A treatise on indigestion and its consequences, called nervous and bilious complaints

Front matter

^ J

A TREATISE

ON

CHAPTER I. Op the symptoms of Indigestion

Of the symptoms of the first stage of Indigestion Of the symptoms of the second stage of Indigestion * Some observations on the third stage of Indigestion Of the various forms and comparative duration of the different stages of Indigestion -

CHAPTER III. Of the treatment of Indigestion

Page.

vii ix si.

VI CONTENTS.

Section i.

Page.

Of the treatment of the first stage of Indigestion - 70 Of the diet in Indigestion ----- 71 Of exercise in Indigestion ----- 88 Of the medicinal treatment in the first stage of Indigestion 96

Of the preparative means - - - - ib.

Of the treatment when the disease is confined to the

stomach and bowels ----- 99 Of the treatment when the disease has spread farther

than the stomach and bowels - 109

Section ii.

Of the treatment of the second stage of Indigestion 116 Of certain trains of symptoms, whose treatment does

not fall under the general plan of cure - - 137 Of the concurrence of the second stage of Indigestion

Recapitulation - - - - - - 157

CHAPTER IV. Of the third stage of Indigestion - - - 159

Section i.'

Of dyspeptic phthisis - - - - - 162

Of the symptoms of dyspeptic phthisis - - ib.

Of the causes of dyspeptic phthisis - - - 167

Of the appearances on dissection in dyspeptic phthisis 168

Of the nature of dyspeptic phthisis - 169

Of the treatment of dyspeptic phthisis - - - 174

Section ii.

Of habitual asthma 183

Of the employment of galvanism in habitual asthma ib.

Preface

TO THE

FIRST EDITION

My chief objects in the following Treatise have been to give arrangement to the various affections which have been termed nervous and bilious; to ascertain the nature of the disease on which they depend; to trace the causes which determine them to assume the various forms in which they are presented to us, and to determine the appropriate treatment of each of these forms.

In enumerating the symptoms, I have been led to enter more fully than, I believe, has hitherto been done, into the manner in which the sympathy of parts influences the phenomena and treatment of diseases, and thus to endeavour to ascertain some of the laws by which it is regulated.

An attempt has been made to distinguish the symptoms which are the more immediate effects of the remote causes, from those which arise from the continuance of the disease itself, and to show. that on a correct knowledge and consequent discrimination of these two classes of symptoms, the successful treatment, in a great degree depends.

My attention has been particularly directed to the latter, by which the changes which take place in the progress of the disease are indicated. I have endeavoured to ascertain the nature of these changes, and the manner in which they influence the various functions, .and at length, in many instances, destroy the organization of some vital part.

Vlll PREFACE.

The adaptation of the means of cure to the changing nature of the disease, has been constantly kept in view; for similar trains of symptoms, at its different periods, we shall find, require different, and sometimes even opposite, means of cure.

I have attempted to point out the influence of regimen, and to determine the rules by which the employment of mercury, which, we have reason to believe, has become too indiscriminate in this disease, should be regulated, and the limits at which its beneficial, no longer counterbalance its injurious, effects.

In the composition of the following Treatise, recourse has not been had to the works of others. It can not, therefore, be regarded as an attempt to present to the reader the sum of our know T - ledge on the subject. I offer it simply as the result of my observations, and the reflections suggested by them, during a space of twenty-five vears.

PREFACE

TO THE

SECOND EDITION.

In revising the following Treatise, the author's only object has been to render it more useful to the practitioner.

As hardly half a year has elapsed since its publication, any considerable enlargement of it is not to be expected; but he hopes that the present edition will be found in several respects improved. Many observations have been added, and an attempt has been made, in several passages, to explain more fully the principles which led to the treatment recommended in it, the author's confidence in which, he is happy to say, has been strengthened since the appearance of the first edition, by communications from several physicians, to some of whom he has not the honour of being personally known.

