1 During a late commercial excitement, so extremely prevalent did dyspepsia become, that it was distinguished by the appellation of the "City Disease".

286. As the skin acts upon the stomach, so does the stomach, in its turn, re-act upon the skin; for all sympathies are reciprocal. A physician who is conversant with affections of the stomach, well knows how to appreciate the indications which the appearance of the countenance affords; there is a peculiar pallor and relaxed condition of the skin, which is truly indicative of a deranged state of the digestive organs, and which gradually disappears under a successful treatment. The want of appetite for breakfast, which is complained of by invalids, is frequently to be attributed, amongst other causes, to the atony produced on the surface of the body, and consequently on the stomach, through sympathy, by the relaxing influence of a warm bed; and hence arises the utility of restoring a re-action, by fresh air and exercise, before we attempt to sit down to our morning repast. The warm-bath, if not at too high a temperature, or indulged in for such a length of time as to induce indirect debility, will be found, by its stimulant operation on the skin, to place the stomach in a condition to digest the dinner when employed a few hours before that meal.

I shall have to refer to these facts when I come to consider the modes of curing indigestion.

1 I extract the following passage from a letter which I received from Dr. John Badeley: - "A gentleman, who consulted my father, complained that on getting out of bed in the morning, and putting on his leather breeches, he constantly vomited, from the sensation of cold thus occasioned. My father recommended him to drink a glassful of cold water before he commenced dressing. The gentleman followed this advice, and found that the vomiting was entirely prevented by it".

287. The influence of a healthy condition of the digestive organs upon the skin, is so well understood by those that direct the art of training, that the clearness of the complexion is considered the best criterion of a man being in good condition, to which is added the appearance of the under-lip, "which is plump and rosy in proportion to the health of the constitution".

288. The stomach also sympathises, in a remarkable degree, with the urinary organs; nephritic complaints are invariably attended with nausea. I lately had a very troublesome case of dyspepsia under my care, which was aggravated, if not originally produced, by a stricture in the urethra, which kept up a constant irritation.

289. I have next to consider the causes which may operate in depressing or paralysing the muscular powers of the stomach, by which the mechanical process, essential to chymification, is imperfectly performed. Of these, undue distention is perhaps the most common, and, at the same time, the most powerful. This may be proved, not only from ample observation on the stomach, but by the analogy of other cavities; if the bladder be distended for some time with urine, its muscular powers are paralysed; it has often happened that where a person has, from necessity, retained his urine for a considerable time, on attempting to void it, he has found himself incapable of expelling a single drop, although the bladder has been ready to burst from over-distention. The same fact occurs with respect to the rectum: if this observation be applied to the stomach, we shall easily perceive why, in an over-distended state of that viscus, vomiting can scarcely be produced by the most violent emetic; and we shall readily understand, from the same train of argument, how greatly the muscular fibres may become permanently debilitated by the repetition of such an excess.

This over-distention is particularly apt to occur in cases where the food has a tendency to swell, from the heat and moisture of the stomach; for a person may not be aware of the quantity he has taken from any sensation of fulness at the time he ceases to eat, and yet, in the space of an hour, he may experience the greatest uneasiness from such a cause. This generally happens where much new bread has been taken; nuts have also this property in a remarkable degree, and ought, for that reason, to be prohibited, where such an effect is to be apprehended. A draught of soda water, or any beverage which contains fixed air, may be visited with the same penalty. There are certain postures of the body, which, by preventing the necessary egress of the contents of the stomach, favour an accumulation in its cavity; this occurs in the occupation of the shoemaker, tailor, engraver, from stooping on the last, or desk, by which their thoracic and abdominal viscera are compressed together for many hours: the margin of the ribs is pressed upwards, so as force the stomach against the diaphragm, and to mpede the passage through the pylorus: it is evident that, if such a habit be continued after a full meal, all the train of dyspeptic terrors must be produced; and we have witnessed too many practical illustrations of the fact, to require further evidence of its truth.

The profession is indebted to Dr. W. Philip, for having proved by experiments, related in his Inquiry into the Laws of the Vital Functions, that the muscular fibre, though independent of the nervous system, may, in every instance, be influenced through it; from which it follows, as a corollary, that the muscular fibres of the stomach may not only be affected by causes acting directly on them, but by such as act through the medium of the nerves. Hence, the presence of offensive matter in the stomach, whether arising from noxious aliment, or vitiated secretion, will have the effect of diminishing its muscular energy. It is in this way that a draught of cold water, or a quantity of ice, may at once paralyze the stomach. In cases, therefore, of protracted indigestion, it is evident that both the chemical and mechanical functions of the stomach Mill be injured; neither the one nor the other can long remain alone affected. Irritation of the nerves will occasion vitiated secretion, and vitiated secretion will become a source of irritation to the nerves.

290. Amongst the symptoms which attend a fit of indigestion, we must not pass unnoticed the troublesome spasmodic affection of the diaphragm, well known by the name of Hiccup, a term, no doubt, suggested by the peculiar dissyllabic sound which characterizes it. By some it has been considered as a disorder of the stomach exclusively, but it is evident from the sound which accompanies the spasm, that it is immediately connected with an affection of some of the organs of respiration, and this is, obviously, the diaphragm. It is, however, true that the spasmodic contraction of this muscle is generally excited by some irritation within the stomach, and especially about the upper orifice, or cardia; thus a large quantity of dry food, taken without any liquid, will often occasion hiccup. Certain acrid substances, either taken into the stomach, or generated during its diseased action, will have a similar tendency, for which reason heartburn is frequently attended with hiccup. On the other hand, it may sometimes arise from inanition, in which case we must suppose that the stomach suffers irritation from its own fluids.

Such are the causes of the common hiccup, which may be regarded as a natural concussion for the removal of any irritating substance from the lower part of the oesophagus, or from the upper orifice of the stomach, to a less sensible part of that organ. In this point of view it is to be regarded as a trifling affection, scarcely requiring any medical assistance, since it will usually cease spontaneously, or may be readily removed by a little warm liquid. The operation of any sudden emotion in at once removing it, is well known; and may be explained upon the general principle, that spasmodic action of muscular parts is frequently stopped by drawing the patient's attention strongly to any particular object. Hiccup, when a symptom of any other disease, is frequently indicative of danger, or the approach even of death, but this form of the complaint is obviously foreign to our present subject. It may, however, be useful to state, that it is common in almost every disorder of the digestive functions: it is, for example, one of the symptoms of a scirrhous state of the liver, and is sometimes found in simple jaundice, in which the biliary ducts are obstructed, although the liver is sound.

291. We have seen the manner in which indigestion may take place in the stomach; but there are cases in which the secretions of that organ are perfectly performed, and in which the muscular contractions of the stomach are carried on with healthy vigour and regularity. The chyme is, therefore, duly elaborated, and the paroxysm of dyspepsia may not commence until the food has entered the duodenum.