K-RC 
 
 816 
 P3 
 
 UC-NRLF 
 

 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 

Dunglison's American Medical Library. 
 THE 
 
 STOMACH 
 
 IN ITS MORBID STATES; 
 
 BEING 
 A PRACTICAL ENQUIRY INTO 
 
 THE NATURE AND TREATMENT OF DISEASES OF THAT 
 
 ORGAN ; 
 
 AND INTO THE INFLUENCE THEY EXERCISE 
 
 I UPON THE 
 
 ORIGIN, PROGRESS, AND TERMINATION OP DISEASES OP 
 
 THE LIVER, HEART, LUNGS, AND BRAIN. 
 
 BY LANGSTON PARKER, 
 
 MEMBER OF THE ROYAL COLLEGE OF SURGEONS, AND 
 FELLOW OF THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY OF LONDON, ETC. 
 
 
 PHILADELPHIA: 
 
 PUBLISHED BY A. WALDIE, NO. 46 CARPENTER STREET. 
 1839. 
 

TO 
 
 JOSEPH HODGSON, ESQ., F. R. S., &c., fcc. 
 
 MY DEAR SIR, 
 
 SOME years ago, you advised the completion of a work 
 on Human and Comparative Physiology, the plan of which I 
 submitted to your judgment. Circumstances have occurred to 
 delay, at least, the completion of that work. In place of it, permit 
 me to dedicate to you the present Treatise : and believe me, my 
 dear sir, with esteem for your friendship and great respect for 
 your high professional attainments, to remain ever 
 
 Your obliged and faithful 
 
 Friend and servant, 
 
 LANGSTON PARKER. 
 
PREFACE. 
 
 THE work I now lay before the public is materially different 
 from all those which have preceded it on the same subject : it 
 is neither devoted chiefly to the consideration of pathological 
 changes, like that of Dr. Abercrombie, nor is it limited to one 
 class of primary morbid states. The subject of organic disease, in 
 itself, has never appeared to me so important as that of the pri- 
 mary conditions which precede it, which, by their continuance 
 through a series of years, ultimately induce incurable affections, 
 either in the organs where they are seated, or, by sympathy, in 
 remote parts. In a practical point of view, the latter is of infi- 
 nitely greater importance than the former. 
 
 It is from this circumstance that I have devoted the following 
 treatise principally to the consideration of the primary morbid 
 conditions of the stomach, and the diseases they induce, by sym- 
 pathy, in remote parts, as the liver, lungs, heart, and brain. The 
 primary morbid conditions of the stomach may be referred to two 
 classes : 1. Congestive or inflammatory states ; and, 2. Affections 
 of its sensibility, both organic and animal. There is a third form 
 a disordered state of the secretions, which I must denominate 
 primary, though it is not really so : we cannot, however, appre- 
 ciate any pathological condition which precedes it. 
 
 After having noticed these conditions of the stomach, their 
 symptoms, and mode of treatment, I have passed to the considera- 
 tion of their influence upon the origin, progress, and termination 
 of diseases in other organs. The question of morbid sympathy is 
 one of extreme importance ; and, as far as the present subject is 
 
VI PREFACE. 
 
 concerned, I am not aware of any author, with the exception of 
 Dr. James Johnson, who has more than touched upon trn sympa- 
 thies of the stomach with internal organs. I have here endea- 
 voured, in some measure, to illustrate this influence ; convinced 
 that the primary morbid states, to which i have alluded in the 
 earlier parts of this work, are daily the sources of disease in 
 remote internal organs, which ultimately, by their continuance, 
 terminate in organic change. 
 
 142, Snow-hill, Birmingham^ 
 Jan. 15, 1838. 
 
THE 
 
 STOMACH IN ITS MORBID STATES &c. 
 
 CHAPTER I. 
 
 OF MORBID STATES OP THE STOMACH CHARACTERISED BY IN- 
 CREASED VASCULAR1TY. 
 
 THE stomach presents two primitive morbid states : the first con- 
 sisting in lesions of its sensibility, and the second in lesions of its 
 circulation ; the latter comprises that great variety of form in dis- 
 eases of the stomach which is termed inflammatory, and which may 
 vary from a mere increased fulness of blood, not tending to the 
 destruction of the parts in which it is seated, to the different forms of 
 inflammation whose continuance is necessarily followed by organic 
 change. It is not necessary here to enquire whether the second is 
 not, in all instances, the consequence of the first. It is with the 
 latter we shall commence the study of this class of diseases. 
 
 The most simple forms of diseases of the stomach, in which 
 derangements of the vascular system are the prominent features, are 
 characterised by morbid fulness of blood in the mucous coat, which, 
 interfering with the functions of the stomach, interrupts digestion, 
 and, if unchecked, ultimately lays the foundation of inflammatory 
 disease. This morbid fulness of blood in the mucous coat results 
 from irritation, generally prolonged and frequently repeated. The 
 irritations which produce sanguineous congestion of the mucous 
 coat, are, most commonly, dietetic errors ; and it then bears the; 
 name of inflammatory indigestion. It may, however, come on a? 
 the consequence of any disease, or during its progress ; and in these 
 instances it is highly necessary that the state of the stomach should 
 be ascertained before any plan of treatment be determined on, lest 
 we convert what is merely a state of congestion of blood into a true 
 inflammation. The form of disease which we are considering is, in 
 general, not dangerous ; and if it remain in the state of congestion 
 merely, disorganisation of the stomach is not to be apprehended, 
 although a repetition of stimulants or irritations may easily convert 
 the congestion into inflammation. Persons thus affected are on the 
 brink of a serious disease, but not in it. Sanguineous cong estn 
 may vary in situation or occupy a more or less extensive portion ol 
 the stomach ; hence the variety of symptoms which attend it, both 
 
8 PARKER ON THE STOMACH. 
 
 in their decree of intensity and the number of sympathies by which 
 they are accompanied. The symptoms themselves may vary from 
 mere distension after food, to constant vomiting attended with thirst, 
 dull pain, fever and headach. 
 
 Sanguineous congestion of the mucous coat of the stomach, is 
 commonly termed gastric irritation, indigestion, dyspepsia; by the 
 French, surexcitation gastrique, embarras gastrique^ digestion 
 laborieuse. It may appear as a temporary or evanescent affection, 
 or, from its constant occurrence in the evanescent form, it may 
 become permanent. The general symptoms which attend it, will 
 be found illustrated by the detail of a few cases selected from those 
 which are daily presenting themselves to our notice. 
 
 A gentleman accustomed to live well, after more than usual in- 
 dulgence, applied to me labouring under the following train of 
 symptoms, which had harassed him, with some variation for two 
 months : constant uneasiness in the epigastrium, increased by 
 pressure and taking food ; his meals were always succeeded by dis- 
 tension of the stomach, flatulence, nausea, and occasional vomiting. 
 He had cough, hurried breathing occasionally, and palpitation, an 
 accelerated pulse, partial headach, with giddiness and indistinct 
 vision ; the bowels were confined, and the urine was scanty and 
 high-coloured ; the tongue moist, coated, red at its point and edges, 
 with an elevated and intensely vivid state of the papillas. To these 
 symptoms are commonly added, in different cases, and in different 
 individuals, where the susceptibility of their organs are different, 
 thirst, general feelings of lassitude, pains in the chest, back, 
 shoulders, or upper part of the abdomen ; general pulsations, more 
 marked in the epigastrium, and synchronous with those of the heart ; 
 heat in the palms of the hands or soles of the feet ; flushing of the 
 face, co-existing with certain local symptoms which point to the 
 stomach as the sole origin of all this mischief, which symptoms are 
 pain, nausea, or vomiting after food, with most distressing flatulence, 
 and feelings of distension and fulness about the stomach, amounting 
 almost to suffocation. 
 
 It may be said, and is said by Broussais and the pupils of his 
 school, that these symptoms of general and local vascular excite- 
 ment are dependent upon an inflamed and not merely a congested, 
 state of the mucous membrane of the stomach ; but with all the 
 great respect I entertain for one who has almost created our present 
 state of knowledge on gastric diseases, there are many proofs which 
 lead us to suppose that these symptoms are not indicative of a true 
 inflammation, but of a mere evanescent congestion, or fulness of 
 blood in the part, for we see them subsiding with the cause that 
 produced them when they are slight, and occurring and subsiding 
 again, and thus continuing for years, without producing emaciation 
 or any serious state of disease. Again, the disease gives way, in 
 many cases, in twenty-four hours, to a proper plan of treatment ; 
 and a patient will change from a state of suffering, indicated by the 
 symptoms above detailed, to one of perfect health, by the simple 
 
INCREASED VASCULARITY OF THE STOMACH. V 
 
 application of ten or a dozen leeches to the epigastrium, and the 
 administration of an aloetic aperient, or a solution of some neutral 
 salt, as the sulphates of soda and magnesia in some bitter infusion. 
 
 It would be difficult to ascertain the true pathologic character of 
 this affection (which never of itself is fatal) unless we had oppor- 
 tunities of examining its nature in patients dying, during its con- 
 tinuance, from other diseases. 
 
 A man, aged forty, who had been troubled with headach for 
 some years, eat freely of cucumber and some other indigestible food, 
 which produced vomiting, uneasiness in the stomach, distension, 
 flatulence, and all the common symptoms of indigestion. During 
 their continuance he was seized with giddiness, which terminated 
 in profound coma, in which state he died, thirty hours after its 
 commencement. On examining the body, eight hours after death, 
 the middle lobe of the left central hemisphere contained a softened 
 portion of brain, about the size of a walnut. The mucous mem- 
 brane of the stomach was vividly injected in patches, which were 
 more numerous towards the pyloric portion of the organ. This case 
 is interesting in a double point of view: first, as it exhibits the 
 state of the mucous coat of the stomach during a fit of indigestion, 
 and explains the pathology of one of its forms ; arid, secondly, we 
 appear to trace some relation between the affection of the stomach 
 and the old standing disease of the brain. The sudden invasion of 
 the attack of indigestion seems to have produced death byre-acting 
 upon the brain, in which an old source of irritation existed. 
 
 The preceding case shows the pathology of this form of indiges- 
 tion, consisting in mere fulness of blood, increased determination, 
 owing to an increased or undue irritation in the stomach from the 
 presence of indigestible food. This state of stomach is termed by 
 Andral, hyperemia 1 of the stomach, in which the blood is propelled 
 into the digestive organs from some irritating cause. It is a state 
 of disease approaching to inflammation, but ought to be carefully 
 distinguished from it. 2 Dr. Beaumont has shown that the mucous 
 membrane of the stomach becomes red and dry from undue excite- 
 ment ; sometimes irregular, circumscribed, red patches, varying in 
 size and extent from half an inch to an inch, are found on the in- 
 ternal coat. These appear to be the effect of congestion in the 
 minute blood-vessels of the stomach. 3 The pathology of this form 
 of disease consists, then, in mere morbid fulness of blood in the 
 mucous coat; other alterations must be present to constitute the 
 true inflammatory condition. These alterations are observed in the 
 change either of the colour or consistency of the mucous membrane 
 
 1 TTS, excess of, aT|txa, blood. 
 
 * Cours de Pathologic Interne, p. 4, Paris, 1836. 
 
 3 These observations were made upon Dr. Beaumont's man-servant who 
 had a fistulous communication with the stomach, through which the process 
 of digestion could be observed. A portion of the side and stomach had been 
 carried away by a musket-shot. The doctor kept this man for the purpose 
 of making experiments upon his digestion. 
 
 9 ft park It 
 
10 PARKER ON THE STOMACH. 
 
 in thickening or softening of the mucous coat itself, or alterations 
 in the condition of the submncous cellular or muscular coats. 
 Andral believes that true inflammation of the mucous membrane of 
 the stomach is seldom unaccompanied by thickening. 
 
 The degree of local or constitutional disturbance which attends 
 a superabundance of blood in the mucous coat of the stomach, will 
 depend upon the degree of congestion and its extent, whether it be 
 confined to small patches of redness, or extend to a general vascular 
 fulness of the whole mucous membrane ; in the former instance the 
 symptoms would be slightly local ones ; in the latter, a general state 
 of constitutional disturbance would be present. This state of 
 stomach is commonly observed at the commencement both of erup- 
 tive and continued fevers ; it accompanies and complicates almost 
 all inflammatory diseases. 
 
 The local symptoms accompanying this form of disease in the 
 stomach are commonly very slight ; they sometimes disappear in a 
 short time and are quickly renewed from any fresh source of irri- 
 tation. This, in Andral's opinion, stamps it at once as a disease 
 distinct from inflammation. The following case exhibits its most 
 simple and common form : 
 
 A gentleman, accustomed to live freely and indulge in the use of 
 malt liquors, became troubled, after indulgence, with nausea, acidity, 
 and distension after food in the stomach and bowels. The tongue 
 was moist and coated. He had no headach, nor any other sym- 
 pathetic affection. The ordinary stomach medicines I employ 
 (referred to in the chapter on treatment) cured the patient in twenty- 
 four hours. 
 
 The ease with which the first attacks of gastric irritation are 
 commonly removed induces persons to believe that the disease is of 
 little consequence, and that repeated attacks occasion no further in- 
 convenience or evil than that felt during their continuance ; but it 
 must be remembered that these repeated attacks of irritation, pro- 
 ducing congestion, directly debilitate the blood vessels of the mucous 
 coat, and that an actual state of inflammation may succeed to these 
 repeated irritations. 
 
 It is evident that the hundred and forty-fifth aphorism of 
 Broussais 1 relates to a state of disease in which mere redness of the 
 mucous membrane is present, which may continue for weeks, 
 months, and years, with all the symptoms of indigestion present 
 during the whole of this time, and no organic change be the result. 
 Even after the long continuance of such disease, the stomach inay 
 return to its healthy state under a proper plan of diet and medica- 
 tion. There is no distinct line of separation to be drawn between 
 the mere fulness of blood or vascular irritation of the mucous coat, 
 and an actual state of inflammation ; indeed, the former appears to 
 be but the primary condition of the latter, although disease may 
 
 1 La plupart des dyspepsies, gastrodynies, gastralgies, pyrosis, cardialgies, 
 et toutes les boulimies sont 1'effet d'une gastro- entente chronique. Examen 
 des Doctrines Medicates, Aphorism cxlv. 
 