For the sake of hasty readers, who seldom see arrangement in a work where the subject is at all complicated, without numerous divisions and references, the author has introduced a greater number of these, which, to the diligent who bear in mind the plan laid down and feel no difficulty in perceiving how the different parts of the subject arrange themselves under it, are often superfluous, and therefore unwelcome interruptions.

A TREATISE

INDIGESTION, &o.

It is a remarkable fact, that there is hardly any disease less understood than that which is most frequently presented to us, and known under the vague denominations of bilious, nervous, and stomach complaints; which seems the more extraordinary, because there is none of greater importance, whether we regard its variety, its consequences, or its connexion with other diseases.

This arises, I believe, from two circumstances. The first relates to the nature of the disease itself. In its early stages, in which other fatal diseases sometimes give us an opportunity of examining the organs chiefly affected, the cause of derangement is in parts too minute for observation; and before its fatal termination, it is so changed, that the inspection of those who fall a sacrifice to it, throws little light on its origin. Who, for example^ can learn from the appearances in the body of a drunkard, what particular state of the parts concerned caused the dyspeptic symptoms, which preceded the indurated liver, and distended abdomen? The second circumstance to which I allude, relates to the causes of the disease. We know that the digestive power of the stomach, depends on a fluid secreted in it, and consequently, that a deranged state of this fluid must be the cause of the symptoms of Indigestion; but we can make little practical use of this knowledge, unless we know the immediate causes of its derange-

12 ON INDIGESTION

ment, and the particular manner in which the derangement operates in producing the symptoms of the disease. These are the questions which chiefly interest ihe physician; and yet, as far as I know, no attempt has been made to answer them; and the practice in this disease remains uncertain and ill defined.

My attention has frequently been arrested by finding, that cases, in which the usual means, in many instances successful, had failed, and indeed often aggravated the symptoms, yielded readily to an opposite plan. Cases relieved by opposite plans of treatment, it is evident, can not be of the same nature, however similar their causes and symptoms. They are either different diseases, or different stages of a disease, whose nature undergoes some change in its progress.

I have arranged the various cases, of which I am about to treat, under the denomination of Indigestion, because the symptoms of this derangement form a more or less prominent feature in all, and all begin with these symptoms I prefer this term to dyspepsia, which has been employed by medical writers to express a disease much less varied, and of much less extent than that I am about to treat of. Indigestion, therefore, in the sense in which I shall use this term, is not synonymous with dyspepsia, but includes it.

The following Treatise may be divided into four parts: — In the first, 1 shall present to the reader, a review of the symptoms of Indigestion, and its more immediate consequences; in the second, consider the remote causes of this disease, the manner in which they excite it, and the nature of the changes which take place in its progress; in the third, detail the plans of treatment which have appeared to me most successful in it; and in the last, make some observations on the symptoms and treatment of the organic derangements, in which it often terminates.

By a disease we mean, not only that collection of symptoms which are present at any onetime, but also those which appear in succession, arising from the same source. We shall find Indigestion the most varied of all diseases. Beginning from simple and apparently unimportant deviations from health, it gradually

AND ITS CONSEQUENCES. 13

becomes so complicated, and often, at length, so undermines every power of the system, that it is difficult to give a view of its symptoms, which shall be at once sufficiently full and distinct. It is an affection of the central part of a most complicated structure, capable of influencing even its remotest parts, and each, through many channels, and in various ways.

CHAPTER L OF THE SYMPTOMS OF INDIGESTION.

I shall divide the symptoms of indigestion into three stages. While this division renders the account of them more distinct, it at the same time answers a more important purpose, for we shall find the disease in these stages varying in its nature, as well as in its symptoms.

Of the Symptoms of the First Stage.

The first symptoms of Indigestion are either such as immediately arise from the undigested food itself; or from the state of the stomach and bowels, which causes the disease, and the irritation of their nerves, occasioned by the undigested food, or their owr vitiated secretions.

