ON

DISEASES OF THE STOMACH.

CHAPTER I.

INTRODUCTION.

LIFE, health, and comfort, are essentially connected with the performance of the function of digestion; when it deviates in but a slight degree from the normal standard, discomfort, in various degrees, is the result; and he is, indeed, a fortunate man who can pass through his daily duties without the thoughts and attention being directed to those operations for the solution, absorption, and assimilation of nourishment, which in health are performed throughout, without any attention, sense of pain, or discomfort. If there be greater derangement of these functions, not only is the attention directed to them, and discomfort entailed, but there is reaction upon the higher capabilities of man's nature: the brain becomes less able to perform its functions, the judgment, the will, the memory, the whole power of thought and intellect, are less free to guide the man in his daily duty, avocation, and research. The muscular movements and power are diminished, and the pleasure of life changes to daily suffering and anxiety. Contrast the vigour of mind and body during health, with the enfeebled energy of the dyspeptic and hypochondriac. The former knows no impediment to the exercise of deep thought and labour, in any sphere that the mind may dictate; the whole attention of the latter is absorbed by those

B

functions which are at best only subservient to the manly exercise of mind and will.

If the digestive process be altogether checked, and no new supply of nourishment absorbed and assimilated, no fresh restoration of the waste entailed by the exercise of every function, life must sooner or later cease; and disease, in its ravages, presents few spectacles more distressing to witness, than the gradual wasting of the frame, and cessation of life itself, from the nonsupply of food. Thus the whole system sympathizes with disorder of the alimentary canal.

A knowledge of the structnre and functions of each part of the digestive apparatus, is necessary to the right understanding of its diseases. Its structures are various, and its sympathies universal; but in health these are so combined as to form a beautiful and harmonious whole. Thus, 1st, we everywhere find a mucous membrane lining the alimentary canal, and very richly supplied with glands, either for its lubrication, or to pour into it secretions which are necessary for its due exercise, acting physically or chemically; and excretions or substances, by this means, are discharged from the blood, as noxious or effete principles. 2nd. Beneath the mucous is the muscular coat, necessary for the execution of the required movements, and the propulsion of the contents. 3rd. The peritoneal or serous covering, which by its smoothness enables movements, where such are required, to be performed by one portion of the intestine upon another, or allows distension to take place. 4th. The binding tissues, which are found between these previously mentioned tunics, and which support the still more essential parts. 5th. The supply of blood, by means of vessels and capillaries; and, 6th, the supply of nervous power from the sympathetic nerve. As Abercrombie has remarked, in reference to diseases of the stomach,—so, also, in reference to every part of the alimentary canal;—for the proper performance of the function of digestion, the mucous membrane must be in health, the secretions normal, the supply of blood and nervous energy such as required, and the movements free. It must, however, be borne in mind, that the alimentary canal contains substances which are, strictly speaking, external to the living agency and control of animal life; and that those chemical forces, which we find in operation external to

the body, act in the same manner within the stomach and small and large intestines: the food becomes dissolved when the same solvents are provided, and other circumstances adapted, as to temperature, movements, &c., equally in a phial as in the stomach. The fermentation of its contents takes place in the stomach and canal, as well as in any chemical receiver; and these facts have to be remembered in the study, as well as in the treatment, of disease. Chemical force is in operation throughout the whole animal economy; it is modified and controlled by the living power, or it is free to act alone.

Each of the parts which have been mentioned, may be alone diseased, or all conjointly; the symptoms arising from each are in some cases distinct, in others we cannot separate the one from the other.

1. Mucous membrane and its secretions. The derangement of these constitutes, perhaps, the greater part of the milder ailments of the alimentary canal. The symptoms vary according to the part affected: in the stomach, producing some of the various forms of dyspepsia; in the intestines, constipation, diarrhoea, &c. But where the mucous membrane alone is affected, it appears probable that pain is not produced, and this is a merciful provision. The lining membrane is exposed to varied causes of irritation, but we do not experience pain; if such were the case, every portion of undigested food might produce discomfort; in some cases severe pain is found in indigestion, but this arises from an extreme sensibility of the sympathetic and nervous supply of the stomach, &c., and is not due to the mucous membrane.

Dr. Beaumont, in his observations on the stomach of Alexis, sometimes observed the mucous membrane dry, injected, and much irritated without the production of pain; so, also, I have observed actual inflammation of the stomach, as found in cases of poisoning by oxalic acid, of chloride of zinc, and even of arsenic, without pain from first to last.

2. The muscular coat we find so stimulated, that it rapidly contracts, and impels onwards its contents, or is enfeebled so as to retain them; sometimes spasmodically contracted, or dilated, as in the forms of colic and flatulent distension, &c. These conditions appear to be productive of pain, sometimes of a very

intense form, as we find in the griping of colic, in enteritis, &c. As long as the peristaltic action is uniform, regular, and healthy we are unconscious of the movement; but as soon as it becomes irregular, tumultuous, retarded, or spasmodic, we are sensible of discomfort, or severe pain; the muscular coat of the intestine is probably excited to contraction by the direct stimulus of its contents, but the harmony of its movements is due to the supply of nervous influence which it receives.

3. The peritoneal or serous investment. This, also, generally manifests its derangement by pain; and here, again, is a wise provision, for as its disorders require rest, or rather an absence of movement of the coils of intestine one upon another, the pain of peritoneal disease is increased by muscular exertion, so that the patient becomes prompted to assume that position, and to retain that state, which is best suited for the restoration from disease. The observant pathologist and physician knows, practically, the importance of rest in the recumbent position, and follows the teaching of nature in his stringent directions: by this means inflammation is localized, and where perforations of the intestine have taken place, the injury is limited and life may be prolonged.

4. The state of the investing or binding tissues, and the supply of blood, are important considerations in the study of these diseases of the intestine. The former, in some cases, appears to be the seat of fatal malady, as in the form of constriction of the pylorus, and in cancer. Still more does the supply of blood call for attention: it may be in excess, as in active or passive hyperæmia; in pulmonary, cardiac, or hepatic disease the engorgement of the mucous membranes leads to peculiar and characteristic symptoms; the rupture of vessels, or ulceration into them, causes hæmorrhage into the canal; and again, a scanty supply or depraved condition of blood prevents the proper performance of digestion, as in great hæmorrhage, in over-lactation, in purpura, scurvy, or starvation.

5. The state of the nervous supply is often lost sight of; it is a most complicate system of nervous fibrils and ganglia, in the most intimate connexion with the cerebro-spinal centres, and the ganglionic centres of other parts,-of the lungs, the heart, and the urino-genital organs. Many of the signs of