wanted to disembarrass it of unwholesome or indigestible food, or to restore it, when below its proper tone, to health and strength.

Under different circumstances, the stomach presents every degree of failure, from capricious and uncertain digestion, to complete inability to chymify food. Except in the last case, the evil generally admits either of being corrected, or of being greatly mitigated. The stomach may be weak, but a diet suited to it will be digested without difficulty or suffering; as on the other hand, food in excess, or of an unwholesome quality, will disagree with the strongest stomach. When the proper ratio is not observed between the strength of the stomach and the quantity and quality of the food, indigestion arises; or an indigestion may proceed from an accidental cause, and be the complaint of a day, or it may proceed from error in the general habits, or weakness of the organ, and amount to established indisposition. By the term indigestion, the latter state of things is commonly meant.

In health, all that we ought to know of our digestion through sensation is, that satiety has succeeded hunger, and that for a shorter or longer period we are indisposed to exertion. When digestion is imperfect, many sensations, local and general, occur to distress and disturb us. The stomach may be the seat of pain, and of feelings of weight and distension; nausea and loathing of

food may take the place of appetite, and retching and vomiting may be continually present; the brain and nerves may be disordered, depression of spirits, headach, confusion of thought, disturbed vision, vertigo, fits of insensibility, may follow; the action of the heart may be irregular; the breathing oppressed and embarrassed, with constant troublesome cough.

The condition of the stomach itself, under these distressing symptoms, may be different in cases where the general features are much alike; and it is remarkable that the extent and ultimate importance of the changes in its structure and organization bear no proportion to the sufferings which the patient experiences. Generally speaking, the most grave diseases of the stomach, except towards their close, produce much less physical distress than the lighter.

All the symptoms now to be considered arise from disorder of the functions of the stomach, and depend directly upon its inability to digest, upon food lying unchanged in the stomach, upon failure or depravation of its secretion, upon exaltation of its natural sensibility; and this functional failure or disturbance may co-exist with no visible alteration of structure, or at all events may depend upon alterations that are so transient as to disappear in death. Ulceration of the stomach, thickening of the stomach, cancer of the stomach, produce more

or fewer of the symptoms which I have enumerated; but they produce them secondarily; they produce them when they at length cause in the stomach at times or constantly that functional failure, upon which indigestion depends.

A physician or surgeon undertaking the management of a case of indigestion, ought, indeed, first to ascertain, if possible, on what the disorder immediately depends; but here, as in other diseases, the progress of the complaint, and the influence of different remedies upon it, commonly throw the clearest light upon its nature.

An indigestion may occur in a person of a good stomach through excess, or from eating something indigestible, or from bile.

Indigestion may depend upon original weakness of the stomach.

Indigestion may proceed from mental causes, from confinement, want of exercise, inattention to the action of the bowels.

Indigestion may arise from chronic inflammation of the stomach, from thickening of its coats, from ulcer of the stomach, from cancer.

I oppose the last head and the three first, not that the three first classes of causes do not often lead to, and are not often rendered worse by the fourth, by inflammation, ulcer, thickening,-but because they may produce an indigestion purely functional, or one in which no change of structure

is detectible; and because this fourth class of causes may come into existence without either of the influences being present which are specified under the three first heads.

Cancer of the stomach, which, in all its forms, I have grouped with the accidental changes of structure, must be considered as so far different from them, that it is unavoidable and incurable. Its seeds are born with one; but its period of invasion may probably be deferred, and its symptoms may certainly be much mitigated, by judicious treat

ment.

I propose to begin with exemplifying some of the principal among the kinds of indigestion above specified, and afterwards to examine the complaint in reference to the more prominent features which give it, in different instances, such different characters.

I pass over the effects of vicious excess and habitual intemperance, which, in their proper punishment, in the helpless palsy of stomach, and sickness and headach which follow, find a temporary remedy. The aim of physic is not to provide the means of combining the pleasures of vice with the comforts of virtue. The man who eats or drinks to an unwholesome excess knows how he might prevent his morning sufferings, at the time that he has not energy enough to break through his habits of self indulgence. The tonic

afternoon draught, to restore the tone of the stomach, and create an appetite out of loathing and nausea, the aperient pill at night to relieve the congestion of the bowels, which the stimulating meal will have produced, afternoon exercise in the open air these, and the like means, help but little men, who indulge in the pleasures of the table, to retard the approaches of disease, and to render the intervals of indulgence less intolerable.

But to take a common accidental indigestion. A few nights ago a gentleman sent for me, who, having dined with moderation, and drunk three or four glasses of wine, had at twelve retired to bed. without any feeling of indisposition. He awoke at one, with nausea and pain at the stomach; he then vomited, but without relief of the pain : the bowels then acted several times. When I saw him about six in the morning, he complained of a dull heavy pain at the epigastrium, pressure upon which gave him great uneasiness: his tongue was a little furred, but he had no pain, nor was there general tenderness of the belly. I considered the pain to arise from undigested food, and therefore mixed for him two tumblers of warm water and salt, which he swallowed and retained in the stomach about ten minutes, and then rejected, along with a quantity of half-digested food, containing some leaves of water-cress very little changed. He felt relieved, slept, awoke at