The symptoms which immediately arise from the undigested food are flatulence, distention of the stomach and bowels, and acid, oily and putrescent eructations.

From the debility of the stomach and bowels, and irritation of the nerves, a greater variety of symptoms spring. Organs of such importance in the animal economy can not long be so deranged as to produce vitiated secretions, without at the same time, giving rise to other disturbance in the system. The debility of stomach, which prevents a due secretion of healthy gastric fluid, must at length, produce some of those other effects which we witness, when the powers of the stomach are disordered by any^offendins cause.

An emetic, while it remains on the stomach, destroys the appetite, occasions nausea, sometimes pain, and produces, in consequence of the sympathy which exists between the stomach and every other part of the system, a general state of debility, now and then almost approaching to syncope. The surface is pale, cold, and shrunk, and the action of the heart is impaired, the pulse becoming small and feeble. The limbs perhaps tremble, and are always unequal to their usual exertions, and the mind is anxious and subdued. These symptoms, however, disappear as soon as the act of vomiting relieves the stomach from the offending cause.

When we consider that the causes which disorder the powers of the stomach in Indigestion are of a more permanent nature, and that the contents which irritate its surface, although often removed, as in the case of the emetic, are soon reproduced, we shall find little difficulty in perceiving the general rationale of the symptoms of this disease. But, in order more particularly to ascertain the state of the stomach and bowels in its various stages, it will be necessary to take a closer view of its symptoms, and attempt a more minute investigation of their immediate causes.

The symptoms which arise immediately from undigested food, exist in various degrees in different cases. In the very commencement of the disease, they are often the only symptoms which occasion much uneasiness, from which it appears, that the functions of the stomach may, for a certain time, be so disordered as to pro* duce a feeble, or otherwise vitiated secretion, without in any other waj very sensibly affecting the functions of the system. People frequently complain of a sense of distention after eating, and flatulent and acid eructations, who notwithstanding, enjoy good general health; and find that even these symptoms may be prevented by taking less food, and that of a more digestible quality; and, if they are prudent in this respect, and the constitution is otherwise sound, and not exposed to the effects of indolence, and other causes weakening the nervous system, the stomach will often recover its powers without further means.

In the majority of cases, however, either from neglect on the part of the patient, or a greater degree of obstinacy in the cause, the above symptoms continue to recur. This never happens for any great length of time, without the other parts of the alimentary canal partaking of the disease. Their secretions also begin to suffer some deviation from the healthy state. Those of the intestines, for the most part, are impaired in quantity, and, at the same time, probably altered in quality. The bowels do not act so readily as usual, and they are occasionally distended and tense, especially some time after eating. The mouth is clammy, and the tongue more or less furred, particularly in the morning.

But these symptoms, the patient finds, yield to some mild aperient, which, at the same time, promotes the action of the stomach, and his feelings on the whole, differ but little from those of health. He is more apt to be thirsty, his appetite is generally more or less impaired and variable, he complains of his feet being cold, but still his strength, and general appearance, are but little affected, and he seldom thinks it necessary to pay particular attention to symptoms which appear so slight and for the time yield so readily.

By degrees, however, they recur more frequently, and begin to be attended with some depression of strength which at first is only occasional. This, in general, is the first thing which seriously calls his attention to the disease. The mind, if the disease proceed, partakes of these returns of languor, and the patient at length finds it difficult at all times to command his attention, and upon the whole, that he is not capable of his usual mental efforts. His sleep is disturbed by perplexing dreams, and sometimes by fits of nightmare. In a large proportion of cases, however, he enjoys good nights, and even those who are troubled with dreaming and restlessness, often feel more drowsy than usual.

He now becomes alarmed, and occasionally feels a degree of despondency. Instead of thinking too lightly of his complaint, he often regards it in the most serious point of view, and can not be persuaded that any thing less than some important derangement, can produce the anxiety and depression by which his attention gradually becomes wholly engrossed; for none but an attentive physician can know how slight a derangement of the alimen-

ON INDIGESTION.

tary canal, especially after the habit of disease is formed, is capable of essentially influencing every function of the system.