INCREASED VASCULARITY OF THE STOMACH. 11 
 
 remain fixed in the first form. The mere irritation of the stomach 
 consequent upon occasional excess is considered by some as a shade 
 of inflammation. " Mere gastric irritation (embarras gastrique)," 
 says Roche, 1 "is certainly an evanescent form of inflammation. Its 
 symptoms consist in a feeling of weight and uneasiness about the 
 region of the stomach, loss of appetite without thirst, bitterness in 
 the mouth, eructations, and nausea : attempts to vomit, and even 
 actual vomiting may be present." These are the symptoms of a 
 common bilious seizure, which are attributed by the pathologists of 
 the school of Broussais to a slight form of inflammation of the 
 mucous coat of the stomach. The term, inflammation, is here 
 employed to designate a certain degree of irritation, of which the 
 chief morbid state is preternatural fulness of blood. 
 
 The terminations of this state of disease, which is characterised 
 by mere symptoms of indigestion, may, if neglected or ill-treated^ be 
 various. It may, in the stomach, end in a true inflammatory state, 
 or, from the constant irritation being kept up. it may induce disease 
 in other organs which are most susceptible, from predisposition, of 
 being thrown into a state of disease. These organs are, generally, 
 the liver, the brain, the heart, and the mucous surfaces of the 
 bronchiae. To the latter parts, irritation soon spreads, and the 
 stomach-cough is soon added to continued gastric irritation. 
 Hypertrophy of the liver very commonly succeeds to continued vas- 
 cular gastric irritation, without any inflammatory disease existing in 
 the stomach, which would of itself, prove fatal except so far as its 
 influences the condition of other organs. Broussais, Cruveilhier, 
 Andral, Carswell, and other pathologists, attribute hypertrophy of 
 the liver to a continued state of gastric irritation of the inflammatory 
 kind. Even where it cannot be easily traced that affections of the 
 liver are directly consequent upon gastric irritation, we find them 
 so closely allied, so constantly existing together, that no doubt can 
 be entertained of their mutual dependence and relation. Affections 
 of the heart commonly cause congestions of the mucous coat of the 
 stomach, which are accompanied by all the symptoms of indigestion, 
 which is in these instances commonly then taken for a primitive 
 disease. I was consulted, a few days since, by a gentleman whose 
 case will be found in another part of this work for what he consi- 
 dered mere prolonged and obstinate indigestion. On examining 
 carefully into his state, I discovered that he had extensive valvular 
 disease of the heart, and that his stomach disease resulted from an 
 unusual quantity of blood retained in the mucous coat of the 
 stomach and its veins from a mechanical obstacle to its free return 
 to the heart, caused by disease existing in that viscus. On the other 
 hand, vascular irritations in the cardiac portion of the stomach, act 
 forcibly upon the heart by increasing the force and frequency of its 
 pulsations, or destroying the regularity of its actions. The brain may 
 become affected from the well known sympathies existing between 
 
 1 Dictionnaire de Medecine et de Chiiurg. Pratiques, art. Gastrite. 
 
12 PARKER ON THE STOMACH. 
 
 it and the stomach, particularly if there be any old-standing disease 
 in that organ. The stomach, however, appears, in these forms of 
 disease, to affect the head through the medium of the heart by 
 quickening its pulsations, increasing their force, and thus sending 
 the blood with greater force and frequency than is consistent with 
 the healthy state, to the central organ of the nervous system. 
 
 All inflammatory and feverish diseases are accompanied, in a 
 greater or less degree, by vascular irritation of the stomach ; from 
 the intimate connection this organ has with all parts of the 
 economy, it is liable to be thrown into morbid states by any impres- 
 sions made upon the constitution at large, or upon any of its parts ; 
 hence we see how prone it is to become affected during the pro- 
 gress of other diseases. During the progress of all diseases of 
 whatever kind, we must ascertain the state of the stomach with 
 reference to the remedies indicated in the cure of the particular 
 disease in question. Thus, in diseases of the heart, where the use 
 of foxglove is indicated, it is a matter of paramount importance to 
 administer it only when the stomach is healthy. If that state of 
 vascular irritation which so commonly accompanies diseases of the 
 heart be present, and which of itself is sufficient to excite or de- 
 range the heart's action, the administration of digitalis would add 
 to the affection of the heart by irritating the stomach. The stomach 
 being the medium through which all remedies act, it is necessary that 
 this organ should be in a state to receive and dispose of them properly 
 when they are given, or the stomach will be irritated instead of the 
 disease, which medicines are given to relieve, benefited. These 
 remarks particularly apply to the use of irritating and stimulating 
 diaphoretic and diuretic medicines. The state of vascular irritation, 
 (forming the first step towards inflammatory disease,) to which I 
 arn alluding, is very commonly set up at the termination of acute 
 diseases, during the period of convalescence, probably owing to 
 dietetic errors at this period ; it comes on during a period of 
 weakness, and, the patient not making the progress that the 
 practitioner expects, tonics are liberally given; but still the 
 invalid recedes towards a perfect relapse, instead of becoming 
 convalescent. If we enquire into the patient's state at this pe- 
 riod, we find him labouring under all the symptoms of vascular 
 irritation of the stomach; such as flatulence, nausea, heat and 
 weight in the epigastrium, with capricious or defective appetite, 
 with or without a loaded tongue, for this is commonly a very 
 deceptive symptom. A little attention to the state of the stomach, 
 speedily restores the patient and the cure becomes complete. It 
 is these affections of the stomach coming on during convalescence, 
 that frequently produce what is termed by the French "false 
 convalescence." 
 
 The eruptive and continued fevers are ushered in commonly by 
 shivering and sickness, and the tongue is intensely red at its point 
 and edges. If the epigastrium be examined it is highly sensible to 
 pressure, and is the only part of the belly where any tenderness is 
 
MORBID STATES DEPENDENT UPON ANEMIA. 13 
 
 experienced. This tenderness of the epigastrium, and vomiting, 
 are dependent upon vascular irritation of the stomach, approach- 
 ing the inflammatory state, and indicated by symptoms which are 
 more intense than in other forms of the disease, from the irritation 
 occupying the whole extent of the mucous membrane of the sto- 
 mach: this is probably occasioned by the accumulation of blood in 
 the great veins of the epigastrium during the cold stage. It is 
 more than probable that this state of stomach, at the commencement 
 of fever, frequently lays the foundation of the aggravated gastric 
 and gastro-enteric diseases upon which fever depends or with which 
 it is associated, and which sometimes of themselves occasion death. 
 
 CHAPTER II. 
 
 OF MORBID STATES OF THE STOMACH DEPENDENT UPON ANEMIA. 
 
 GREAT discharges of blood, particularly those occurring after par- 
 turition, or from abortions, occasionally produce all the symptoms 
 of vascular irritation of the stomach ; such as flatulence, fulness, 
 tenderness in the epigastrium, with pain and weight after food. We 
 find here the same symptoms accompanying a deficiency of blood 
 as those which denote a superabundance of it. I shall detail a few 
 cases of this kind, in order to give a clearer idea of the disease. 
 
 A lady, aged thirty, miscarried in the third month of her preg- 
 nancy, at which time she lost much blood. At the present time, 
 two months after the abortion, she is labouring under the following 
 train of symptoms : Great pain in the epigastrium, aggravated by 
 pressure, and accompanied by strong pulsation in this region. 
 Fulness, pain, and distension after meals, with nausea, occasional 
 vomiting, palpitations, and inactive bowels. A medical practitioner, 
 supposing these symptoms were dependent upon some inflammatory 
 affection, had ordered leeches to the stomach, which had aggra- 
 vated all the symptoms. The pil. aloes, assafoet. et saponis, was 
 ordered subsequently, to regulate the bowels, and chalybeates were 
 freely given. Under this plan, the pain, tenderness, pulsations, 
 vomiting and distension disappeared, and the patient recovered her 
 usual health. 
 
 This case presents all the symptoms depending upon vascular 
 irritation, namely, epigastric tenderness and pulsations, (which latter 
 are, however, but rarely present, and that in highly irritable pa- 
 tients), vomiting, with distension after taking food ; in fact, a train 
 of symptoms accompanying laborious digestion generally, and 
 which are dependent on vascular irritation of the stomach. Leeches 
 here afforded no benefit, and did not, in the slightest degree, remove 
 the symptoms. The patient, however, rapidly recovered under a 
 nutritious diet and the use of the preparations of iron. It is evi- 
 dent, when, we review the previous history of the patient, that the 
 
14 PARKER ON THE STOMACH. 
 
 affection was produced by loss of tone in the stomach, the conse- 
 quence of her great discharges, which had produced a state of irri- 
 tation similar to that resulting from congestion or inflammatory 
 action. 
 
 A lady, aged forty, miscarried in the early months of her preg- 
 nancy; the flooding accompanying the abortion was most profuse, 
 and she remained in a state of alarming faintness for many hours. 
 On the second day after she began to complain of her stomach. 
 She had constant nausea, with vomiting, acidity, and flatulence, 
 with great tenderness in the epigastrium. She was not subject to 
 any stomach derangement habitually. Her food occasioned great 
 pain, and lay like a "lump of lead," in the stomach. The symp- 
 toms yielded in a few days, under the administration of the tinct. 
 ferri muriatis. 
 
 A lady, aged forty, miscarried a fortnight before the symptoms 
 about to be described set in ; she lost a vast quantity of blood, 
 which produced a state of great weakness and irritability. She now 
 complains of great oppression and fulness, seated in the epigastric 
 region ; she is afraid to eat, food of any kind increasing the oppres- 
 sion to such an extent as to produce a feeling of impending suffo- 
 cation. Slight pressure over the stomach occasions a sensation of 
 uneasiness, which the patient describes as dreadful. Tongue 
 moist, but coated ; the pulse is one hundred and twenty, sharp and 
 small; lits of palpitation occasionally;, hurried breathing, with 
 constant cough. Percussion and auscultation afford no evidences 
 of disease in the lungs or heart. The stools are scanty, dark, and 
 offensive ; the urine is almost suppressed, and constitutes one of 
 the most troublesome features of the disease. It is made in quan- 
 tities of not more than four or five table-spoonfuls in the course of 
 twenty-four hours, and this is altogether composed of a light yellow 
 sand. This state of urine came on two or three days after the 
 distension and epigastric uneasiness. Small doses of blue pill and 
 aloes were given at bed-time, and in the day the patient took the 
 tincture of the muriate of iron in a bitter infusion. The diet was 
 to consist of porter and animal food. Three weeks from the com- 
 mencement of this plan of treatment the distension and uneasiness 
 in the region of the stomach had disappeared, the tongue was clean, 
 the bowels regular, and the urine plentiful and clear. In a week 
 after this report the patient was perfectly well ; with the improved 
 state of the general health, and the increase of strength, all the 
 symptoms of irritation in the stomach had disappeared. 
 
 A lady miscarried early in her pregnancy. She was fainting 
 and almost pulseless for two or three days. To this succeeded 
 pain in the stomach after food, increased by pressure and accom- 
 panied by nausea, eructations, swelling of the stomach, and vomit- 
 ing. She recovered rapidly under the use of the tincture of the 
 muriate of iron. 
 
 A lady had the same train of symptoms after profuse menstrua- 
 tion. She recovered from using the same medicines. 
 
MORBID STATES DEPENDENT UPON ANEMIA. 15 
 
 OBSERVATIONS UPON THE PRECEDING CASES. 
 
 The stomach, like all other organs, requires a due supply of 
 blood to keep it in a healthy state ; and if it be deprived of this, it, 
 like all other organs, is thrown into states of disease which, in their 
 characters, strictly resemble those which result from excess of 
 blood, yet the two diseases require directly opposite modes of treat- 
 ment. "It is a law in pathology that, in every organ, the diminu- 
 tion of the quantity of blood which it should contain in a healthy 
 state, produces functional disturbances, as well as the presence of 
 an excessive quantity of blood ; and what is more, in both cases 
 these functional disturbances are precisely similar." 1 In the cases 
 which I have detailed, we observe the loss of blood producing 
 symptoms of. stomach derangement perfectly analogous to those 
 which depend upon excess of blood, or upon inflammation ; if we 
 analyse the symptoms they are the same. The subject of the third 
 case in particular exhibits, in the most marked degree, all the symp- 
 toms attendant upon the incipient stages of inflammatory disease 
 of the stomach. The pain after food, tenderness in the epigastrium 
 on pressure, vomiting, scanty urine, are what commonly denote an 
 inflammatory state of the mucous membrane of the stomach. 
 " We have often seen," says Andral, " individuals who seem almost 
 destitute of blood, who digested with pain to themselves, and some 
 even rejected the little food they put into their stomach. After 
 great discharges of blood, digestion sometimes remains so laborious 
 that the stomach is unable to repair its losses. The stomach here 
 suffers with the economy at large, and the derangement in its func- 
 tions is dependent upon constitutional causes ; but the peculiarity 
 of its functions, being the medium through which strength is re- 
 paired, and its ultimate connection with all parts of the system, 
 render it more likely to be disturbed in its function, by causes affect- 
 ing the economy at large, than any other organ. Dr. Graves has 
 recognised this form of stomach disease depending upon consti- 
 tutional causes, when he says that "it is sometimes produced by 
 debility of the vital powers of the stomach and intestines, affected 
 by causes which act on the whole organisation." 2 
 
 1 Andral, Clinique Medicale, Spillan's translation, p. 91 
 
 2 Clinical Lectures in the London Medical and Surgical Journal, vol. vii. 
 p. 642. 
 
16 PARKER ON THE STOMACH. 
 
 CHAPTER III. 
 
 GENERAL REVIEW OF THE SYMPTOMS AND SYMPATHIES DEPEND- 
 ENT ON VASCULAR IRRITATION OF THE STOMACH. 
 
