307. From considering a fit of indigestion in the stomach or duodenum, let us now proceed to trace its consequences, when it is frequently repeated or protracted. In this case, other organs become successively involved in the mischief, and a train of distressing and complicated symptoms arises. Dr. Wilson Philip has considered indigestion as divisible into three distinct stages. Under the first, he arranges those symptoms which merely announce a disturbed and unhealthy condition of the digestive functions. The second stage he considers as denoted by the tenderness of the epigastrium, and the hardness of the pulse. The third stage includes those diseases which he supposes to arise from the change of structure, which is ultimately produced by long-continued functional derangement. I have no great objection to a conventional division of this kind, if it can in any way assist the memory of the practitioner, and contribute to the perspicuity of the description, by presenting the symptoms in well-defined groups, rather than in a separate and unconnected form. But the arrangement is wholly artificial.

Nature does not acknowledge it, nor will she submit to it; if, then, any advantage is to be derived from it, it must be received and considered only as an attempt to class together those symptoms which may arise from functional aberration, and those which are more usually associated with organic change. We must renounce all rigid adherence to definite stages and arbitrary divisions, which nature disclaims. Every practitioner of any experience must well know that the hard pulse and tenderness of the epigastrium are likely to occur in even a temporary attack of indigestion; and I have frequently witnessed extensive mischief, with change of structure, without the occurrence of such indications, with regard to the "third stage," I would observe, that if the diseases therein stated as the results of indigestion, be purely such, we may as well, at once, refer all organic disease to the same source, and, like the ancient physicians of Egypt, confine our prescriptions to vomits, purgatives, and abstinence.

308. In the former editions of this work I animadverted upon a form of pulmonary disease, to which Dr. Wilson Philip gave the name of "Dyspeptic Phthisis;" I declared myself sceptical as to the existence of any malady which could be strictly entitled to such a specific appellation. I never doubted the tendency of dyspeptic disturbance to call into activity previously-existing tubercles, nor have I ever ceased to rely upon measures which are calculated to invigorate the functions of digestion, as those most likely to retard the develope-ment of tubercular disease. I know, from ample experience, that persons may pass through a long series of years with extensive pulmonary disorganization, provided the diet and habits be judiciously managed, - the circulation kept in check, and, above all, the expenditure of muscular power cautiously economised. On the contrary, the fatal termination may be equally accelerated by creating a permanent disturbance in the digestive functions, and by repeated fatigue.

The system of exposing such patient to that combination of evils which are inseparable from a constant change of place, or long-continued journeys, has too frequently cut short the thread of life.

309. If Dr. Philip designates a latent disease, thus kindled into activity, Dyspeptic Phthisis, we are no longer at issue. Mr. Travers, in one of the most philosophical works that has appeared in our times1, has demonstrated, by argument and examples, that "most individuals carry within themselves the seeds of disease and death. Upon examination of the bodies of persons dying from disease or accident, after the middle of life, it is rare not to meet with some palpable evidence of organic change not previously known, or at best only vaguely surmised to exist." Diseases sometimes lie hid, as if they had, by slow introduction and encroachment, inured the system to bear with them; "but," continues Mr. Travers, "it is unnecessary to urge this argument farther than to show that minute organic changes, scarcely discernible in detail, because not actually inducing illness, compose in the aggregate an amount of mischief whicb clogs the machine when called upon by any extraordinary emergency." Mr. Rose has stated that, during the Peninsular war, he met with several instances of abscesses in the lungs occurring after amputations and wounds of the extremities.

1 "A further enquiry concerning Constitutional Irritation, and the Pathology of the Nervous System".

310. But to return from this digression to the subject more immediately before us, viz. the complicated train of symptoms which successively present themselves in cases of protracted dyspepsia.

311. It has been seen that indigestion may originate in the stomach, or intestines, either from vitiated secretion, muscular imbecility, nervous derangement, or biliary and pancreatic disturbance; but, from whatever cause the disease may primarily originate, after it has remained for some time in operation, the different organs, directly or sympathetically connected with the chylopoietic apparatus, will participate in the mischief, and it will not be easy to distinguish between primary symptoms, and those of mere induction. There is, perhaps, not any disease which is more proteiform in its aspects than dyspepsia: we shall rarely find any two cases precisely similar in the origin and progress of their symptoms, although, to an experienced judge, they will present such a general similitude, as to leave no doubt of their nature and causes.

312. The dyspeptic patient having, for some time, suffered from those feelings of uneasiness which have been already described, experiences some diminution in his strength. This, at first, is only occasional, and is for awhile attributed by him to some accidental circumstance; he had felt it before, and the readiness with which his elasticity and strength returned, naturally inspires a hope that his present depression may be removed; but it has endured longer than usual, and he ultimately becomes alarmed. It is in this stage of the malady, that the patient frequently introduces himself, for the first time, to a physician. It is of great importance, upon such an occasion, to distinguish between that feeling of transient depression, which, as Tissot observes, is invariably associated with alimentary disturbance, and that debility which announces a general diminution of constitutional energy. In the former case, there are periods in which the patient feels perfectly well and strong; but in the latter, although his spirits may vary, he never rises to the healthy standard of vigour.