While the symptoms thus proceed, a change, sooner or later, takes place, which marks an important step in the progress of the malady. The alvine discharge begins to deviate from the healthy appearance: it sometimes contains uncombined bile, sometimes it chiefly consists of bile; its colour at other times is too light, more frequently too dark; and occasionally, at length, almost black; at different times it assumes various hues, sometimes inclining to green, sometimes to blue, and sometimes it is mixed with, and now and then almost wholly consists of, undigested bits of food. When there is much straining, it often contains mucus in distinct masses, and not unfrequently, substances resembling bits of membrane. It frequently separates from the canal with more difficulty than usual, and leaves a feeling of the bowels not having been completely emptied

We have reason to believe that the above change and variety of colour arise chiefly from the state of the bile, to which the alvine discharge owes its natural tinge, being quite white, when no bile flows into the bowels. It would appear that the properties of the bile are sometimes changed without change of colour; but this is comparatively so rare, that if the colour of the alvine discharge be natural, we may generally im% that the function of the liver is duly performed.

The disease has hitherto been what is called stomach complaints. It is now, from the various appearances of the vitiated bile, and the various symptoms which arise from the irritation it occasions in the alimentary canal, what is called bilious and nervous complaints. The former of the two last appellations has also arisen from the bile, of which there is sometimes a superabundant secretion, being, occasionally, in consequence of the inverted action of the duodenum, thrown into the stomach; and there exciting nausea, headache, and bilious vomiting.

Many conceive that the changes of colour in the alvine discharge are often to be ascribed more to circumstances in diet, and changes which the contents of the bowels undergo in their passage through this canal, than to the state of the bile; and, I have no doubt, these causes operate to a greater or less extent. The long delay of their contents in the bowels generally darkens the colour; a railk diet produces a discharge of a lighter colour than one consisting chiefly of animal food, and some vegetables and medicines communicate a certain tinge to the discharge. According to my experience, however, these causes, on the whole, produce less effect than might be < xp^cted, and, with a little attention on the part of the practitioner, will seldom mislead him. It must always be kept in view, that the appearance of the discharge often changes, when it has remained for some time out of the body.

The urine also deviates from the healthy state. In its most healthy state, it is perfectly transparent when passed, and remains so nfter it cools, its colour being more or less deep in proportion to the degree in which its contents are diluted. It is, however, liable to some deviations from this state under circumstances which can hardly be said to affect the general health.

It appears from some experiments which I made many years ago for the purpose of ascertaining the effects of various circumstances in diet, &c, on the state of the urine, an account of which the College of Physicians of London did me the honour to publish in the last volume of their Transactions, that when acid greatly prevails in the stomach and bowels, or the skin becomes more inactive than usual, so that it does not freely throw off the acid, which it appears from these experiments always passes by this organ, a red deposition, which consists of lithic acid, takes place from the urine after it has stood for some time, this fluid still remaining clear; and on the other hand, that, when the skin has been unusually excited, or an alkalescent state of the stomach and bowels prevails, it becomes turbid, and deposites a white sediment, which has been ascertained, by the experiments of Dr. Wollaston, to consist of the phosphates of the urine.

Both these states, particularly the former, are more apt to appear in Indigestion than in ordinary health; and the urine in this disease is sometimes covered with a very thin oily film, which appears to arise from an imperfect state of the assimilating process Sometimes also it is limpid, and passed in unusually large quantities, more frequently scanty and too high coloured. It is then most apt, as we should a priori expect, to deposite the above sediments unless some degree of fever prevail, when it often either deposites nothing, or a little of the red sediment.