 THE inflammatory nature of one form of indigestion, has been 
 admitted by many writers, but the affection has never, to my know- 
 ledge, been clearly followed out in what appear to be its most im- 
 portant points, its influence upon the condition of other organs. 
 The late Dr. Parry, of Bath, considered that dyspepsia itself con- 
 sisted in a morbid fulness of the vessels of the mucous coat of the 
 stomach, and after detailing some facts in proof of his opinion, he 
 concludes that this excessive determination would probably bring 
 the malady within the limits of inflammation. 1 The opinions of 
 Broussais on this point are the same ; he attributes the greater part 
 of all forms of indigestion to chronic inflammation of the lining 
 membrane of the stomach. 2 Bouillaud observes that this kind of 
 indigestion differs but in degree from that form of irritation known 
 by the name of gastritis, or gastro-enteritis; the inflammatory irri- 
 tations of the stomach assuming a series of shades in their degrees 
 of intensity, of which indigestion of this kind is the first arid most 
 simple, and cholera the most severe. 3 Goupil 4 Merot, 5 and others, 
 all admit this species of indigestion as a symptom or group of 
 symptoms of a diseased condition of the lining membrane of the 
 stomach, which is characterised by inflammatory action. We daily 
 meet in society a class of persons who are neither well nor ill, 
 complaining of want of appetite, heaviness, and loss of spirits, who 
 are distressed, as they inform, you, with constant flatulence: some- 
 times there is a disposition to take food of a savoury character, and the 
 appetite may be capricious or variable ; occasionally a fit of vomit- 
 ing will seize them, which is attributed to some unwholesome food 
 which has been eaten, but which in reality is owing to the irritable 
 and diseased condition of the lining membrane of the stomach ; the 
 tongue is foul, the mouth dry, and the bowels almost constantly 
 confined, to which latter circumstance all the evils are attributed, 
 although this is but a symptom of the complaint a consequence, 
 and not a cause. These persons are, in most cases, affected with a 
 congested or inflamed condition of the mucous membrane of the 
 stomach. Let us examine the symptoms in detail : 
 
 1 Elements of Pathology and Therapeutics, by C. H. Parry, M. D., Bath, 
 3825. p. 165. 
 
 2 Commentaires de Propositions de Pathologic, t. i., p. 277. Paris, 1829. 
 3 Dictionnaire de Medecine Pratique, tome x., art. Indigestion. 
 
 4 Exposition des Principes de la Nouvelle Doctrine Medicale. Paris, 1824. 
 
 5 Dissertation sur la Dyspepsie. 
 
VASCULAR IRRITATION OF THE STOMACH. 17 
 
 OF THE STATE OF THE TONGUE IN THE PRIMARY FORMS OF 
 VASCULAR IRRITATION OF THE STOMACH. 
 
 In inflammatory irritation of the stomach, characterised by 
 symptoms of indigestion, the state of the tongue is very variable, and 
 hears no strict relation to the degree of disease or irritation existing 
 in the gastric mucous surfaces. The most common and uniform 
 state is a contracted tongue, of a dry appearance, coated in the 
 centre,' and vividly red at its point and edges ; the papillae are 
 developed, and of a more vivid colour than the red surface on 
 which they are placed. This condition commonly coincides with 
 the ordinary and more common symptoms of distension and weight 
 in the epigastrium, nausea and vomiting. Another condition occurs 
 where the coating of the tongue spreads over its whole surface, 
 through which the papillae appear intensely red and vivid; the 
 coating extends to the very edge of the tongue, and there is merely 
 a red line at the point and edges. Generally with this state the 
 sensibility is more developed; we find despondency, languor, and 
 faintnes^. with indescribable feelings of uneasiness in the epigas- 
 trium, which are brought on and increased by pressure. A third 
 state occurs where the tongue is red and smooth ; the papillae have 
 almost disappeared, and there is a coating in two distinct lateral 
 layers, one on each side of the tongue. "This, in most instances, 
 indicates a far more serious degree of disease than the other two ; 
 and though other symptoms may not be so strongly marked, still this 
 state, though merely accompanied by the ordinary symptoms of 
 indigestion, should excite our suspicion of the degree of complaint 
 in the stomach being very serious. The very nature of these dis- 
 eases prevents their exhibiting any marked physical symptoms ; yet 
 if the epigastric region in these conditions of tongue be carefully 
 examined, we shall commonly find it hard and resisting, indicating 
 a thickened or scirrhous state of the membranes entering into the 
 composition of the stomach. I have now a gentleman under my 
 care with this state of tongue, who is forty-five years of age. He 
 has had symptoms of indigestion, with vomiting of food, for 
 twenty-five years, doubtless depending upon chronic gastritis. On 
 examining the epigastrium, there is a distinct and almost defined 
 uneven hardness, which is probably a thickened state of the coats 
 of the stomach : he has now daily vomiting and progressive ema- 
 ciation, which hardly offers the hope of recovery. 1 attended an- 
 other person, for two years, with this state of tongue, who gained 
 but temporary relief from any mode of treatment adopted. He 
 died at the end of this time, and on examination the coats of the 
 stomach were found much thickened, its mucous coat uniformly 
 and intensely injected, with the liver slightly enlarged. 
 
 Notwithstanding what I have said of the occasional coincidence 
 of a certain state of tongue with a fixed morbid condition of the 
 stomach, still the state of the tongue, taken as an isolated symptom, 
 9 g park 2 
 
18 PARKER ON THE STOMACH. 
 
 will afford no certain or even probable data on which to act in 
 relation to the pathologic state of the gastric mucous surface. The 
 results of my own observations are corroborated by those of Louis 1 
 and Andral ; 2 and although the researches of these physicians chiefly 
 refer to the relations existing between the state of the tongue and 
 stomach in fever, still, as Andral justly remarks, the same discre- 
 pancy exists between the states of these organs in other diseases. In 
 the earlier stages of inflammatory indigestion there is every variety 
 of tongue, and a clean and moist state of this organ may be found 
 where the symptoms of gastric irritation are very urgent. 
 
 A lady, eighteen years of age, was brought to me, suffering from 
 symptoms of inflammatory irritation of the stomach ; she had been 
 irregular in her menstruation for some time. There was tenderness 
 and heat in the epigastrium, with corresponding pains in the 
 back and left shoulder ; she had constant nausea, with daily vomit- 
 ing of food, and a full hard pulse, at one hundred. With this state 
 the tongue was pale, broad, and moist. 3 
 
 Occasionally a state of inflammation in the tongue itself coincides 
 with the symptoms of which we have been speaking-. Thus, we 
 occasionally see an intensely red tongue, with aphthous spots, 
 which is a purely local disease, and certainly not indicative or symp- 
 tomatic of any gastric disturbance with which it may be associated. 
 I have a gentleman now under my care who is in this state. The 
 twenty-ninth and thirtieth observations of Louis 4 are also cases of 
 a similar character. 
 
 OF THE STATE OF THE EPIGASTRIC AND HYPOCHONDRIAC 
 REGIONS. 
 
 It is rare not to find, on careful examination of the regions cover- 
 ing the spleen, stomach, and liver, some physical signs of the com- 
 mencement of inflammatory irritation of the stomach or the organs 
 strictly dependent on it, as the liver and spleen. These symptoms 
 are chiefly fixed pain, fulness, heat, and distinct tumefaction. 
 Fixed pain may occur in several situations; on the left of the 
 sternum, deep in the left hypochondriurn, in the epigastrium, or in 
 the right hypochondriurn. The several seats of pain are generally 
 indicative of the seat of complaint, whether it be in the cardiac 
 portion of the stomach, in the greater curvature, or in the pylorus. 
 The state of sensibility in the centre of the epigastrium, which 
 
 iDe la Gastro-Enterite, &c., tome ii., p. 64. Paris, 1829. 
 
 2 Clinique Medicale, by Spillan, part iv. 
 
 3 It should be well observed that in the same manner as redness of the 
 tongue is not necessarily connected with gastric irritation, so whiteness of 
 the tongue does not always exclude the existence of this irritation. It is for 
 other symptoms to disclose this; we may then estimate their importance, 
 and calculate how far the existence of this irritation may modify the treat- 
 ment. Andral, p. 745, part iv. 
 
 4 Op. cit., tome ii., pp. 66 and 77. 
 
VASCULAR IRRITATION OF THE STOMACH. 19 
 
 corresponds to the situation of the great nervous ganglia of the 
 abdomen, is extremly deceptive, since most persons are sensible to 
 moderate pressure in this situation. Fulness in the epigastrium 
 and left hypochondrium is commonly attendant on the primary 
 stages of disease ; in the latter periods, when the coats of the sto- 
 mach become thickened, this disappears, and is replaced by a resist- 
 ing hardness and dull percussion. Fulness and distension some- 
 times run to so distressing an extent that the throat feels filled with 
 flatus, and the stomach and bowels are distended to suffocation. If 
 much gas be evolved during digestion, the sound is clear, when 
 these regions are examined by percussion, and the extent of this 
 clearness is very variable. I have noticed it, as in the subject of 
 Case VI., 1 extending below the umbilicus ; after death the inflamed 
 and dilated stomach was found occupying nearly the whole of the 
 abdomen.* Percussion is generally clear in the hypochondriac and 
 epigastric regions in the earlier stages of inflammatory disease of 
 the stomach, unless this organ be distended by aliment. The tem- 
 perature is always elevated, particularly in the centre of the epigas- 
 trium. After fits of repletion in persons accustomed to live well, 
 and who habitually carry about with them the symptoms of chronic 
 gastritis, there is commonly distinct tumefaction in the left hypo- 
 chondrium, which appears to be dependent on a congested state of 
 the spleen. I have often found the spleen much enlarged and 
 united by strong adhesions to the stomach, after death from chronic 
 gastritis : the subject of Case I. 2 affords a remarkable example of 
 this pathologic state. 3 Nausea is almost an invariable attendant 
 upon inflammatory indigestion; it may occur at various periods 
 after taking food, immediately, or at any time during the first two 
 or three hours; it is sometimes the first indication of complaint, 
 and, coupled with vomiting, often continues for years without any 
 other marked symptom attracting the attention of the patient. These 
 states may co-exist with pain, or the latter symptom may be entirely 
 absent ; even uneasiness, or tenderness about the epigastrium, or 
 hypochondria, may be entirely wanting, and no indications of dis- 
 ease present, except nausea and vomiting. I have often seen these 
 symptoms resist every attempt at cure, except leeches to the epi- 
 gastrium. 
 
 Constipation most commonly is present, but there are states of 
 incipient and confirmed inflammatory disease of the stomach in 
 which the bowels are either regular or inclined to relaxation. 
 Occasionally there are alternate states of constipation and diarrhoea. 
 In the latter stages of the disease the latter symptom is commonly 
 present, from an extension of disease to the mucous surfaces of the 
 small and large intestines. 
 
 1 See Case VI. in the chapter on the influence of the stomach upon the 
 heart. 
 
 2 See Case I. in the chapter on the influence of the stomach upon the 
 liver. 
 
 8 See Broussais, Cours de Pathologie, &c., tome ii,, p. 76. 
 
Jn 
 
 20 PARKER ON THE STOMACH. 
 
 Pulsations and tremulous motions in the epigastrium are com- 
 monly attendant on incipient gastritis. They are sometimes eva- 
 nescent, coming on for a few minutes or an hour, and then ceasing ; 
 at other times they are more permanent, constantly present during 
 the whole continuance of the disease. They are sometimes only 
 evident to the patient, who will complain of beatings in this situation 
 which no manual tact can discover, but, in many instances, sensible 
 not only to the hand but to the eye. These symptoms are gene- 
 rally attended by others which indicate a state of exalted sensibility. 
 I have most frequently observed them where the disease was accom- 
 panied by great anxiety and despondency; in these instances the 
 epigastrium has always been hot and tender, pressure upon it not 
 occasioning so much pain as an undescribable feeling of wretched- 
 ness and uneasiness in the patient, which is commonly by htm 
 termed awful. In most cases they have been cured by antiphlogistic 
 treatment. 
 
 OF THE STATE OF THE ORGANS OF RESPIRATION. 
 
 No system is more commonly affected from inflammatory disease 
 in the stomach than the organs of respiration. The strict union 
 of the stomach with the diaphragm, the connection of this with the 
 pleura, and the latter with the lungs, and the strict nervous union 
 by the branches of the par vagum, render the sympathies between 
 the organs of respiration and the stomach exceedingly marked and 
 closet Several symptoms of disease in the stomach are to be found 
 in the organs of respiration. The first is a short dry cough, which 
 has been denominated, by the French, toux gastrique ; sometimes 
 this is the only symptom, but it may be accompanied by expectora- 
 tion of frothy, bloody, heavy, discoloured mucus, accompanied by 
 pains in the sternum, epigastrium, hypochondria, or some points of 
 the thoracic parietes. 
 
 I have seen acute pains, resembling pleurisy, supervene upon 
 this gastric disease, and evidently produced by it ; and it is a fact, 
 of which I daily acquire more conviction, that many persons 
 ultimately perish from chronic bronchitis, which is produced by 
 chronic gastritis, and of which the first symptom is a short dry 
 cough. The state of the case is rendered commonly much worse 
 by the stimulating expectorants which are exhibited to relieve the 
 pectoral disease. Accelerated respiration, wilh or without cough, is 
 another symptom in the organs of respiration depending upon dis- 
 ease of the stomach. This very commonly approaches the character 
 of pneumonia, in the aspect the breathing assumes, when no disease 
 of the lung is present ; and if no other use were ever to be made of 
 the stethoscope, its value in ascertaining the state of the lung when 
 the respiration is hurried or quickened from causes not aifecting the 
 integrity of the lung or its membranes, but depending upon other 
 causes, would entitle it to be ranked among our most important 
 means of diagnosis. In children, hurried breathing is sometimes 
 
VASCULAR IRRITATION OF THE STOMACH. 21 
 
 the most marked symptom of gastritis ; occasional sickness, with 
 cries and the accelerated respiration, are the chief marks of the dis- 
 ease. In these cases we are almost sure to wander into error, unless 
 guided by the stethoscope, the more marked pulmonary symptoms 
 completely masking the gastric disease which produces and keeps 
 them up. The influence of disease of the stomach upon the organs 
 of respiration has attracted the attention of Stoll, 1 Baillou, 2 Brous- 
 sais, 3 and Dr. Philip : 4 by some other physicians, who are not such 
 good pathologists as those just mentioned, these pulmonary affec- 
 tions have been treated as chimeras. I am convinced, from long 
 and close attention to this class of diseases, that the stomach is a 
 most common source of pulmonary disease. 
 
