353. It has been a question more frequently discussed than satisfactorily answered, whether the morbid acidity which occurs in the stomach of invalids be the product of a fermentation generated by indigestible food, or the consequence of a certain condition of the gastric secretion? It seems to me that it may arise from either of these causes. In cases of imperfect chymification it may depend upon the ingesta actually undergoing the acetous fermentation, or upon an increased acidity in the gastric juice itself, occasioned by the indigestible nature of the aliment upon which it has to operate; for it has been already remarked (30) that the gastric solvent varies in this respect, according to the character of the ingesta which excite its secretion. The acidity, therefore, so prevalent in weak stomachs, instead of being regarded as of morbid origin, ought to be frequently considered as an effort of nature to assist digestion. It has been very truly stated that the necessity of acid for the chymification of vegetable food affords an explanation of the fondness which the Germans and Dutch display for saur kraut, or cabbage in a state of acetous fermentation, and of its alleged easy digestibility 1. Besides the above sources of acidity there still remains one to be examined, more obscure in its nature, and far more difficult in its cure; it is a condition of the stomach arising from its sympathetic action with some distant organ, as the kidneys, uterus, etc.

Cardialgia, from this latter cause, resists the ordinary methods of cure, and is more frequently relieved by acids than alkalies, or by the exhibition of a narcotic.

1 Dr. Combe on the Physiology of Digestion.

354. The above view of the sources of Cardialgia, or heartburn, will suggest some very important hints for its cure. Should it arise from the indigestible nature of the food, a change of diet will promise success; if, however, it can be supposed to depend upon a condition of the gastric solvent, rendered necessary for the solution of the ingesta, a different plan of treatment will suggest itself to the practitioner; and let me here protest against the too prevailing fashion of taking, indiscriminately, doses of soda, or of some alkaline salt, after a meal, "to correct any acidity," - to correct acidity! say rather to neutralize that power which nature has provided for our well-being. Acidity is essential to chymification, - if it be excessive, let us inquire how far it may be morbid, or salutary, before we attempt to remove it from its sphere of action by the interference of art.

355. In ordinary cases of acidity, or those depending upon an acetification of the food, and complicated with symptoms of indigestion, the procuring evacuations from the bowels is the first measure to which we are to resort, and this may be effected by the combination of some purgative and antacid. According to my own experience, which has been tolerably extensive, I have never found any formula so efficacious as the following.

℞. Decoct. Aloes comp. f ℥iv. Infus. Sennse, f ℥iss. Ammoniae Sesquicarb. Ʒss. Tinct. Sennae, et Tinct. Rhei, co. aa. f Ʒij. Fiat Mistura, de qua sumr. Cochl. duo ampla quotidie mane.

The purgative force of the mixture may be readily varied according to circumstances by modifying the proportion of infusion of senna. If, from the appearance of the discharges, we discover an undue secretion of bile, a pill composed of the compound extract of Colo-cynth, with a grain or two of Calomel, may be given with advantage. We have afterwards to adopt such treatment as may prevent its recurrence. This indication is to be fulfilled by bringing the digestive organs into healthier action by a well-regulated regimen, and by such medicines as may give tone to the stomach, and increase that propulsatory action of the bowels, by which they are enabled to pass off the undigested portions of food; and here again, the compound decoction of Aloes, in combination with some bitter and aromatic ingredients, will be found a most valuable compound for the occasion; or the following formula, which is a modification of one proposed by Dr. Fothergil, may be adopted: -

℞. Aloe Spicat. ℥j.

Rhei Rad. et Calumbae Rad. aa. ℥ss.

Liquor Calcis, f ℥viij.

Spir. Armoracise comp. f ƷSS.

Infunde per horas xij. in vase clauso, et cola. Colaturae sumr Cochl. ij. ampliora, bis de die.

356. The exhibition of alkalies and absorbent earths, although it may remove the existing evil, will not avert the cause from which it arises. Carbonate of Ammonia is, perhaps, the most efficacious of the antacids, since it neutralises a portion of the acid matter which appears to exist in a gaseous state in the stomach, and which on that account eludes the action of the fixed alkalies. It is, moreover, calculated to relieve the gastric debility which so frequently follows an attack of this nature. Diarrhoea, as might be predicated, is not an unusual attendant, in consequence of the irritation which the mucous membrane receives from the contact of the acrid matter; small doses of Magnesia, combined with a few drops of Laudanum, and made into a draught with mucilage will generally be found to pacify the bowels, and relieve the complaint.

357. We are, however, to look for permanent relief to a change in the food; all the vegetables should be withdrawn, and a diet of animal food substituted: but if such a change should excite the disgust of the patient, we must relax in our commands, for the stomach will never digest that against which the inclination rebels. The substances which are found, by experience, more particularly liable to create this disorder, are all fried articles, butter and greasy viands, pastry and crude vegetables; in short, whatever is indigestible may act as its exciting cause. Astringent wines, as port, are very apt to favour its occurrence. I have before observed, that the stomach is frequently sensible to very minute portions of astringent matter (258). Dr. Philip says, that he has known more than one instance in which the stomach was even sensible to the difference between coloured and colourless brandy. Broths of every description, but especially those made of the meat of young animals, are a fruitful source of heartburn.

Veal contains a saccharine principle which is very susceptible of acetification.

358. It has been stated that in certain morbid conditions, the contents of the stomach exhibit an opposite character, and that in the place of acid, an alkali may predominate. Dr. Thomson, in a highly interesting paper1 on "The Chemistry of the Digestive Organs," has announced the important fact of having actually detected such a condition in several cases of Pyrosis, and that the attack was cured by diluted sulphuric acid. It has unfortunately occurred to me to have met with many cases of this disease, which baffled all my efforts. In most of them I can assert that the gastric liquid was generally neutral, occasionally acid, but as far as I know, never alkaline; I do not, however, intend by these observations to throw the slightest discredit upon the experiments of Dr. Thomson; on the contrary, I place implicit reliance upon his results, and the relief which I have witnessed from acids, in certain forms of gastric disease tends to confirm the opinion. If, however, I can adduce one case of Pyrosis, in which the liquid is proved to be neutral, it must be admitted that alka-linie, like acidity, is only contingent, and not essential to the disease.

The profession is much indebted to Dr. Thomson for his researches upon the subject; they will have the effect of more immediately directing the attention of the practitioner to the state of any liquid that may be ejected from the stomach, and of thus leading to a more scientific and successful plan of practice.

1 This paper was read before the Medical Section of the British Association, 26th August, 1836, and subsequently published in the British Annals of Medicine, March 1837.