A remarkable sympathy between the state of the kidneys and intestines is often observed in Indigestion, the urine remaining scanty and high coloured, when the bowels are constipated; and flowing freely, and of a paler colour, as soon as a free discharge from them has been obtained. Even in those dropsical affections which supervene on this disease, it is common for all diuretics to fail when the bowels are constipated, and for the operation of cathartics alone to be followed by a free discharge from the kidneys.

The copious flow of urine which sometimes attend Indigestion seems frequently to arise from a failure in the action of the skin, as appears from some of the experiments just referred to. The kidneys and skin separate the same fluid from the blood, and a failure of secretion from the latter is often compensated by an increase of that from the former, if they have not by sympathy partaken too much of the state of the skin. Thus in dyspeptics an unusual application of cold to the surface, when the powers of the system are not able so to re-act as to support the due action of the skin under it, frequently occasions an increased flow of urine.

The same cause often occasions a greater discharge from the bowels. It particularly demands attention in this disease, that, although the increased discharge from the bowels in the instance before us is of a watery nature, when the skin has, from the state of that disease, become uniformly languid, the increase is often in the solid, as well as liquid, contents of the bowels. On the same principle, the quantity which passes from the bowels of delicate children when the skin has become dry and shrivelled, is often astonishing, and that even when little nourishment is received, as if not only what ought to have passed by the skin, but a great deal of what lias been inhaled by this organ were deposited in a solid form in the alimentary canal. Some facts would lead us to suppose that in such a state of the skin, the inhalation by it is often very great. I have seen several gallons of water drawn off from a child ten or twelve years old, labouring under extensive abdominal disease, and apparently re-collected in eight or ten days, although but littlt fluid had been taken.

What is here said is well illustrated by an opposite state of the system. In very great eaters, the alvine discharge is often no greater than in other people, but the secretion by the skin is found much more free. Even in a remarkable case of this kind, an account of which appeared in the journals of the day (1797) in which an individual could eat daily twelve or fifteen pounds of raw meat, and would have starved if confined to the allowance of two or three ordinary men, the alvine discharge was little, if at all, greater than usual, yet he continued thin, and the superfluous quantity of food ran off by profuse night sweats.

The sensible change in the appearance of the alvine secretions in Indigestion, is generally attended with some change in the other symptoms. The stomach is more apt to be oppressed after eating, the patient often observing that he feels as if there were not room for what he had taken. The bowels are frequently variable, diarrhoea often supervening without any evident cause, almost uniformly followed by fits of constipation. These, the patient finds, can not now be removed by the simple medicines which at first restored due action to the bowels, larger doses or more active medicines are necessary, and their effect corresponds with the previous state of the bowels. The discharge is generally unsatisfactory, something seeming to be retained. It is very often watery, or frequent small semi-fluid, teasing, mixed with mucus, and sometimes streaked with blood, and after it has been repeated, often chiefly consists of mucus and a little blood, the passage of which is attended with much griping and bearing down, and followed by a constant desire o» further evacuation. The patient takes more medicine, with the hopes of a freer effect, but he thus often increases the straining more than the discharge.

After this state of irritation has continued to recur for a great length of time, a degree of permanent spasmodic stricture sometimes appears to take place in the rectum. This I have known happen to such a degree as to give a tape-like appearance to the alvine discharge for many months without intermission, and suggest the idea of organic stricture, till an examination of the part proved its real nature. A more temporary contraction of the rectum, occasionally giving this appearance to the discharge, is not an uncommon symptom.

In the meantime the patient is harassed with a variety of other symptoms, arising from the irritation occasioned by the morbid contents of the alimentary canal, increasing languor, pains of the stomach, more frequently of the bowels, and particularly of the lower part of the bowels, sometimes continued, generally of the griping kind, a sense of heat, or, as the patient often calls it, burning, referred to the stomach, and now and then extending to the bowels, which sometimes proves the most obstinate and distressing symptom of the disease, or of weight in the right hypochondriuni or lower part of the abdomen, with unusual distention of the former, sometimes disappearing in a day or two, particularly after freer evacuations, and returning again, at other times more stationary, a more foul and clammy tongue, nausea, more rarely vomiting, a depression of strength, which sometimes, particularly after the unsatisfactory operation of cathartics, almost amounts to syncope, and a despondency that is hardly equalled in any other disease.

