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discretion and firmness in the practitioner to ensure that persistence in their use which alone can render them of avail.
Though not seeing cause for the apprehension as to alkaline medicines which some have entertained, I believe that they are often employed in needless, perhaps injurious, quantity, and indiscreetly as to the time of taking them. As they cannot fitly be termed a remedy for dyspepsia, but a relief merely to one symptom of the disorder, there is reason for closely conjoining their use with that part of digestion which it is the object to alter. Taken together with the food requiring this correction, the effect is generally more beneficial than when used after acid has been actually formed. It is a manner of prevention better according with the whole function of digestion, and avoiding that sudden extrication of fixed air, which, if the alkaline carbonates are employed, is sometimes injurious to it.*
Celsus mentions the "clara lectio" among remedies for dyspeptic complaints; and this merits more attention than it receives. As the condition of the abdominal viscera affects the organs of respiration and the voice, so reciprocally does the free exercise of the lungs and diaphragm influence bene
The suspicion that the alkalies, taken medicinally, may produce a morbid state of the blood, and thereby disease in different organs, though it cannot be affirmed impossible, under excess of use, yet is not warranted by any ordinary experience on the subject. The effects of sudden injection of carbonate of soda into the circulation cannot be received as sufficient evidence. At the same time, the singular importance of this great relation of acid and alkali in every part of the chemistry of animal life, and the unquestionable agencies of alkalies on certain secretions, presumably through the blood, fully prove that the habitual use of this remedy is not negative in effect; and we have probably yet to learn some of its effects, only partially shown when taken to neutralise acid in the alimentary canal. The Liquor Potassæ, sufficiently diluted (a point of some consequence to its successful employment), is perhaps the most beneficial form when a constitutional effect is desired.
ficially the organs of digestion; and this effect may even perhaps be stated as one of the causes which make it more salutary to act with others than alone. The effect is doubtless in part one of mechanical kind. But, since in dyspepsia the arterialisation of the blood by the lungs is generally deficient,
may readily be conceived that certain sustained and equable efforts of the voice are further beneficial in exercising the respiration, and thereby remedying the default.
The influence of free air and sufficient respiration is, in fact, a point of singular importance in the treatment of this disorder, even independently of those exercises of the body which are usually and fitly recommended to dyspeptic patients. Good air is essential to perfect digestion: close and crowded rooms evidently disturb and impair it. The experience of every one may afford proof of this; yet is it certainly not enough regarded in common practice.* The dyspeptic, distempered in his feelings, languid in muscular power, and with feeble circulation, willingly indulges his indolence by making drugs the sole remedy for his ills; and this preference is too much sanctioned by the ordinary course of medical treatment in such cases.
The habits thus generated are the reverse of those which lead to cure. Neglecting or avoiding fresh air, the patient forfeits the safest and most effectual of all remedies; one which goes furthest towards the root of his disorder. For, in dyspepsia, no symptom is better marked than the languid circulation of the blood through the extreme vessels. This is especially obvious in the state of the skin and extremities.
* A familiar illustration may be drawn from the singular difference of effect in travelling on the outside or inside of a carriage, immediately after a meal. Though the food be alike in both cases, digestion in the first goes on easily and healthily; in the second, often with much disturbance and difficulty, increased in proportion as the air is more confined.
of the body; and, looked to as a habit, forms one of the most essential characters of the disorder. If we might suppose, what is probable from the corresponding feebleness of the heart's action, that the same condition of faulty circulation extends to the capillaries of internal surfaces and secreting organs, we obtain a general expression of altered state and balance of blood throughout the system, which might well admit of being received as a proximate cause, and as rendering explanation of many of the multiform symptoms of the complaint. The absence or diminished quantity of blood in the capillary system, through which all the more important functions are performed, and its stagnation in the great vessels, and particularly within the venous system throughout the body, illustrate in especial manner some of the more singular anomalies in the disorder.