 OF THE PULSE AND HEART. 
 
 An inflammatory condition of the mucous membrane of the 
 stomach exerts a most marked influence over the heart and arteries, 
 independent of the mere increase in frequency and force of pulsa- 
 tion which is characteristic of all inflammatory conditions, whether 
 acute or chronic. The state of the susceptibility of the nervous 
 system varies much ; and hence we find that whilst the heart is 
 uninfluenced in the regularity of its actions, in many instances, in 
 others, fits of palpitation are present which threaten suffocation. 
 The heart may be affected by irritation in the stomach in many 
 ways ; by mere, increased impulse, by occasional intermissions of 
 its pulsations, or by irregular and tumultuous motions. In some 
 instances, an actual physical si^n of disease may be present, and 
 after death the heart be found perfectly healthy. Cruveilhier has 
 recorded a case of this nature, 5 where the action of the heart and the 
 morbid sound it emitted were dependent upon stomach disease. I 
 have recorded another, which will be found in a subsequent part 
 of this volume. The pulse is also liable to occasional variations, 
 which are sometimes independent of the action of the heart. These 
 symptoms are manifested in a double or triple motion of the artery 
 to each contraction of the ventricle. Many cases of this kind will 
 be found in the chapters on the influence of the stomach upon the 
 heart. Whilst the symptoms which mark the existence of disease 
 in the stomach are found principally, in some instances, marked in 
 the heart, so are the symptoms of diseased heart sometimes princi- 
 pally manifest in the derangement of the functions of the stomach. 
 I have recorded one or two cases where the only symptoms of dis- 
 eased heart were pain and tenderness in the epigastrium, nausea, 
 distension, and weight after eating, and occasional vomiting. 
 
 1 Medecine Pratique. 
 
 2 Opera Omnia. 
 
 3 Histoire des Phlegmasies Chroniques. 
 
 4 Treatise on Indigestion. 
 
 5 Anatomic Pathologique. 
 
22 PARKER ON THE STOMACH. 
 
 Broussais 1 is of opinion that the complaint in the stomach is gene- 
 rally confined to its cardiac portion when the sympathies of the 
 heart are so marked ; at least affections of this part act more easily 
 upon the heart than when disease is seated in other portions of this 
 viscus. 
 
 OP SYMPTOMS PRESENTED BY THE BRAIN AND SENSES. 
 
 These are of many kinds, and are manifested in the brain by 
 stupor, giddiness, and confusion of thought. In some instances, a 
 great degree of mental excitement is present, in others as much 
 despondency. These states, however, depend very much upon the 
 natural constitution of the nervous system, and its degree of 
 susceptibility to impression. In a great number of instances there 
 is li-ttle affection of the head, and this is then confined to a constant 
 headach, seated in the temples and forehead. Horrible dreams of a 
 peculiarly vivid and distinct character, are commonly present. The 
 countenance is sometimes puffed or bloated, and the patient has a 
 sense of not being able to collect his ideas with judgment or cer- 
 tainty. The states of excitement in the brain sometimes approach 
 complete delirium, and occasionally terminate in lunacy or mania. 
 Bordeu, 2 Pinel, 3 Prost, 4 Richond, 5 and Broussais, 6 dwell, with reason, 
 upon the states of the head which depend upon, or are produced by, 
 chronic gastritis, or by irritation in the stomach. In reference to the 
 senses, the symptoms most commonly observed are either a diminu- 
 tion in the acutehess of their acustomed degree of perception, or 
 an exalted and depraved exercise of this power. We observe in 
 the ear dulness, approaching to deafness, or an acute perception, 
 which magnifies mere whispers into loud sounds. In the functions 
 of the eye we find dimness or cloudiness of vision, or hallucinations, 
 which vary from the simple appearance of a few black specks float- 
 ing in the air, to the fancied presence of one or more objects, whether 
 of animals or men. These cases do riot commonly occur, and 
 chiefly are owing to morbid states of the sensibility of the organs 
 in which they are met with, called into action by the same .state 
 of morbid sensibility in the gastric nerves ; but several cases will 
 be found in subsequent pa^es, where these depraved sensations were 
 clearly the result of an inflammatory process. 
 
 OF LOCAL PAINS. 
 
 The pains which are symptomatic of inflammatory diseases of 
 the stomach are not always confined to the epigastric region ; pains 
 
 1 Cours de Pathologie et Therapeutique Generates. 
 
 2 CEuvres Completes, par Richerand. 
 
 3 Nosographie Philosophique. 
 
 4 Medecine Eclairee, par 1'Observation ef 1'Ouverture des Corps. 
 6 De I'lnfluence de 1'Estomac sur la Production de PApoplexie. 
 
 6 Op. cit. 
 
INFLAMMATORY AFFECTIONS OF THE STOMACH. 23 
 
 in parts of the thoracic or abdominal parietes may co-exist with 
 pain or uneasiness in the epigastrium, or this may be entirely 
 absent. This depends altogether upon the situation in which 
 the disease in the stomach exists, whether in the cardia, in 
 the curvatures or in the pylorus. Pain in the centre of the 
 sternum, with soreness of the skin in this situation, and absence of 
 uneasiness in the epigastrium, is a very common symptom. We 
 also find these pains on either side of the sternum, in its lower half, 
 in the mammae, in both shoulders, under the scapulae, in the centre 
 of the back, and in the throat, with difficulty of deglutition. Shoot- 
 ing pains are felt also, in certain cases, on almost all points of the 
 lower parts of the chest. These pains may resemble pleurisy or 
 pneumonia, and I have frequently seen persons misled by them ; 
 here the stethoscope, and a careful analysis of the conditions of the 
 various organs of the chest and abdomen, alone can guide us. 1 We 
 have these pains existing without accelerated or hurried breathing 
 or cough, and when this is the case we may generally conclude that 
 they are not connected with any pulmonary complaint. They may, 
 however, co-exist with these symptoms and still be gastric. Here 
 the stethoscope is our only safeguard. 
 
 CHAPTER IV. 
 
 ON CONFIRMED INFLAMMATORY AFFECTIONS OF THE STOMACH. 
 
 The passage of disease from the mere hyperemic state to the in- 
 flammatory is very easy, and the shades which separate them are 
 very faint ; in fact, the symptoms which accompany the first state are 
 sometimes more marked than those which are proper to the second. 
 In the hyperemic state we have sometimes symptoms of great inten- 
 sity accompanying digestion, whilst in the confirmed inflammatory 
 condition there is occasionally little more symptom of complaint 
 than obstinate constipation, with dull pain in the epigastrium, 
 hardly perceived till the patient's attention is directed to it. These 
 symptoms, co-existing with an anxious cast of countenance, slight 
 emaciation, low spirits, and slight flatulence after food, are then all 
 that denote complaint. 
 
 1 II faut eviter de rapporter au poumon les douleurs lancinantes, et pongi- 
 tives qui, partant des papilles nerveuses de 1'estomac retreci, et remonte sous 
 la voute du diaphragm, pourraient aller retentir aux environs du mamelon. 
 F. J. V. Broussais, Histoire des Phlegmasies Chroniques, tome iii., p. 45. 
 Paris, 1829. 
 
24 PARKER ON THE STOMACH. 
 
 OF INFLAMMATORY AFFECTIONS OF THE STOMACH ACCOMPANIED 
 BY A PECULIAR CONDITION OF THE TONGUE. 
 
 Man y of our best pathologists, among whom are Louis and Andral, 
 are of opinion that there is no direct relation existing between the 
 state of the tongue and the state of the stomach in disease ; that is, 
 that the former does not afford, as it has been supposed to do, any 
 certain evidence of the condition of the latter. Sometimes the 
 tongue is clean, and the symptoms of disease in the stomach of an 
 aggravated character, and strongly marked ; at other times we find 
 the tongue coated, or covered with aphthous crusts, and intensely 
 red and smooth in the intervals of these crusts. This may exist 
 without any affection of the stomach. We again find that this state 
 of the tongue sometimes exists with pure chronic gastritis, but that 
 the state of the tongue is not altogether indicative of the disease in 
 the stomach, but results in a great measure, from local disease in 
 the tongue itself. Thus, we may have a clean tongue with a dis- 
 eased stomach, a diseased tongue with a healthy stomach, or disease 
 co-existing in both organs, but independent of each other. 
 
 CASE 1. Aphlhous and ulcerated tongue co-existing with symptoms of 
 
 chronic gastritis. 
 
 A gentleman, of middle a^e, had been out of health for some time, 
 yet no very marked symptom of complaint was present to which 
 his attention was directed ; he complained merely of loss of spirits, 
 had bad nights, and occasionally a little nausea, although the appe- 
 tite was good. After the continuance of these symptoms for some 
 months, during which time the countenance acquired a sallow tinge, 
 the tongue became dry, red, and foul, and covered with aphthous 
 crusts ; on the borders of the tongue the white incrustations dropped 
 off, and left small ulcerations underneath. In the intervals the 
 tongue was vividly red and dry, and the surface thickly loaded 
 with a brown fur. With this state of tongue there existed the most 
 obstinate constipation ; the bowels were never relieved without 
 medicine, and when suffered to pass for three or four days, without 
 discharging their contents, sickness and vomiting succeeded. The 
 patient suffered from great languor and mental depression ; the pulse 
 was feeble, creeping and slow. On examining the epigastrium we 
 found there existed considerable uneasiness upon slight, pressure, 
 occasionally a shooting pain was felt, and the patient was tormented 
 with flatulence. The emaciation, although the disease had con- 
 tinued for many months, was hardly perceptible; but the limbs had 
 lost their usual firmness, and were become soft. The aphthons 
 state of the mouth was always increased by constipation ; if the 
 bowels were kept free the state of the tongue was always amended, 
 but if constipation was suffered to continue nausea came on, and 
 
INFLAMMATORY AFFECTIONS OF THE STOMACH. 
 
 the tongue became encrusted and dry, the gums spongy, and 
 covered with spots as well as the tongue. 
 
 It is not often that we observe this aphthous state of the tongue 
 and gums coinciding with chronic gastritis ; for, in the case under 
 consideration, it is evident that the state of the tongue arid gums 
 was dependent upon that of the stomach ; on the removal of the 
 constipation, and keeping the patient for a week or two upon fari- 
 naceous food, the aphthse would disappear, the tongue become 
 moist, and lose its vividly red and smooth appearance, whilst a 
 recourse again to stimulating food, and neglecting the state of the 
 bowels, would as constantly bring the tongue to its primitive morbid 
 condition, and the symptoms of disease in the stomach would return 
 at the same time. It must not be forgotten that this state of tongue 
 and gums may be purely local, and unconnected with any stomach 
 disease ; depending upon an inflammatory state of these organs 
 themselves, independent of disease in any other. Again, we see it 
 produced by gastritis, as in the present instance, and, under these 
 forms, is generally accompanied by a depressed state of the vital 
 powers generally. It is commonly a very serious symptom, but I 
 have seen many cases, where, under a judicious treatment, the 
 aphthous crusts, have fallen off, the tongue has become moist, and 
 the gums have lost their spongy appearance. If the aphthous state 
 be treated, under these circumstances, as a purely local disease, and 
 the complication of gastritis with it be overlooked, it is extremely 
 probable the patient will die, since under some circumstances, 
 chronic inflammation of the stomach is a disease of so insidious and 
 obscure a character, even when it has occasionally proceeded to a 
 state of disorganisation of the mucous membrane, that a superficial 
 observer may pass it over. Louis has recorded two cases, in his 
 work, De la Gastro- Enter ite, fyc., exhibiting inflamed and ulce- 
 rated states of the tongue, in fever independent of any gastric 
 affection. These states may doubtless occur, but I am anxious to 
 impress upon the reader the fact, that these peculiar states of tongue 
 may be present with inflammatory conditions of the stomach, of 
 which they are commonly the only strongly marked symptoms. A 
 peculiar sensibility of the tongue is sometimes indicative of gastric 
 disease. I know a lady, in whom attacks of gastric inflammation are 
 manifested by a peculiarly sensible and painful state of the tongue, 
 accompanied by an itching, which is extremely distressing. In a 
 second lady, severe attacks of vomiting, attended with all the phe- 
 nomena of inflammatory action, accelerated pulse, heat of skin, and 
 tenderness of the epigastrium, were preceded and accompanied by 
 an exalted state of sensibility in the tongue and a constant sensation 
 of pricking. In both these latter cases the tongue was moist and 
 clean. 
 
 In all these instances we find the same state of disease manifested 
 by symptoms which are of various kinds, even in the same organ, 
 proving that no system of nosology can give proper ideas of disease. 
 So different are the susceptibilities of different organs, that we find 
 
26 PARKER ON THE STOMACH. 
 
 the evidences of chronic gastritis sometimes in one organ, sometimes 
 in another; occasionally they are marked by depraved sensations 
 of various kinds, and sometimes entirely unaccompanied by pain. 
 Not only are the symptoms of stomach disease sometimes found in 
 one organ, and sometimes in another, but the kind of morbid con- 
 dition in the same organ is extremely variable, being sometimes 
 manifested by depraved sensations, and again by various forms of 
 inflammatory action. 
 
