He tells you, that "he begins to feel his usual avocations irksome, and too laborious; that he has long suffered from a bad digestion," which by care and management he had been hitherto enabled to control; but that he has now little or no appetite, that his strength fails him, and that he fears he is "getting into a bad way." He finds that the slightest exercise occasions fatigue, and deluges him with perspiration. On examining the tongue, it will be usually found coated on the posterior part, and on its centre, with a brownish-yellow fur: his bowels are, by turns, costive, and too much relaxed; the pulse at this period is generally slow and small, although it is sometimes hard; his countenance is more palid than usual; the eyes appear sunken, and the eye-lids swollen, and the eye-balls are occasionally injected with yellow streaks.

313. In some cases, heartburn and a sense of oppression are experienced after meals; but in others, the patient only complains of languor and extreme listless-ness. On some occasions, a sense of constriction is felt about the fauces, and a difficulty of swallowing is experienced, as if the oesophagus presented some mechanical obstruction to the passage of food. Dizziness; unusual drowsiness; pains in the head; ringing in the ears; a disagreeable taste in the mouth; an altered state of the salivary secretion, being sometimes limpid like water, and at others thick and ropy; palpitation and a sense of faintness are symptoms which also, in a greater or less degree, usually distress the dyspeptic sufferer. His hands are alternately hot and cold; in the former state they are dry, in the latter more usually damp. His nights are sometimes, but not generally, disturbed by restlessness and uneasy dreams. He wakes in the morning without that feeling of refreshment which follows repose in health, and is unwilling to rise from his bed, or indeed to move; his limbs ache, the muscles of the trunk are even sore to the touch; and any change of position is attended with inconvenience.

Every alteration in the weather is felt as a serious evil; if it becomes a degree or two colder, he creeps to the fire, and inveighs, in terms of bitterness and sarcasm, against the variableness of the climate: if its temperature be raised he is oppressed with heat. His bowels become more and more untractable; the usual purgative ceases to produce its accustomed effect; he increases the dose, and when it does operate, the action is too powerful, and its effects are not easily checked; a diarrhoea is established, and this again, in its turn, is superseded by still more obstinate constipation. "If I could but obtain a medicine," cries the invalid to his physician, "that would keep my bowels in a regular state, I should soon become convalescent:" there lies the difficulty; the evil arises from the inconstant and unsettled state of the alimentary secretions, and it is not easy to graduate an artificial stimulant so that it shall always correspond with the varying state of the organs upon which it is to operate. The depression of his spirits increases as the disease advances: he gives his case up as lost; loses flesh, suffers a thousand distressing sensations, and fancies the existence of a thousand more.

Wandering pains are felt in the bowels and side; a tenderness in the epigastrium is experienced on pressure; the abdomen is often preternaturally tense; his breathing is occasionally oppressed; a short dry cough distresses him, and expectoration is extremely difficult. If, under such circumstances, the alvine discharges be inspected, they may present every variety of morbid appearance; they may be unnatural in colour, odour, consistence, figure, or quantity. I shall, hereafter, have occasion to speak more fully upon this subject, as well as upon the morbid appearances which the urine presents under such circumstances.

314. The patient, in this state of his disorder, will sometimes complain of being disturbed, on first falling asleep, by fearful startings, and catching of the limbs, uneasiness in the region of the chest, attended with difficulty of breathing, so as to resemble angina pectoris; and it is not unusual for him on such occasions to perceive flashes of fire, like lightning, with a numbness in his hands; this numbness is sometimes only felt in one or two fingers. Sore throat, occasioned by relaxation, is also a very usual symptom; the skin is frequently dry, and even scaly; the tongue also becomes drier, and sometimes clean, and of a brighter colour than usual. Harassed by such feelings, the unhappy invalid anxiously proposes a trial of change of air, and his friends acquiesce in the belief that such a plan will tend to his recovery. He quits his residence, but to no purpose; his emaciation increases: his ancles swell: and the general debility thus produced sooner or later calls some other disease into activity, the nature and locality of which will necessarily vary in different cases.

If the spring of a piece of machinery snaps, and all its different parts are hurried into violent motion, the wheel upon which the greatest strain is made, or that which is of the weakest construction, will be the first to give way. Just so is it with the human body. Those organs more immediately connected with the digestive function will more readily undergo a change of structure, on account of the protracted irritation they must have sustained. Then, in succession, those which are connected by the ties of sympathy; while the general loss of balance, thus occasioned, will render any organ, originally weak, very liable to disease. This view of the subject is supported by experience; the history of those complaints which terminate the life of the dyspeptic patient will sufficiently explain the manner in which they were produced. Unless they take their origin in a viscus immediately connected with the digestive functions, as in the stomach, intestines, mesenteric glands, liver, etc. dyspepsia can only be considered in the light of a general debilitating cause; and it is a circumstance no less extraordinary than important, that when any new disease is permanently established, the original symptoms are mitigated, and sometimes wholly suspended; whereas, if the new affection be only symptomatic, instead of relieving, it often aggravates them. 315. Dr. Philip lays great stress upon the hardness of the pulse, as indicative of approaching mischief; I confess that my experience does not confirm the importance he has ascribed to it.