organs of Waste in Indilieved by leeches and counter- gestion ;' and Dr. P. commences irritants. The individuals most it with remarking, that it very subject to this peculiar uneasiness frequently happens in the second are young women, from sixteen stage of indigestion, that when years of age to thirty; and the the disease begins to yield, the seat most generally affected is patient gets thinner, whether he
has been losing flesh previously cations of treatment remain the or not, which arises from the or- same. It is, however, more congans of waste being the first to sonant to our general knowledge regain their due action.'
of the absorbent system; for hithWe were at first somewhat erto no proof has ever been adsurprised at this observation, and duced of its energy being dimicould not recollect any instance nished in disease. On the conin our own practice where such trary, it acts with apparently inan occurrence had had place. creasing energy as the general On reading, however, a little system becomes weaker, and further, we discovered that Dr. even remains active when all the Philip alludes to that bloated and other functions of life have ceased, unhealthy bulkiness of the body The loss of bulk can only be in which the system is rather considered favorable, as we have puffed up and bloated than really stated, when it is attended with overnourished. The secretions increase of strength, or at least in these cases appear imperfect without its diminution. But when throughout the whole animal eco- an opposite progress has place, nomy, and the fat thrown out is and the strength diminishes, the of a medium consistency between disease will generally prove exactual health and edema. The tremely difficult to cure. Dr. countenance exhibits in fact that Philip, justly considering this appearance which has been term- symptom as one of much impored leucophlegmatic. The loss of tance, enters into an examination blood, therefore, in this case, is of its causes, some part of which not, we apprehend, a true loss of we extract. flesh, but rather of this unhealthy It evidently arises from sevesecretion, arising perhaps not so ral causes, but I believe chiefly much from the organs of waste from the following. All causes being first to regain their due ac- of irritation tend more or less to tion, as from the secerning ves- excite a feverish state. Hence sels regaining theirs, whence fat the tight pulse, and frequent ocmore perfectly elaborated, but currence of some feverishness, smaller in quantity, is laid down. particularly towards evening, in The immediate consequence of the second stage of indigestion, this is a diminution in bulk, be- one of the most severe and obsticause even should the absorbents nate causes of irritation. The exert no more than their usual tight pulse, indeed, which energy, the supply being less than ways present in a greater or less before, the size of the body must degree at this period, constitutes decrease, though the muscular itself a certain degree of feversystem is actually at the very ishness, and, when considerable, same time on the increase. Un- is accompanied with all its essender these circumstances, there- tial symptoms. The vessels, in fore, the loss of bulk must cer- consequence of the continued irtainly be regarded as a favorable ritation of the most sensible nerves symptom. The explanation we of our frame, are excited to emhave offered of this phenomenon brace the blood more strongly may appear superfluous, because than in health ; hence the tight the fact being allowed, the indi- pulse. Now this state, though a
morbid one, tends for the present It has not unfrequently occurred to support the strength, and we to ourselves to see patients who know, when in the extreme, will had been thus treated. even give a preternatural degree muli had been forbidden to indiof strength. I have repeatedly viduals who had been accustomed been consulted by dyspeptics, to take them in great excess. who said that the most unac- The result was so quick and comcountable peculiarity of their plete a prostration of strength, as case was, that they never felt really to deserve the epithet of tired, but felt as if they could frightful. Every function seemwalk forever. This, so contrary ed about to cease at once, and to what is usual in indigestion, the patient passed rapidly from arises from peculiarity of habit; one fainting fit into another. We but strikingly illustrates a point are the more inclined to press this of great importance in the nature circumstance on our readers, beof the disease. In such patients, cause, if we recollect rightly, the nerves are so braced by the Mr. Howship has inculcated a tightened circulation, as not only contrary practice, and maintains to obviate the usual debilitating that he has never seen any ill efeffects of the irritating cause, but fects to proceed from a sudden even to give a preternatural vigor. change from a highly stimulating
Could we suddenly relieve to a mild diet. That he may the dyspeptic from the causes of have met with such instances, is irritation to which he has been so not improbable ; but they are long subject, by at once removing certainly exceptions to the genethe disease, he would feel a de- ral rule. pression of strength, till the Another cause of depression in nerves had accommodated them- the commencing treatment of dysselves to the change. The tight- pepsia, is the impossibility of reened state of the circulation lieving cases of long standing, would be relaxed, and the effect without some of those measures of this would be increased by the which more directly soften and secreting surfaces, which were relax the secreting surfaces.' bound up, beginning to separate These measures are of an antiphlomore freely their various fluids, gistic kind, but require extreme and also by the alimentary canal caution and sagacity in employing being less distended with flatu- them. Without recurring more lence, and a collection of undi- or less to their employment, it gested food, which, however in- will be often found impossible to jurious, for the time gives tension, make any impression on the disand therefore tone.'
order, and yet a very slight exThe direct inference from this cess in depletion will induce the reasoning is precisely that which most obstinate hysterical affechas been long confirmed by expe- tion. It is also no unusual conserience, namely, that dyspeptic quence of bleeding, especially if patients very ill bear any sudden it be general, to induce an inchange in their habits. However creased flatulence, but which is injurious may be the tendency of usually very transitory; and if the stimulants, to withdraw them inflammatory tendency be suffisuddenly is even more prejudicial. ciently overcome to admit their
administration, readily yields to deal of good in all this ; but in a the use of topics. The following very large majority of such cases remarks of Dr. Philip so perfect- these means prove ineffectual. ly coincide with the result of our The cure is then said to be hopeexperience, that we would par- less, and the patient must use the ticularly recommend them to the means which his experience tells attention of our readers.
him suit him best, and make him• The difference in the manner self as comfortable as he can. In in which different individuals bear such cases, a permanent cure can the changes necessary to reco- generally be effected by no other very, in advanced states of the means than simply removing the disease, is very remarkable. In tight pulse and bound state of the some, the habit may be quickly secreting surfaces, by gradually altered, with but little depression weaning the patient from his stiof strength ; while in others, it mulants, at first rejecting the requires all the attention of the more powerful, and combining the physician to prevent a considera- milder with those means which, ble degree of it-such is the dif- without acting as stimulants to ference of constitution. The the stomach, already too much treatment should be regulated stimulated, both by the disease accordingly, and any great degree and the means employed for its of depression prevented.
relief, excite the organs, to which • The physician may overlook the debility, originally confined to the essential change which takes the stomach, has now spread ; in place in the progress of indiges- consequence of which the system tion, and constitutes the difference is neither receiving what it ought between what I have called the to receive, nor throwing off what first and second stages ; but it is it ought to get rid of; and thus impossible for the patient himself the disease, in one of its most disto overlook it. We constantly tressing, and in by far its most find dyspeptics declaring that the obstinate form, is prolonged. stimulants which used to relieve When this necessary change them seem now to do harm ; and of measure produces depression, that they cannot continue their the remedy is simply to make it use for many days together, by slower degrees, to make the though the sense of depression dose of the alteratives extremely which they feel on abstaining small, and to retain as much of from them, still impels them to the tonics as will not materially return to, and even to increase interfere with the only means of them, by which they never fail restoring health.' to aggravate the disease. They Excess in diet is yet another are taking a course exactly the source of this depression ; and, reverse of the only one which excepting where very highsealeads to health.
soned dishes are eaten, we be• In this disease, it is common lieve the quantity to have much to recommend change of scene, more effect than the quality of a mild and nutritive diet, mineral food on dyspeptic patients. In waters, and no inore medicine the treatise to which the present than the patient finds absolutely small volume is only an appendix, necessary; and there is a great Dr. Philip has entered at consi