 A long and close attention to the condition of the tongue, as 
 affording any certain da'ta of the kind or degree of disease existing 
 in the stomach, has convinced me that there is no reliance what- 
 ever to be placed upon it, considered as an isolated symptom. 
 From the examination of a number of cases of disease of the 
 stomach, accompanied, as all inflammatory affections are, with 
 febrile action of a more or less intense character I must concur in 
 the deductions made by Louis on the state of this organ in febrile 
 and inflammatory affections generally ; that the tongue, like all other 
 organs, during febrile or inflammatory states of the constitution, is 
 liable to attacks of inflammation, which give to it its various mor- 
 bid appearances. 1 I have shown, in many parts of this work, the 
 truth of another point, (first established by Louis,) that the stomach, 
 during general states of feverish disturbance, is liable to become 
 inflamed, but not necessarily so : the same remark applies to the 
 tongue. 
 
 CASE 2. A lady, aged thirty-six, had symptoms of gastric dis- 
 ease for two years, during which time the tongue was never red, 
 but always pale, moist, and very slightly coated. Death at the end 
 of this period, from ulceration of the lining membrane of the heart. 
 Pyloric portion of the stomach intensely red, covered with patches 
 of red points ; cardiac portion studded with small red clusters of 
 points, in the centre of which the mucous membrane was softened. 
 
 CASE 3. A youth, aged twenty, had symptoms of chronic 
 gastytis for many months. The tongue was pale, moist, and 
 slightly coated in the centre. Death from acute peritonitis. The 
 cardiac portion of the stomach was inflamed and softened, for a 
 space as large as the open hand. 
 
 CASE 4. "A girl, aged twenty, died from typhus fever. The 
 stomach was inflamed and softened, but the tongue moist, contracted, 
 and pale." 2 
 
 In many of the cases detailed by Louis, the tongue did not differ 
 from its healthy state, whilst the mucous membrane of the stomach 
 was inflamed or softened. 
 
 In some of the cases collected by Andral 3 of the terminations of 
 
 1 La derniere consequence des fails rapportes, c'est, qu'on ne doit examiner 
 la langue que pour ellejneme, et non pour connaitre 1'etat de la membrane 
 muqueuse de 1'estomac. Louis, Op. cit. tome ii., p. 106. 
 
 * Louis, Observation the Fifth. 
 
 8 Clinique Medicale. 
 
INFLAMMATORY AFFECTIONS OF THE STOMACH. 
 
 chronic gastritis in scirrhus, or thickening of the coats of the 
 stomach, the tongue did not deviate from its naturally healthy 
 state. 
 
 If we carry our observations on the state of the tongue to cases 
 of the milder forms of stomach disease, we shall notice such affec- 
 tions, of great intensity, where the tongue presents little or no 
 deviation from the healthy state. I have now under my care two 
 patients who have been the subjects of chronic diseases of the 
 stomach for several years, in whom emaciation has slowly pro- 
 gressed, who have defined tumours in the epigastrium, but in both 
 of whom there is not the slightest morbid condition of the tongue. 
 
 We have a second series of cases, in which morbid states of the 
 tongue, of an inflammatory kind, are met with; and on examination 
 after death the stomach is found free from all appreciable disease. 
 
 CASE 5. A gentleman, aged forty, had symptoms of gastric dis- 
 ease for many years, which consisted in daily vomiting of food both 
 solid and fluid, in an intensely acid state ; he had considerable pain 
 and tenderness in the epigastrium, with a tongue vividly red, 
 shining and smooth. He subsequently died of disease of the lung, 
 the gastric symptoms continuing- even, under an aggravated form 
 up to (he period of dissolution. The stomach was free, in all points, 
 from the least appearance of disease. 
 
 " We have observed some persons," says Andral, " who for several 
 months in succession, presented such a state of tongue : they had all 
 the other signs characteristic of chronic gastritis. But this appear- 
 ance of the tongue alone should not suffice to cause us to admit its 
 existence: from time to time persons are met with who, without 
 experiencing any disturbance in their digestive functions, have, like 
 the preceding, a red and smooth tongue." 1 
 
 The third series of facts are those in which an inflammatory state 
 of the tongue co-exists with the same disease in the stomach. 
 
 CASE 6. A lady, aged 53, had suffered from symptoms of chronic 
 gastritis for twenty-five years. She had constantly a smooth dry 
 tongue of a deep red colour. On examination after death, which 
 took place from prolonged gastric disease, the cardiac portion of the 
 stomach was intensely red, presenting one uniform surface of 
 inflammation, covered with a bloody mucus. 
 
 CASE 7. A lady, aged forty, was subject to pain after food, with 
 daily vomiting, for three years. The tongue was of a smooth, 
 shining red, perfectly dry, the redness most marked at. the point 
 and edges. On examination after death, the whole mucous surface 
 of the stomach presented a pink appearance; in some places there 
 were patches of a deep red colour, consisting entirely of minute 
 blood-vessels. 
 
 These series of facts show how uncertain are the data afforded 
 by the state of the tongue in confirmed organic disease of the 
 stomach. In the earlier stages of disease, in which there is mere 
 
 1 Op. cit. 
 
28 PARKER ON THE STOMACH. 
 
 fulness of blood, or slight irritation unconnected with confirmed in- 
 flammatory disease or its terminations, the state of tongue is as 
 variable as in the circumstances just mentioned. 
 
 One condition of the tongue may be here alluded to, which is 
 almost invariably an index of gastric irritation, of an inflammatory 
 kind. It is when this organ, not materially changed in other cir- 
 cumstances, presents, at the point and edges, a number of vividly 
 red points. These resemble grains of vermillion scattered over the 
 tongue. They appear to be the papillae enlarged, and supplied with 
 an increased quantity of blood. When there is any coating upon 
 the tongue, the brilliant papillae are seen uncovered by it. I believe 
 this condition is seldom found unaccompanied by vascular irritation 
 of the stomach. When it is met with in persons who do not offer 
 any symptoms of stomach derangement at the time we may always 
 con-elude that there is a strong predisposition to it, and that a very 
 slight cause is capable of producing gastric disturbance. 
 
 OF THE SYMPTOMS REFERABLE MORE PARTICULARLY TO THE 
 STOMACH ITSELF. 
 
 The evidences of diseases, in all organs, are principally to be 
 sought for in the derangements of those functions which are proper 
 to them in a state of health, and the degree of constitutional dis- 
 turbance which accompanies such derangements. In inflammatory 
 diseases of the stomach and their terminations, the first are chiefly 
 loss of appetite and an impaired state of the function of digestion, 
 remarked in pain, distension, anomalous nervous symptoms, nausea, 
 and vomiting. In many cases of chronic gastritis there is ttle 
 alteration in the appetite, and the patients fancy the degree of dis- 
 ease cannot be very great whilst the appetite continues so good. If 
 the whole surface, or a greater portion of the surface, of the mucous 
 membrane be affected, there is total loss of appetite ; but if the dis--. 
 ease be partial, as it most commonly is, and the inflammation con- 
 fined to patches of the mucous membrane, the appetite experiences 
 but little alteration. Although the appetite continue good, the 
 patient undergoes various inconveniences from attempting to satisfy 
 it; he is tormented with flatulence during digestion, feeling, after 
 having taken but a small portion of food, as though he had eaten a 
 full rneal, from the degree of distension which it produces. At other 
 times this distension mounts to the throat, and the sufferer is 
 annoyed by a sense of choking amounting to suffocation. At one 
 time, a burning heat follows a meal, at others, acute, lancinating 
 pain, the seat of which is variable; and again, a degree of uneasiness 
 is produced, which is not appeased till trie whole of the food taken 
 has been rejected. At other periods, indescribable feelings of sinking 
 and depression are experienced in the neighbourhood of the stomach. 
 AVhen the epigastrium is pressed these feelings are sometimes 
 brought on or aggravated. They are sometimes relieved for a short 
 
INFLAMMATORY AFFECTIONS OF THE STOMACH. 29 
 
 time by taking food ; at other times they are immediately aggravated 
 by it. 
 
 A lady under my care, with chronic gastritis, had a sense of some 
 impending evil about to befall her, with sinking and fainlness every 
 time the gastric symptoms became aggravated. 
 
 The evils experienced on taking food during the continuance of 
 chronic gastritis, are variable. 
 
 A gentleman, aged thirty-eight, had laboured under chronic 
 gastritis for three months. He had vomiting of food daily, with 
 great acidity, and internal heat " as hot as a hot iron," to use his 
 own expression. 
 
 A second gentleman had laboured under the symptoms of chronic 
 gastritis for many months. He had very acute pains after taking 
 food, which were not appeased till the food was rejected. The pain 
 was seated in the centre of the epigastrium. 
 
 The seat of pain occurring in chronic gastritis, is not always the 
 same. It may be felt in the throat, in the centre of the sternum, on 
 various points of the surface of the chest, under the prominences 
 of the ribs, on either side, or in the dorsal portion of the spine, or 
 under the scapulae. 
 
 The most common seat of pain is the centre of the epigastrium 
 itself; varying from mere uneasiness to a dull constant aching, 
 increased to acute lancinating pain on the aggravation of the gastric 
 symptoms, or from irritating or stimulating diet. 
 
 In a second form, the pain is referred to the centre of the sternum, 1 
 <>nd is supposed by many to indicate some affection of the chest, 
 especially when accompanied, as it sometimes is, by cough or 
 quickened breathing. 
 
 In some instances the pain is felt in the throat, and when swal- 
 lowing, accompanied at the same time with uneasiness in the region 
 of the stomach, shooting to the centre of the back or under the left 
 shoulder. These symptoms, in the opinion of Broussais, indicate 
 the localisation of the disease in the cardiac portion of the stomach. 
 
 A lady, aged twenty-six, had suffered from daily vomiting of food 
 for two years. Great distension, acidity, and pain, followed each 
 meal. The more prominent features of her complaint, however, 
 consisted in pain in the throat when she swallowed, and pain also 
 in the centre of the back, between the scapulas. She had also con- 
 siderable tenderness in the epigastrium, aggravated to a great degree 
 by pressure. The disease was removed altogether, in a short time, 
 by leeches, and blisters applied to the epigastrium and dorsal por- 
 tion of the spine, with some attention to diet, and the use of internal 
 remedies mentioned in the chapter on treatment. 
 
 The pains which accompany inflammatory conditions of the 
 
 1 On en voit qui eprouvent des donleurs fortes dans toute le thorax ou au 
 moins dans sa moite inferieure. * * La sensation est autant rapportee a 
 la peau du thorax qu'a 1'estomac. Broussais, Cours de Pathologic, tome ii., 
 
30 PARKER ON THE STOMACH. 
 
 stomach are not necessarily felt in the stomach itself, neither is pain 
 a pathognomonic symptom of the disease. " Chronic inflammation 
 of the stomach is not necessarily acornpanied with pain in the 
 region of the suffering organ." 1 We commonly find it seated on 
 various points of the upper part of the abdomen ; sometimes evidenced 
 by a sense of constriction, or binding; at other times by stinging, 
 lancinating pains felt as low as the umbilicus, in the belly, or in 
 the chest, upwards as far as the mammae, but this more particularly 
 on the left side. 
 
 CASE 8. A gentleman, suffering from all the symptoms of chro- 
 nic gastritis, had acute, lancinating pains, radiating from the centre 
 of the epigastrium over the left side of the chest as high as the left 
 mamma. These were all the local pains he suffered. 
 
 CASE 9. A second gentleman, whose gastric disease was evi- 
 dently produced by an affection of the heart, had a sensation of 
 binding, as though a string had been tied tightly round his waist, 
 after taking a moderate meal. 
 
 It is very common to find patients complaining of pain, some- 
 times constant and fixed, at other times accompanying or following 
 a meal, deep under the ribs, in the left hypochondrium ; with this 
 pain co-exist all the other more marked symptoms of chronic gastri- 
 tis, though tenderness in the epigastrium is absent. The pain which 
 is seated under the ribs in the left hypochondrium, is dependent 
 upon disease localised in the greater curvature of the stomach. It 
 is very commonly met with in free livers, and is sometimes accom- 
 panied with a congested state of the spleen, so great that a distinct 
 tumefaction is discoverable. In many cases of examination after 
 death from chronic gastritis, the spleen is found much enlarged, 
 and united, by strong adhesions, to the stomach. I have reported 
 one or two examples of it. "Ce gastrite se decele par une douleur 
 profonde dans la region de la rate sous I'hypochondre gauche. 
 La douleur qui Paccompagne est fort incommode pendant plusieurs 
 heures, et plus violente lorsqne les alimens commencent d'etre dans 
 un etat de coction avancee." 2 
 
 The pain which is felt in the centre of the epigastrium is the 
 most common of all, though by no means pathognomonic of a dis- 
 eased condition of the mucous coat of the stomach. 3 It is the most 
 common for two reasons*: 1st. Because the pyloric portion of the 
 stomach, here situated, is generally the most frequent seat of in- 
 flammatory disease; and 2dly. Owing to the exalted sensibility of 
 the great nervous centres of the epigastrium, which generally accom- 
 panies an inflamed state of the mucous coat of this organ. We 
 have sympathetic pains accompanying inflammation of the mucous 
 coat of the pyloric portion, shooting into the region of the liver, 
 
 1 Andral, Op. cit. 
 
 'Broussais, Cours de Pathologic, tome ii., p. 76. 
 
 3 La sensibilite est variable suivante les individus; les uns en eprouvenl 
 une tres vive a la region de 1'epigastre, et les autres n'en emprouvent aucune. 
 Broussais, Op. cit. 
 
INFLAMMATORY AFFECTIONS OF THE STOMACH. 31 
 
 under the rigfht scapula, and to different parts of the right side of 
 the chest. These pains are very likely to mislead, and to make us 
 suspect a diseased condition of the liver, if we are not very careful 
 in our examinaton of the state of the patient. 
 