As these symptoms proceed, others, the consequence of the sympathy which exists between the stomach and other parts of the system, gradually show themselves. These are different in different parts, and other complaints, of the head, affections of the sight, the hearing, smell, or taste. More or less habitual inflammation, and even ulceration of the throat are by no means uncommon, and the voice and articulation are sometimes variously affected. The patient is distressed with spasms of the trunk or limbs, numbness, and even temporary loss of power in the latter; and feelings of endless variety are described as sometimes in one part of the body and sometimes in another.

By constant recurrence of such attacks without being uniformly ill, for the rapidity with which the patient rallies is often as great as that with which he is subdued, he is gradually rendered unfit for the active duties of life. This preys on his mind, increasing the despondency which makes a part of his disease, and which in its turn, by further debilitating the digestive organs, aggravates all the symptoms.

These organs being no longer in a proper state to supply due nourishment, the body becomes emaciated, and more permanently feeble, the strength by degrees rallying less readily and less perfectly after the frequent returns, and what was at first only a temporary depression from a debilitating cause affecting the nerves of the alimentary canal, is gradually changed into real debility, the countenance, which is almost alwavs a sure index of what is passing internally, becoming pale and haggard.

It is of great importance in judging of the state of this disease to distinguish between debility and what may be called depression of strength. In the latter the action of the vital powers is only impeded, in the former their vigour is impaired. The one may supervene in a moment, and may be as instantly relieved; the other, unless the cause be very powerful, comes on more slowly, and in all cases slowly removed. We have an instance of depression of strength in the effects of an offending cause in the stomach and bowels, which cease as soon as the cause ceases to operate; of debility in the effects of repeated irritation of these organs, which continue after the cause of irritation no longer exists. Thus the debility, which appears suddenly at the commencement as well as at otherperiods of Indigestion, is oftrifling importance, compared with that more permanent debility which supervenes gradually, the symptoms of which are often slight compared with those of temporary depression of strength, but which is always more difficult of cure. The one is chiefly important as it indicates what is passing internally; the other proves that the powers of the constitution are yielding to the disease. Either mistaken for the other leads to serious errors in practice.

The patient, often from an early period of Indigestion, feels some uneasiness on lying on the left side, more rarely this is the case with respect to the right side. In the progress of the disease, lying on either side becomes uncomfortable, and, in its advanced stages, the only easy position is on the back, with the shoulders a little raised, and generally inclined to the right side.

Such is the general course of the disease we are considering. Those who are acquainted with the laws of sympathy, which in so striking a manner modify the phenomena of disease, will expect, that in the parts which most sympathize with the stomach and bowels, and consequently partake most of their affections, the symptoms of this disease will be found most varied. Thus it is that the tongue and other parts of the mouth are variously affected from the commencement. Their secretions become more and more thick and clammy, the former being covered with a white or brownish mucus, which also more or less adheres to, and irritates the fauces; sometimes all these parts are more or less parched and stiff, at other times the saliva is morbidly thin and copious, the tongue being cleaner but often of a whitish and sodden appearance. In protracted cases when the symptoms have been rather obstinate than severe, and considerable debility has come on, this symptom is often very troublesome, the saliva frequently running from the mouth.

In the advanced stage of the more severe cases, there is often a viscid frothy secretion from the fauces, while the mouth in general is drier than usual, which forms a very prominent feature of the disease. The patient is constantly hawking up this matter } particularly after eating, and will tell you that all his food turns to phlegm. This discharge is sometimes so great and harassing as to prove the most distressing symptom, and seems not a little to add to the debility. In some cases the tongue, in the more advanced stages, becomes clean, shining, and morbidly smooth 5 and at length affected with aphtha?. This state of it is seldom