278. The symptoms which arise from the food undergoing its appointed changes in the stomach with difficulty, or in an imperfect manner, are generally those which first indicate the approach of indigestion, and frequently recur at intervals, for a considerable period, without occasioning any constitutional disturbance, or even a degree of local distress sufficient to awaken the alarm of the patient. In some cases indeed they are only produced by the use of particular aliments, or under the operation of peculiar circumstances; but in others, they follow the ingestion of every species of food, although their violence is usually influenced by the quality and quantity of the meal. In this latter case, a morbid state of the stomach exists, which ought to be remedied without delay. In investigating the circumstances of an indigestion produced only by some particular aliment, we shall soon discover whether it is to be attributed to a peculiar idiosyncrasy of the stomach, which cannot be said to amount to disease, or to a debilitated condition of that organ, which renders it unable to digest any food that requires considerable powers for its chymification.

The mucous membrane of the stomach in certain persons appears to be irritated by particular aliments, as the skin is known to be by particular coverings: I am acquainted with a person who can never wear cotton stockings without suffering from considerable cutaneous irritation; and I also know a gentleman who is incapable of eating the smallest quantity of mackerel without experiencing uneasiness in the stomach, and yet he digests every other species of food with facility: this is not disease, but idiosyncrasy, and it is very essential to distinguish them from each other. If, on the other hand, a person informs me that, as long as he lives upon mutton or beef, his digestion goes on well, but that if he eats pork, veal, or fried meat, he suffers from heartburn, and other unpleasant feelings in his stomach, I deduce a different conclusion, and infer that his general powers of digestion are feeble, and easily depressed; and that he is consequently unable to convert into healthy chyme those aliments which acquire a higher degree of exertion.

279. There is no fact better understood, than that the living principle of our organs possesses the power of preventing the chemical changes to which their contents would, under other circumstances, be exposed. The blood does not coagulate or putrefy in the vessels; the urine does not undergo decomposition in the healthy bladder; nor does the food ferment in the stomach, unless that organ be in a state of disease; but if its vital powers fail, the chemical affinities gain the ascendency, and after a certain interval, various symptoms arise, which clearly evince the change which has been produced. This is the philosophy of an ordinary attack of indigestion, when, either from the quantity or quality of the food, the stomach is inadequate to perform its necessary duties. An uneasiness and sensation of weight and distention is experienced in the region of the stomach, acidity prevails, and eructations of disengaged air distress the patient; a sensation of nausea is felt, arising from an effort of the stomach to eject that which it is unable to digest. Chilliness is perceived, and a general lassitude arises from the sympathy which is produced on the nervous and sanguiferous systems.

These effects are felt particularly towards the end of chymification, and, after a certain period, pass off, and the remaining parts of the process are conducted with regularity. But this is a statement of the symptoms which attend a casual fit of dyspepsia, as it may occur to persons in health, from the influence of various circumstances, such as an overloaded stomach, indigestible food, a too hearty meal after long fasting or fatigue, obstructed bowels, or any other cause which may occasion a temporary debility of the stomach. It is only necessary, in such a case, to avoid in future the exciting causes, and to clear the bowels of any superfluous and crude matter which may be supposed to lodge in them. But lightly as we may, in general, treat a casual indigestion of this kind, cases are on record which should awaken us to a sense of its possible mischief, especially if the subject of it be a person advanced in life. If a patient retires to rest before the stomach is relieved from its load, he may pass into a comatose state, accompanied with apoplectic stertor, from which it is not unfrequently difficult to rouse him; and which arises from the sympathy of the brain with the oppressed stomach.

It is of great importance to distinguish such an affection from genuine apoplexy, since, if the stomach be not relieved, the stupor increases, and the patient is lost. We should carefully examine the epigastrium, in order to ascertain whether any considerable fulness can be felt in that region, and inquire into the history of the patient: if he can be awakened, no time should be lost in administering an emetic, and it will be a safe practice to abstract a quantity of blood from the arm, which will have the additional advantage of accelerating the operation of any medicine that may have been administered for his relief.

280. I have lately met with two cases which are well calculated to illustrate this subject. The one was that of a gentleman painfully engaged in mercantile speculations of great extent and considerable hazard. His custom had been to proceed to the house of business early in the morning, and to remain until seven in the evening, when he returned to the west end of the town and dined. At ten he retired to bed, and at one or two in the morning, he frequently awoke with palpitation of the heart, and a dyspnoea, which on more than one occasion was so violent as even to have threatened his life. The treatment indicated by the circumstances of this case was as obvious as it was successful. Here was a person exhausted throughout a long day by mental anxiety and fatigue, who imposed upon his digestive organs a labour which they were incapable of performing, and who consequently retired to bed with a load of undigested matter in his stomach. The paroxysm was invariably relieved by a warm and active purgative; and its recurrence was ultimately prevented by a revolution in his habits - the dinner hour was changed, and the principal meal being thus taken before the waning of the vital powers, its digestion was accomplished before night.