 One of the most common symptoms, attendant on an inflamed 
 condition of the stomach, is distension, fulness, or flatulence, ac- 
 companying or immediately succeeding a meal. It is very common 
 to meet with patients in whom the appetite is good, but who are 
 totally unable to satisfy it, from the degree of distension and 
 oppression which are consequent upon eating. Sometimes the ful- 
 ness is felt in the throat, at others in the region of the stomach 
 itself; patients, to relieve themselves from the state of distress and 
 inconvenience under which they labour, are obliged to slacken their 
 clothing, unbutton their waistcoats, or unlace their stays. It is not 
 after a full or over-hearty meal that these symptoms come on, but 
 occasionally after having taken the smallest quantity of food. This 
 state of distension is particularly marked and frequent where the 
 gastric disease is consequent upon an affection of the heart. I have 
 two gentlemen now under my care, in whom this was the first and 
 chief symptom attracting their attention. 
 
 Although chronic vomiting may depend upon various pathologic 
 states of the stomach, as also upon diseases in other organs, without 
 any affection of the stomach itself, still it is sometimes the only symp- 
 tom indicative of an inflamed condition of this part. I have frequently 
 had patients brought to me, in whom the principal complaint was 
 that they could not retain their food. They have had with this 
 other symptoms of partial gastritis, as a dry, coated tongue, heat 
 and tenderness in the epigastrium, headach, and thirst. Many 
 cases had been present for three, six, and more months, and some 
 had lasted for two or three years. In the opinion of Andral, 
 vomiting, as a symptom of an inflamed condition of the mucous 
 membrane of the stomach or its terminations, occurs principally in 
 two states ; where a chronic state assumes the acute type, or where 
 an obstacle is offered to the free passage of the food, either in its 
 entrance to, or exit from, the stomach. It is certainly not attendant 
 on all cases of gastritis, but occurs in many, both in its primary 
 stages, where the mucous membrane is turgid with blood and 
 the general sensibility exalted, and in its terminations also, where 
 the mucous membrane presents alterations either of colour or consist- 
 ence. In the earlier stages of inflammatory diseases of the stomach 
 vomiting is a much more common symptom than it is in the more 
 confirmed and chronic condition. 
 
 A lady, aged eighteen, was brought to me, who had daily vomited 
 all her meals for six months ; her stomach had absolutely retained 
 nothing. She had tenderness and heat in the epigastrium, but 
 scarcely any other symptom indicating an inflammatory condition 
 of the stomach. 
 
 Many such examples, which are not uncommon, might be 
 adduced. Occasionally vomiting is the only symptom present, and 
 
32 PARKER ON THE STOMACH. 
 
 takes place, without pain being produced, at an earlier or later period 
 after meals, varying from one to six hours. At other times vomiting 
 is accompanied by internal pain, shooting to various parts of the 
 abdominal or thoracic parietes, according to the seat and extent of 
 the disease. 
 
 After the more acute symptoms of inflammatory disease of the 
 stomach have subsided, arid the confirmed chronic state alone is 
 present, vomiting is not so common ; whilst, after the terminations 
 of such disease in change of structure, we commonly find this 
 symptom reappear with great intensity. 1 Vomiting, as a symptom 
 of chronic gastritis, is more common at the commencement and at 
 the termination of disease. We very commonly see intense vomit- 
 ing set in at the termination of chronic diseases of the stomach, 
 where change of structure has taken place from the long continu- 
 ance of insidious inflammatory action. The matters vomited may 
 consist of blood, food, or bilious matters. 
 
 CASE 10. A gentleman had laboured under the symptoms of 
 chronic gastritis for two years, the prominent feature of which 
 consisted in great pain after food, shooting to the back and over the 
 sides of the chest ; indeed, from the pain he was never entirely 
 free. During the latter weeks of disease he vomited small quantities 
 of blood, and suddenly a large quantity, soon after which he died. 2 
 A mass of fungoid vegetations were found in the pyloric portion of 
 the stomach, the whole of the mucous membrane being reddened, 
 at intervals, in patches. 
 
 In this case pain was the chief symptom present, vomiting not 
 coming on till the latter periods of disease. 
 
 CASE 11. A middle-aged lady had suffered, for some time, great 
 pain after her meals ; at length a vomiting set in, which was in- 
 controllable. No medicines afforded any relief. On examination 
 after death the mucous membrane was found covered by several 
 slate-coloured patches, about the size of a half-crown piece. We 
 commonly find vomiting take place during the progress of inflam- 
 matory diseases of the stomach, where the symptoms become aggra- 
 vated from errors in diet or other causes, and the affection passes 
 to a more acute stage, in which also the nervous irritability of 
 the stomach becomes much more exalted. This is very often met 
 with in those cases where chronic gastritis is associated with dis- 
 eases of the liver, as it so frequently is. In such instances the 
 stomach affection is constantly assuming the acute or sub-acute 
 type, and vomiting comes on ; whilst in subsiding to the mere 
 chronic form again this symptom ceases, although the inflammatory 
 action still remains. 
 
 1 have now under my care four patients with distinct and large 
 
 Chez quelques malades les vomissements durent autant que la maladie; 
 chez quelques autres ils n'ont lieu qu'au debut, chez d'autres au contraire, 
 qu'a la fin. Andral, Cours de Pathologie Interne, tome i., p. 62. 
 
 2 Q,uelque fois du sans: est rejecte vers la fin de la gastrite chronique, c'est 
 alors un signe de mort prochaine. Andral, Op. cit., p. 62. 
 
INFLAMMATORY AFFECTIONS OF THE STOMACH. 33 
 
 hepatic tumours, with which are associated all the symptoms of 
 chronic gastritis. In these cases, although the disease may remain 
 latent for a time, there is a constant tendency to assume the acute 
 type, which is invariably accompanied by vomiting. 
 
 Vomiting taken as an isolated symptom, is by no means indica- 
 tive of an inflamed condition of the mucous coat of the stomach; 
 in conjunction with others, it demands great attention. In chronic 
 gastritis, as I have said, it occurs chiefly when this is passing into 
 the more acute forms, or when organic change exists either in the 
 cardia or pylorus. 
 
 Vomiting of bile, food, and various discoloured secretions, may 
 take place from the stomach, consequent upon disease in other 
 organs, the stomach remaining healthy. These are chiefly to be 
 ranked among lesions of the nervous influence of the stomach. It 
 must be here remarked, however, that protracted functional derange- 
 ments may terminate in organic changes, which are attributed to 
 inflammatory action, although none of the symptoms of inflamma- 
 tory action are at first in existence. In fact, those which are called 
 functional derangements, are very commonly the first symptoms of 
 an organic change which is, perhaps, already commencing. 
 
 The Clinique Medicate contains the detail of the case of a 
 person " who,. from his eighteenth to his thirty-seventh year, scarcely 
 passed a summer without being attacked with copious vomiting of 
 bile, and alvine evacuations of the same nature. He, for some days, 
 felt a kind of general indisposition and fatigue : he lost appetite, the 
 epigastrium became a little sensible to the touch, and bilious eva- 
 cuations commenced ; they continued for two or three days, and 
 then his health was restored. In all the other seasons of the year 
 this person digested his food well, and suffered nothing from his 
 stomach; but such did not continue to be the case. Towards the 
 thirty-sixth year of his age his stomach began to be permanently 
 affected, and by degrees he presented all the symptoms of scirrhous 
 pylorus." This is a very good example of the mode in which 
 repeated attacks of gastritis lay the foundation for, and ultimately 
 terminate in, organic disease. The attack, at first corning on from 
 accidental causes, leaves a disposition in the organ to its recurrence 
 on the application of slighter exciting causes than those which at 
 first produced it, the mucous membrane remaining in a state to be 
 thrown into inflammatory action from slight dietetic errors; and 
 hence repeated irritations of the inflammatory kind, which in the 
 intervals leave the patient apparently free from complaint, ultimately 
 terminate in confirmed organic change. 
 
 I have had the charge of several patients in the latter stages of 
 gastric diseases, who have been able distinctly to trace the com- 
 mencement of their complaints. These have seldom commenced 
 before the age of twenty-five, at the periods when they had begun 
 the habitual use of a fuller and more stimulating diet than that of 
 the earlier periods of life. The symptoms with which they were 
 first affected were those of simple indigestion, in its various forms 
 10 a park 3 
 
34 PARKER ON THE STOMACH. 
 
 of pain or distension after food, nausea, or vomiting. These have 
 ceased at intervals, have been relieved by various plans of treatment, 
 but have shown a disposition to recur at longer or shorter intervals 
 from dietetic errors or excesses, or from other causes, in more aggra- 
 vated and obstinate forms than those in which they first made their 
 appearance, and accompanied by sympathetic irritations in the 
 head, heart, liver, or lungs, exhibited in the forms of giddiness, 
 palpitations, jaundice, or cough. 
 
 On examining the bodies of such patients after death, what has 
 been the condition of the organs exhibiting these symptoms during 
 life? In the stomach, changes of colour or consistence, ulcerations 
 or vegetations ; in the brain, thickening of its membranes, effusions, 
 increased determinations of blood; in the heart, alterations of its 
 internal or investing membranes, or, what is more common, of its 
 muscular structure ; in the lungs, congested, or inflamed states of 
 the bronchial mucous surfaces, or of the lungs themselves; and in 
 the hepatic system a diseased condition of the veins or substance 
 of the liver, alterations of colour or consistence, and various morbid 
 states of the bile, the gall-bladder, and the excretory passages of 
 the bile. Many of the patients in whom dyspeptic symptoms have 
 commenced about the ages of twenty-five or thirty, have fallen 
 victims to gastric diseases, and their complications at the ages of 
 from forty-five to fifty-five. A number of the histories of these 
 patients, detailed in the subsequent pages of this work, have been 
 carefully collected from the sufferers themselves ; and the pathologic 
 changes their organs exhibited have been ascertained by my own 
 dissections after death. 
 
 The internal pain experienced in purely inflammatory diseases 
 of the stomach is generally obscure, unless the disease be associated 
 with a degree of nervous excitement approaching, in some measure, 
 the character of neuralgia. This organ is the seat of two morbid 
 actions, which are attended by pain; each of which may be in 
 existence without the other, or they may be associated during the 
 progress of disease. These are vascular irritations or inflammations, 
 and nervous irritations; when the excitement is confined to the 
 nervous capillaries of the stomach, it is called, in medical language, 
 erethism. The pain which attends chronic gastritis, if this exist 
 in its simple state, without complication, is generally dull and 
 obscure. There is generally in this disease uneasiness or weight 
 in the stomach, which is occasionally relieved for a short time by 
 taking food, but the pain returns, in an aggravated form, at a varia- 
 ble period of time after eating. Sometimes immediate pain is felt, 
 again it is mere uneasiness at a protracted period of digestion, and 
 produced, as patients will often inform us, by the food touching a 
 sensitive surface, over which they can feel it passing. 
 
 CASE 12. A gentleman, suffering from the ordinary symptoms 
 of chronic gastritis, marked by pain and tenderness in the epigas- 
 trium and left hypochondrium. with distension, weight, flatulence, 
 and acidity after eating, complained to me of a sense of pain or pecu- 
 
INFLAMMATORY AFFECTIONS OF THE STOMACH. 35 
 
 liar uneasiness, occurring five or six hours after a meal, when he 
 fancied the food was passing over a surface more sensitive than the 
 other parts of the stomach. 
 
 In this case, although the symptoms of inflammatory disease of 
 the stomach were strongly marked, there is mere uneasiness after a 
 meal present. 
 
 If chronic gastritis occur in patients where the nervous system 
 is highly irritable, the character of pain occurring after taking food 
 is sometimes very violent. 
 
 CASE 13. Violent pain succeeding meals, apparently dependent upon 
 chronic gastritis. 
 
 A lady, aged forty-three, had been subject to attacks of pain after 
 food, with occasional vomiting, for fifteen years ; the attacks were 
 generally brought on by mental uneasiness. For three months 
 preceding my first attendance upon her she had been much worse. 
 At the time of my first visit she was much emacuted, had constant 
 pain in the stomach, aggravated to such an extent by taking food 
 that she was reduced to small quantities of cold gruel, and even 
 this occasioned much pain. There was most obstinate constipation, 
 with a dry, red tongue, and a small, rapid pulse. 
 
 The pains felt after food in this patient were very peculiar: 
 sometimes they shot into the mammae most acutely, and resembled 
 pleurisy; at other times she felt as though some one were scraping 
 the surfaces of the ribs in the hypochondria. With all this there 
 was no sign of pectoral disease, corroborating the remark of Brous- 
 sais, that we must not attribute all the pains that are felt in the 
 chest to a diseased condition of some one of its contained organs. 
 
 The pain was, in this case, not a nervous affection independent 
 of, and merely coinciding with, the inflammatory disease, but a 
 state of irritability strictly dependent upon, and produced by, the 
 gastritis, since it yielded to leeches, counter-irritation, and warm 
 aperients, and abated in the same degree as the inflammation which 
 companied it. In many instances, as in the following, we shall find 
 that this is not the case, but that the pain becomes more acute as 
 the symptoms of inflammation are less so. 
 
 CASE 14. Nervous affection of the stomach associated with inflammatory 
 disease, the nervous affection remaining after the inflammation had 
 subsided. * 
 
 A gentleman came under my care in November, 1834, labouring 
 under the usual symptoms of an inflamed condition of the mucous 
 membrane of the stomach. He had constantly uneasy sensations 
 in the stomach, which were considerably increased by taking food. 
 He had occasional vomiting 1 , distension after food, acid eructations, 
 with heat and tenderness in the epigastrium. These symptoms 
 yielded to antiphlogistic treatment, and all the symptoms of a dis- 
 eased condition of the stomach subsided, with the exception of un- 
 
36 PARKER ON THE STOMACH. 
 
 easiness after food, which augmented, as the inflammatory affection 
 disappeared, to violent pain. This latter symptom was aggravated 
 by all antiphlogistic treatment, but yielded to morphia with the 
 salts of iron. 
 
