The permanent tenderness of the epigastrium, if accompanied by a clean bright tongue, excites a greater apprehension in my mind. The pulse is very treacherous in its indications: I have found it to be soft and undulating in cases where no doubt could exist as to the presence of organic mischief. It is just, however, to state, that Dr. Philip acknowledges that its hardness is sometimes only perceptible when examined in a particular way He says that those who have been much in the habit of examining the different states of the pulse, must be aware, that its hardness is most perceptible when a slight degree of pressure is employed. A certain degree, by greatly compressing the vessel, will give some feeling of softness to the hardest pulse, and a slight degree of hardness is not perceptible with the pressure generally employed in feeling- the pulse. If the pressure be gradually lessened till it comes to nothing, it often happens that a hardness of pulse is felt before the pulse wholly vanishes under the finger, when no hardness can be perceived in the usual way of feeling.

316. After indigestion has continued to harass the stomach for some time, its villous coat may certainly become affected: and as the pylorus, from the peculiar nature of its office, is more exposed to the continued source of irritation than other parts of the stomach, it is perhaps liable to become inflamed, and the tenderness in the epigastrium may possibly in some cases be thus explained; but it should be remembered that, in internal diseases, the pain is frequently referred to a part at some distance from the real source of it; a morbid distension of the liver, an irritated state of the duodenum, and a gorged condition of the colon, are not uncommonly attended with the same feeling. It is, at the same time, difficult to imagine, how serious mischief can be inflicted upon the pylorus without the occurrence of vomiting.

317. When the bowels have been long in a state of disorder, the villous coat becomes tumid, turgid with blood, and sometimes ulcerated; and Mr. Abernethy states that these appearances have been most manifest in the large intestines. He says that he has repeatedlv observed, in dissections of these cases, the large intestines to be more diseased than the smaller ones, and he accounts for this fact in the following manner. If digestion is incomplete, the indigested food must be liable to chemical changes, and the products resulting from this cause are likely to be most stimulating to the large intestines. Indeed, he adds, in advanced stages of this disorder, mucus and jelly tinged with blood are discharged, and it seems probable that a kind of chronic dysentery may be thus induced. In my own practice, I have witnessed several cases of this kind; but I confess that I cannot perceive why the duodenum and smaller intestines should not be equally exposed to such a source of irritation, unless we suppose that Nature has kindly thrown a protection around that part of the canal which is most active in the process of digestion.

318. It is not extraordinary that protracted dyspepsia should sometimes terminate in a disease of the mesenteric glands; it is only surprising that such a state of irritation and imperfect developement of chyle should continue for so long a period, as they are in many cases known to do, without occasioning such an effect. We must suppose that the selecting tact with which the lacteals are endowed, enables them for a considerable time to reject imperfectly-formed or vitiated chyle, and that it is not until this is destroyed, that the irritating matter finds its way to the glands. The circulating fluids of the body are for the same reason not materially deteriorated until the dyspeptic disease has continued for some time; the blood then undergoes some important change, but animal chemistry is not yet sufficiently advanced to demonstrate its nature. I have examined the blood of a patient who had long laboured under a disease of the digestive organs, and the most remarkable character which it presented was the loose texture of its crassamentum, and a deficiency in its red globules.

In some cases the serum assumes an opaline appearance.

319. When we consider the connexion which subsists between the function of the kidneys and that of the chylopoietic organs, we shall easily explain the disturbed appearance of the urine, and the occurrence of calculous disorders in cases of dyspepsia.

320. In relating the diseases immediately consequent upon a deranged state of the digestive organs, it may appear somewhat strange to introduce the consideration of a condition of the body, generally arising from a vigorous action of these organs, but which, nevertheless, must be considered, when it passes beyond certain bounds, as a serious evil; I allude to the excessive formation of Fat. The subject has been very ably considered by Mr. Wadd (Cursory Remarks on Corpulence), and his work, which, during its progress through three editions, has fattened from a meagre pamphlet into a portly octavo, may be said to comprehend nearly all the knowledge we possess upon the subject. It is written in a humorous style, and if there be any truth in the popular adage, "Laugh and grow fat," I will, without hesitation, assert, that the perusal of the work is ill calculated to benefit the class of patients for which it was written. He enumerates the several remedies which have, at different times, been proposed to check the excessive formation of fat; but he appears to have overlooked the most important, and, in my judgment, the only medicinal agent which is likely to answer the object of its exhibition, viz., small doses of the sulphate of magnesia, so as to increase the peristaltic motion of the alimentary canal, at that period of the digestive process, when the chyle is about to enter the lacteal system.

321. Before I proceed to consider the medical treatment and dietetic regulations most appropriate for the cure of the several forms of indigestion, it will be necessary to inquire into the remote and immediate causes of that disease. In fulfilling this part of my duty, I shall deviate from the usual plan of such investigations, and arrange my observations in an order that may, in some degree, correspond with that which should be adopted by every physician who undertakes to examine a patient with a view to detect the cause, nature, and seat of his disease. I shall first present the reader with a tabular arrangement of the objects of such an inquiry, and then comment upon the relative importance of each.