Here the better arterialisation of the blood is a main remedy; and without which none other can be of thorough avail. Open air and free respiration are to be sought for; under some condition of bodily exertion, if possible; but without it, if this be prevented. In another place I have mentioned the benefits to be obtained from the direct exercise of respiration; and these are scarcely less obvious and assured in dyspeptic complaints than in others which seem more expressly adapted to them. All that can give air free ingress to the lungs and to the blood, if not a primary remedy, is, at all events, so powerful an accessory to cure, that it behoves the physician to keep it ever before him in his treatment of the disorder.
These considerations involve in some part the theory of dyspepsia; a topic, however, which I refrain from here, as implying a more exact definition and history of the complaint than is intended in these general remarks. The or
dinary states, bearing this name, are produced chiefly by circumstances in diet and mode of life acting topically upon the organs of digestion. But that one remarkable form of it, connected with hypochondriasis, and often inducing atrophy, depends on a state of the nervous power, is likely, or perhaps even certain.* What this state actually is, whether of deficiency or depravation, or what part of the nervous system is chiefly concerned in it, our present knowledge does not enable us to affirm; the same difficulty, in truth, existing as to the causes of hypochondriasis itself. These are points involving many curious relations in pathology, and upon which we have much still to learn. †
An example illustrating the connexion between the states of dyspepsia and hypochondriasis, and not less remarkable in itself, is the effect of nursing in certain female habits, or of
In the writings of Dr. Whytt, so fertile throughout in sound and original views, will be found some excellent remarks on atrophy from morbid state of the nerves of the stomach and alimentary canal.
+ The frequent occurrence of hypochondriasis among the people of the Western Islands of Scotland, is a fact for which we have the authority of Dr. Macculloch. It is curiously corroborated by an observation I made in Iceland (confirmed to me by the information of the priests and other intelligent natives) of the great frequency of the same disorder in that island. There is reason to suppose that certain similar conditions of diet and manner of life are concerned in this effect. And the relation to scurvy is of some interest here; a disease in which there is similar depression of the nervous powers; and which depends chiefly, as far as we can see, on non-acescent or salted diet, confinement to one spot, &c.; circumstances to which the almost entire deficiency of vegetable food, the long winters, and possibly the singular contrast between the physical condition and intellectual culture of the Icelanders, peculiarly expose this remarkable people. Accordingly, scorbutic complaints are common and severe in Iceland; treated, when even these remedies can be had, by decoc. tions of trefoil, juniper, the sedum acre, and scurvy-grass. In a Thesis I printed in 1811, on the Diseases of Iceland, may be found some more detailed notices on this subject.
great excess of nursing in all. The experience of most practitioners will furnish them with instances where this cause has brought on extreme disorder of the nervous system; sometimes verging on maniacal state; more frequently shown in general debility and hypochondriacal depression; and in the latter case generally connected with obstinate dyspeptic symptoms. I have known cases where effects, manifestly having this origin, have continued in certain degree even for years. The more rapid mischief occurring in some constitutions is familiar to all.
Nor can we even assert the affection of the nerves to be itself a primary cause in these and other instances. It may be that the first condition is that of an altered state of blood, or in some cases a morbid matter, like that of gout, present in the circulation; and thence producing its effects, more or less directly, on other parts of the system. And there is some argument for the latter view in the undoubted connexion between dyspeptic disorders and the irregular forms of the gouty constitution; a connexion sufficiently close and familiar to observation to justify the belief of relation to some common cause; acting under different modifications from age, sex, and other temperament of body; as well as from variations, it may be, in the quality or proportion of the morbid matter itself. Though much here is still speculative, yet we know enough to see that future discovery lies before us in this direction.
Recurring to the feeble state of the capillary circulation in dyspepsia, whether this depend on altered state of the nervous power or not, equally is it important to obviate the evil of such tendency. For this object, exercises, friction, and bathing in different forms, together with change of air or scene, may rightly find place before most of the internal remedies which are usual in such cases. And our treatment of the dis