 In this instance, we observe the pain accompanying the inflam- 
 matory affection obscure, whilst the symptoms of inflammation 
 remain ; but as these subside, the pain, which was evidently of a 
 nervous character, becomes more acute and only yields to anodyne 
 and tonic remedies. The character of the pain, becoming worse 
 as inflammation subsides, and the effects of the remedies employed, 
 at once stamp it as a disease distinct from inflammation, although 
 associated with it. The fifth, sixth, and eighth cases in my paper 
 "On Diseases of the Stomach," in the Dublin Medical Journal, 
 are examples of this association of neuralgic pains in the stomach, 
 which sometimes accompany, and sometimes succeed to, inflamma- 
 tion. Whether these pains are the consequence of inflammatory 
 action or not, is a difficult question to determine. 
 
 It is a common circumstance to observe, during the progress of 
 diseases of the stomach, two distinct species of irritation in it at the 
 same time : one the consequence of inflammation, the second de- 
 pending upon an unduly excited state of the nervous system in the 
 same organ. Sometimes the nervous symptoms are associated with 
 the inflammatory; in other instances they succeed to them, becom- 
 ing more severe as the inflammatory irritation subsides. In a third 
 form inflammation comes on after a long continuance of the nervous 
 affection. Barras relates two remarkable cases of this kind in his 
 Treatise on the Nervous Affections of the Stomach and Bowels. 
 The concurrent testimony of Louyer Villermay, Barras, and Goul- 
 tier de Claubry, at once prove the existence of nervous and inflam- 
 matory irritations in the stomach at the same time. 1 
 
 CHAPTER V. 
 
 ON AFFECTIONS OF THE STOMACH CHARACTERISED BY DERANGE- 
 MENTS OF ITS SENSIBILITY. 
 
 I have shown, in the preceding chapter, that the characters of 
 pain attendant upon inflammatory conditions of the stomach are 
 extremely variable, being sometimes obscure, at others violent, 
 bearing no strict relation to the character or degree of that inflam- 
 
 1 La gastrite peut se rencontrer avec 1'exaltation de le sensibilite nerveuse 
 de I'estomac. Barras, p. 607. II est des circonstances ou cette phlegmasie 
 est primitive et 1'exaltation nerveuse secondaire ; mais la maladie sort alors 
 de la classe des nevroses pour rentrer dans celle des inflammations; c'est 
 une gastrite compliquee de phenomenes nerveux. Barras, Op. cit., p. 608. 
 
DERANGEMENTS OF ITS SENSIBILITY. 37 
 
 mation upon which they depend, or with which they are associated. 
 There are many diseases of the stomach which consist in a purely 
 morbid state of the sensibility of the gastric nerves, without the 
 association of any inflammatory action ; these have been well 
 described by Dr. James Johnson, in his work on the Morbid Sen- 
 sibility of the Stomach and Bowels, and into their primary forms I 
 consider it unnecessary to enter, referring my readers to that book 
 for information on these points. 
 
 M. Barras has produced a work of some merit, entitled Sur les 
 Gastralgies et les Enteralgies, or Nervous Diseases of the Stomach 
 and Intestines. A careful perusal of the work will, however, show 
 that many of the cases detailed in it were evidently inflammatory 
 in their commencement, and only rendered purely nervous by the 
 pernicious system of large local depletions, adopted by most of the 
 French physicians of the physiologic school, acting upon the apho- 
 rism of Broussais, that the greater part of all indigestions, in what- 
 ever form they are exhibited, are due to a chronic inflammation of 
 the mucous coat of the stomach. M. Barras maintains, merely in 
 opposition to M. Broussais, that the greater part of these affections 
 are of a nervous kind, and dependent altogether upon certain and 
 varied states of depraved sensation in the gastric and intestinal 
 nerves; and to these causes he refers the group of dyspeptic symp- 
 toms of pain, cramp, spasm, chronic vomiting', morbidly increased, 
 depraved, or defective appetite, and other symptoms of this kind. 
 
 The truth, however, rests neither with M. Broussais nor M. 
 Barras, but between the two. There are, questionless, certain and 
 frequent forms of disease in the stomach which terminate fatally, 
 in which no organic change can be detected in the stomach or in 
 any other organ connected with it, and which can be referred only 
 to a diseased condition of the nervous powers of the stomach, in 
 which the function of chymification, or stomachal digestion, is 
 destroyed, or so much impaired as not to be able to support life. 
 Andral has detailed a remarkable case of this kind : 
 
 CASE 1. "A female aged thirty-eight, entered the hospital of 
 La Pitie labouring under the following symptoms: A total want 
 of appetite, which had continued for seven or eight months ; every 
 time she took food she felt an insupportable weight in the region 
 of the stomach, and occasionally an acute pain. From time to 
 time she vomited some whitish mucus. Strong pressure on the 
 epigastrium produced no painful sensation in this region. The 
 remainder of the abdomen was soft and free from pain ; the patient 
 was habitually constipated; tongue natural; no disturbance of any 
 other organ : she was much emaciated and very feeble. She men- 
 tioned that the appetite began to fail after having been subjected to 
 severe mental distress. 
 
 This patient was considered, by her medical attendants, to be 
 labouring under chronic inflammatory disease of the stomach ; and 
 from the clean state of the tongue, cancerous degeneration of its 
 submucous cellular tissue was suspected. A seton was placed 
 
38 PARKER ON THE STOMACH. 
 
 over the epigastrium, but without effect. The patient wasted away, 
 and died without presenting any new symptoms. On examination 
 after death the stomach was found perfectly healthy; its nerves 
 and tissues were in their natural condition. None of the other 
 organs of the body presented any appreciable deviation from their 
 usual healthy condition. 
 
 A lady, mentioned by Dr. Abercromby. had constant vomiting of 
 food and severe pain after eating, which at length became so bad 
 that she was unable to retain any thing upon her stomach, except 
 fluids in very small quantities. No treatment afforded relief, except 
 blisters to the epigastrium. She gradually wasted and died, and 
 on examination of the body no disease could be detected, except 
 some enlarged glands behind the stomach. 
 
 These two cases are examples of disease of the stomach attended 
 by marked symptoms of functional derangement, but unaccom- 
 panied by any appreciable organic lesion upon which they can be 
 said to depend. We observe no change in the colour or consistence 
 of the stomach or its membranes; its nerves and tissues appear to 
 be in the most perfectly natural condition : yet the food taken 
 creates pain, is rejected by vomiting, and the patients emaciate and 
 die. We certainly must suppose that these symptoms are owing to 
 a complete loss of the digestive power of the stomach, depending 
 upon causes we cannot appreciate. In some instances, we observe 
 affections of the stomach, of this character, come on, which are 
 dependent upon disease in other organs. Here, likewise, all the 
 parts entering into the composition of the stomach are found 
 healthy. 
 
 CASE 2. A middle-aged lady was subject to occasional attacks 
 of vomiting and pain in the epigastrium, of a very severe character, 
 which had harassed her for several years. At times her stomach 
 digested well, and she felt no inconvenience from eating; at others, 
 the food taken occasioned great pain and distension, and was com- 
 monly rejected by vomiting. In these states she found great benefit 
 from leeches and blisters to the epigastrium, and the internal admi- 
 nistration of mild aperient and sedative remedies. After the con- 
 tinuance of this affection, with little variation, for many years, the 
 patient died from an attack of acute pleuro-pneumonia. I was 
 most anxious to have an opportunity of examining the condition of 
 the lining membrane of the stomach, which had exhibited symp- 
 toms of disease for so long a time. On laying open this organ I 
 was surprised to find it perfectly healthy, it was not even slightly 
 injected ; all its tissues were in the most natural state, as far as 
 anatomy enabled us to appreciate them. The right ovary, however, 
 was converted into a cyst, containing a large quantity of hair and 
 a few portions of bones. 
 
 Affections of the sensibility of the stomach, or in which derange- 
 ments of the sensibility are the prominent features of the disease, 
 may be either acute or chronic, and evidenced under a vast variety 
 of forms. Sometimes they are of long standing, and are attended, 
 
DERANGEMENTS OF ITS SENSIBILITY. 39 
 
 like organic diseases generally, by progressive wasting of the body; 
 at other times they come on suddenly, yet are purely nervous dis- 
 ease?, at least the local determination of blood which accompanies 
 them is a secondary consideration. They are also accompanied by 
 sympathetic irritations in other organs, which are of the same pa- 
 thologic character as those existing in the stomach. In many 
 instances they perfectly resemble diseases which are of an inflam- 
 matory character, yet are aggravated by a treatment exclusively 
 antiphlogistic. 
 
 It is very common for these affections to succeed to large or 
 repeated hemorrhages, of which I have given several examples in 
 the second chapter of this work : here they are evidently dependent 
 upon loss of tone in the nervous system, due to a want of its pro- 
 per stimulus a certain quantity of healthy arterial blood. In such 
 forms they are best and most speedily cured by large doses of the 
 preparations of iron ; the carbonate of iron with the powder of 
 calumba*ls then exceedingly useful. .1 have seen patients restored 
 very quickly by such remedies where, in the first instance, the 
 affection had been mistaken for an inflammatory one, and so 
 treated. 
 
 There are other forms of disease, in which derangements of the 
 sensibility are the prominent features, which succeed to long-con- 
 tinued indigestions of the inflammatory kind; the latter have 
 yielded to antiphlogistic treatment, but the patient still continues to 
 be harassed with most distressing sensations connected with his 
 stomach, under the forms of .pain after food, distension, nausea, 
 vomiting, uneasy sensations and beatings in the epigastrium, with 
 variable conditions of the bowels, and sympathetic affections of 
 other organs; as hurried breathing and cough, palpitations, giddi- 
 ness, a copious flow of thin pale urine, or one scant in quantity 
 and loaded with amorphous deposits. Many of these affections are 
 precisely the forms of disease which M. Barras has described, in 
 his work, as nervous diseases of the stomach and intestines, and 
 which have succeeded to, and have been produced by, inflammatory 
 affections which have been treated by large losses of blood from 
 the epigastrium. I have had many patients under my care where, 
 in the first forms of complaint, local depletions from the region of 
 the stomach have afforded vast relief in conjunction with other 
 remedies; but there has arrived a period in the history of these dis- 
 eases where leeches have ceased to afford relief, and where, in fact, 
 they have rather aggravated than relieved the affection. Sometimes 
 the nervous affections, which succeed to the inflammatory, present 
 nearly the same symptoms as those of inflammation ; and it is 
 merely from a discovery that the use of the same remedies ceases 
 to afford relief that we are made aware that the character of the 
 disease is changed. Again, the nervous affection is characterised 
 by new and other symptoms than those which were present in the 
 inflammatory form. Occasionally the character of pain becomes 
 changed; it is more acute, or various acid secretions are discharged 
 from the mouth, arid the affection assumes a complexion which 
 
40 PARKER ON THE STOMACH. 
 
 Andral has described under the name of secretory irritation, or 
 gastrorrhrea, in which there is an excessive secretion of mucus 
 from the lining membrane of the stomach. 
 
 In many cases of diseases of the stomach we find affections of the 
 sensibility constantly combined with inflammation, even on the first 
 appearance of disease; and hence many symptoms accompanying 
 protracted and severe forms of indigestion, which are of the inflam- 
 matory kind, do not give way to an antiphlogistic treatment. This 
 has not escaped the penetration of Andral, when he tells us that 
 " many of the symptoms observed during the progress of inflam- 
 matory diseases of the stomach, such as nausea, vomiting, &c., are 
 due to affections of the sensibility." 1 
 
 In practice, these remarks are found of vast importance. Thus, 
 when we find that certain forms of indigestion, of the inflammatory 
 character, cease to be relieved by antiphlogistic treatment the 
 symptoms continuing in almost their primitive intensity, or perhaps 
 even more acute a recourse to other remedies will sometimes at 
 once remove them. Here combinations of the salts of morphia with 
 those of iron, of bitters and chalybeates, or of the sub-nitrate of bis- 
 muth with magnesia, will be of the greatest service. We must not 
 suppose, because the affection has not yielded to antiphlogistic 
 treatment when it appeared inflammatory in the commencement, 
 that such remedies have been improper or useless. These have 
 removed the inflammatory action, but have left the disease of sensi- 
 bility remaining. The exhibition of tonic medicines before the use 
 of leeches to the epigastrium would, in all probability, have con- 
 siderably aggravated the disease. 
 
 There are certain affections of the sensibility of the stomach 
 which are combined with inflammatory action from the commence- 
 ment, and in which a combination of treatment is highly successful. 
 Thus, patients will commonly present themselves labouring under 
 nausea and pain in the stomach, with great distension and 
 acidity after eating; with these symptoms there commonly co-exist 
 palpitations and pulsations in the epigastrium, with heat, pain, 
 and tenderness, rolling and indescribable feelings of uneasiness. 
 Accompanying these states there is frequently hurried breathing, 
 considerable arterial excitement, and excessive mental distress. The 
 mental affections, in such conditions, are often of the most distress- 
 ing character, in some instances, almost approaching to the insane 
 state. Many cases in the work of M. Barras are of this description, 
 and several of those in my paper in the Dublin Journal are of 
 similar character, particularly cases eight, nine, ten ; eleven, and 
 twelve. Whatever may be the primitive character of such diseases, 
 there is evidently local determination of blood to the parts situated 
 in the epigastric region, such as the stomach, and the great nervous 
 centres immediately behind it. 
 
 In such forms of disease a combination of treatment, apparently 
 
 1 See Cours de Pathologic Interne, tome i., p. 62. 
 
DERANGEMENTS OF ITS SENSIBILITY. 41 
 
 of an opposite character, is the most certain method of cure. I have 
 seldom seen it fail ; I have seen such forms of disease repeatedly 
 aggravated by a tonic treatment, or by an antiphlogistic one sepa- 
 rately employed. I have seen them quickly cured by applying 
 small numbers of leeches to the epigastrium from time to time, four 
 or six at each application ; regulating the bowels with warm aloetic 
 aperients, combined with morphia and prussic acid ; at the same 
 time administering freely the preparations of iron, of which I believe 
 the common carbonate, combined with calumba powder, to be the 
 best. 
 
 I shall detail a few cases of such forms of disease, in their com- 
 bination with certain local determinations of blood and also in their 
 forms of sympathetic irritation of other organs. 
 
 CASE 4. Gastrodynia Pyrosis. 
 
 I was consulted, by a lady, for a disease characterised by the fol- 
 lowing symptoms : Intense heat in the stomach and throat, with 
 pain so great, on taking even the simpler forms of food, that she was 
 unable to do so more than once in the twenty-four hours. The 
 affection had commenced, some months back, with slight uneasiness 
 after meals, and had been progressing till now, in spite of varied 
 medical treatment. The long periods of .abstinence from food, and 
 the imperfect digestion of what little was taken, had reduced my 
 patient to an extreme degree of emaciation ; her weakness was great 
 and she walked with much difficulty. The local pain was accom- 
 panied by regurgitations of sour fluids and gases; whatever was 
 taken by way of support was generally vomited intensely sour. 
 The bowels were constipated, which always added to the existing 
 complaints; there was hardly any tenderness on pressing the 
 epigastrium, but this region appeared rather full when carefully 
 examined. Every kind of medicine hitherto taken had increased 
 the pain equally with aliment. 
 
 A blister was ordered to the epigastrium, and half a dram of the 
 ponderous carbonate of magnesia prepared by Henry, of Manchester, 
 was given every four hours, combined with ten grains of calumba 
 powder, and the diet was limited to the farinaceous food made by 
 Hards, of Dartford. 
 
 8th. The first powder had eased the pain ; to-day there is much 
 less ; the food had not been vomited, and had given no pain. No 
 action upon the bowels. 
 
 9th. Bowels acted upon three times. All the symptoms ame- 
 liorated. 
 
 llth. Still improving. Animal broths and chicken are taken 
 with tolerable comfort, but the bowels not having been acted upon, 
 and the head, in consequence, affected, I ventured to prescribe some 
 aperient medicine, of a character rather more active, still combining 
 it with the carbonates of soda and magnesia. The aperient had 
 produced so much pain that it was obliged to be laid aside. The 
 
42 PARKER ON THE STOMACH. 
 
 powders, which invariably gave relief, were again taken, with a 
 wine glass of the compound decoction of aloes, and two drops of 
 hydrocyanic acid, three times a day. 
 
 16th. The medicines act sufficiently, and cause no pain. Boiled 
 mutton and chicken are taken with but a trifling degree of incon- 
 venience. The tongue is clean : she has gained flesh and strength. 
 
 Remarks. It is evident, on examining the history of this case, 
 that its origin is to be traced to* morbid irritability of the nervous 
 capillaries of the stomach ; and we find the secretions of its follicles 
 and lining membrane secondarily becoming disordered. As the 
 secretions of all parts go on under the direction of the nerves supply- 
 ing them, it follows that they can only remain healthy as long as 
 the secreting organ is supplied with its due proportion of nervous 
 influence in its normal physiological state ; and when this is im- 
 paired or deranged, is in excess or diminution, over-excited or not 
 sufficiently sensible to stimulus, a corresponding condition of morbid 
 secretion is the consequence. After long-continued irritability of 
 the stomach, of which pain after meals is at first the only symptom, 
 we have obstinate pyrosis, and the moment the pain begins. the 
 glairy acid fluid will begin to run from the mouth ; this 1 have 
 commonly seen. In some cases, there is such a disposition to the 
 formation of acid on taking food, from the defective quantity or 
 morbid quality of the secretions of the stomach, that every article 
 of diet, whether solid or fluid, is either rejected in a perfectly acid 
 state, or constantly regurgitates into the mouth fluids so sour as 
 almost to disorganise its lining membrane. This action from time 
 to time, upon the coats of the stomach, at length renders it so sen- 
 sible that it is unable to bear either the impression of food or medi- 
 cine, and the patient if not speedily relieved, would soon fall into a 
 state of disease from which he would with difficulty recover. The 
 first step in the treatment of these forms of disease is to correct the 
 morbid secretions of the stomach, and for this purpose no medicine 
 is so beneficial as Henry's ponderous carbonate of magnesia, com- 
 bined with calumba powder, and administered in the way I have 
 directed ; a sixth or eighth of a grain of the acetate or muriate of 
 morphia may be added, or from ten to twenty minims of the liq. 
 opii sedativus, dropped into the vehicle in which it is administered. 
 I am convinced that every thing of a more active character that is 
 employed before the secretion of acid is corrected, and the stomach 
 rendered less sensible to impression, only aggravates the disease, 
 and renders the recovery longer and more tedious. The second 
 step in the treatment consists in endeavouring to remove the dis- 
 position to the formation of acid ; this I shall exemplify in the 
 further detail of this case. 
 
 March 29th. The pain still continues in a milder form, and 
 invariably comes on after taking a mixture of aliments at dinner. 
 The medicines at first prescribed invariably relieve the pain when 
 it occurs, probably by merely correcting the acid secretions which 
 cause it, I ordered the acetate of morphia now to be taken in doses 
 
DERANGEMENTS OF ITS SENSIBILITY. 43 
 
 of a sixth of a grain, three times a day, combined with four of rhu- 
 barb ; and the powders to be taken occasionally in the event of an 
 attack of pain and acidity. 
 
 April 18th. Since the last report there has been no pain, except- 
 ing on one day, when, at a dinner party, she ate freely of mixed food 
 and green vegetables, and drank a glass of sherry; immediately 
 after the meal, sudden swelling of the stomach took place, with pain 
 and vomiting of sour fluids. In order perfectly to restore my 
 patient, I limited her to Hard's farinaceous food with milk or with- 
 out, for breakfast and supper, and common milk-and-flour pudding 
 for dinner, which was afterwards changed to any one species of 
 animal food, without vegetables. At the same time the ammonio- 
 tartrate of iron was taken in doses of four grains three times a day, 
 with rhubarb and morphia. Under a steady perseverance in this 
 plan, my patient perfectly recovered health and spirits. 
 
 Remarks. In cases like the present, accompanied by the pre- 
 dominating symptoms of pain and acidity, the attacks are exceed- 
 ingly liable to recur, unless the patient can be persuaded to persevere 
 in a strict dietetic regimen, and also in medical treatment. The 
 effects i. e., pain and acidity are soon removed by an appropriate 
 plan of treatment, as is well marked by the detail of this case from 
 the 7th to the 16th of March, at which time .my patient fancied herself 
 well, but the morbid irritability of the gastric nerves is not so soon 
 or so easily cured. As long as they are kept free from impression, 
 by having the morbid secretions corrected, or are not irritated by an 
 over-stimulating diet, the patient is tolerably easy ; but the moment 
 one is discontinued, or the other indulged in, the attacks of pain 
 come on with as much violence as at first. This case well illus- 
 trates the evil of a mixed diet, in cases of morbid irritability like the 
 present, evidenced in the reports of the patient's state on March 29th 
 and April 18th. Persons will remain tolerably easy under any one 
 article of food, even if it be rather of a stimulating kind ; but a 
 mixture invariably produces a return of suffering. We know, from 
 the researches of Prout, Tiedemann and Gmelin, and Dr. Beaumont, 
 that the gastric juice, during digestion, contains free acetic and 
 hydro-chloric acids, and that these acids are furnished in greater 
 quantity in direct proportion to the more or less stimulating quali- 
 ties of the food: under a mild farinaceous diet, the acid is hardly 
 to be detected. It is the impression of stimulating food upon a 
 morbidly sensitive surface which gives rise to the formation of so 
 great a quantity of acid, which, when formed, reacts upon the 
 mucous coat, and produces pain. We have certainly cases of dis- 
 ease in which the stomach experiences pain merely from the im- 
 pression of food; but the one under consideration appears to derive 
 additional Tnischief from the presence of its own morbid secretions, 
 for the moment they are corrected, and the acid neutralised, the 
 patient is, for the time, free from pain. The plan of treatment con- 
 sists in removing all the sources of irritation, in correcting the 
 morbid secretions, and rendering the nerves less sensible to impres- 
 
44 PARKER ON THE STOMACH. 
 
 sion. The two former objects are to be accomplished by diet and 
 medical treatment, such as I have recommended in the detail of the 
 case. For the latter purpose 1 I have tried nothing more efficacious 
 than the combination of morphia with the salts of iron, at the same 
 time having occasional recourse to the alkalies. The farinaceous 
 food, made with milk and lime water into gruel or puddings, is 
 exceedingly serviceable. The bowels which are inclined to con- 
 stipation in most cases, may be regulated by small doses of the 
 ponderous carbonate of magnesia in some bitter infusion, as casca- 
 rilla or orange peel, to which still should be added some sedative, 
 of which the liquor opii sedativus is the best ; the tincture of hop 
 or hyoscyamus may likewise be employed, but, as far as my expe- 
 rience goes, the first is the best. 
 
 The sympathetic affections of other organs whether functional or 
 organic, which are called into action by diseases of the stomach are 
 exceedingly variable, and are most commonly seated in the lungs, 
 the heart, the kidneys, or the brain. Functional affection of the 
 brain, as regards the exercise of the intellectual faculties, producing 
 despondency, impaired judgment, and mental excitement, is a dis- 
 ease well known as a result of these, under the term hypochondria. 
 Accompanying functional affection of the brain, as far as that part 
 of it devoted to the intellectual faculties is concerned, we find a 
 similar species of derangement extending to the nerves of the 
 special senses, producing false impressions both upon the eye and 
 ear. The nerves here partake of the same morbid action as those 
 of the stomach, and convey false impressions to the brain ; and, in 
 the second instance, this organ does not receive the impressions 
 which are transmitted to it correctly, but judges of them in an 
 erroneous manner. The point of commencement of this general 
 state of nervous excitement will, I believe, be most commonly 
 found in the stomach ; at least, in the present instance, I have only 
 to do with it as far as this organ is concerned ; we shall find it ag- 
 gravated or allayed in proportion to the mitigation or increase of the 
 stomach disease. It may or may not be accompanied by vascular 
 excitement. 
 
 CASE 5. Morbid sensibility Epigastric pulsation, with great mental 
 
 uneasiness. 
 
 A lady, aged forty, had menstruated irregularly since the birth 
 of her last child, which is three years old ; occasionally profuse dis- 
 charges have taken place, but iibr a month preceding her attack 
 there had been none. Her food now occasioned great pain, accom- 
 panied by nausea and great distension after eating. Sensation of 
 rolling in. the stomach, with broiling and intense acidity. These 
 symptoms were partially alleviated by small doses of the ponderous 
 carbonate of magnesia and the application of a blister. Great 
 despondency succeeded, with indescribable sensations of uneasiness 
 in the stomach, not amounting to pain, but occasioned by a sensa- 
 
DERANGEMENTS OF ITS SENSIBILITY. 45 
 
 lion of rolling in it. The nausea continued, and frequently ended 
 in vomiting. The tongue was clean; bowels slightly constipated; 
 pulse sharp, and at eighty. On examining the epigastrium, a strong 
 pulsation was evident to the eye ; it was confined to this region, 
 and raised the hand with great force when laid over it ; it was ac- 
 companied by a dull pain, extending over a small surface, which 
 was slightly increased by hard pressure. The skin was also here 
 very hot. Various remedies were tried, hut all, even the most 
 simple such as the carbonate of soda or magnesia, with morphia 
 increased the pain and added to the distress. Leeches were now 
 had recourse to, which were applied every other day for six days, 
 and were succeeded by one or two blisters. Under thifc treatment 
 the more urgent symptoms yielded, but the uneasiness of mind, 
 pyrosis, and occasional vomiting, continued; which, when the 
 stomach was able to bear medicine, were relieved materially by 
 small doses of morphia and lime water. During the whole of this 
 distressing affection, which continued for several weeks, the patient 
 had the most haggard and anxious countenance. All kinds of ali- 
 ment increased "the complaint, except Hard's farinaceous food, 
 which was taken with tolerable comfort. 
 
 This case, similar, in many of its features, to inflammation of the 
 mucous coat of a subacute character, does not appear to me to have 
 been a disease of that nature. The extreme despondency, almost 
 approaching to the insane state, the epigastric pulsation, the almost 
 entire .absence of tenderness on pressure, arid the more than usually 
 irritable state of the stomach (exceeding that observed in subacute 
 inflammatory disease), are, in my opinion, proofs that the disease 
 was riot of this character ; at least it had other complications. The 
 " rolling sensation, over and over," which this patient complained 
 of, is likewise peculiar ; I have seen several instances of it. The 
 heat in the epigastrium is worthy, also, of remark. We have in 
 this a class of symptoms certainly indicating increased local determi- 
 nation of blood, but whether accompanied by inflammatory action 
 of the mucous coat or not is a matter difficult to determine : I cer- 
 tainly am inclined to think that they are not. Dr. Abercromby 
 mentions the case of a lady who had constant vomiting of food and 
 severe pain, which at length became so bad that she was unable to 
 retain any thing upon her stomach, except fluids in very small 
 quantities. No treatment afforded relief, except blisters to the epi- 
 gastrium. She gradually wasted and died, and on examination no 
 disease could be discovered in the epigastric region, except some 
 enlarged glands behind the stomach. I do believe that many cases 
 of the description I have related are rather affections of the coeliac 
 ganglia and great nervous centres, 1 such as the solar plexus, 
 than diseases of the coats of the stomach itself. The nature of the 
 diseases is such, however, that this can rarely be verified by dis- 
 
 1 Cerebrum abdominale, Lobstein, Ue Neivi Sympathetic! Fabric^, Usu ei 
 Morbis, Commentatio, &c., &c. 
 
46 PARKER ON THE STOMACH. 
 
 section. Dr. Abercromby's appears to verify this view ; the direct 
 communication of the coronary plexuses of the stomach with the 
 great nervous centres of the epigastrium would at once account for 
 any sympathetic disease of this organ. The distribution of the 
 nervous plexuses, also, in the course and upon the coats of the 
 aorta, and arterial branches in the epigastrium, seem to explain their 
 increased pulsations by some irritation of the nerves supplying them. 
 We know that in common gastritis epigastric pulsation is rarely 
 present. The ganglia and plexuses of the nerves of the involun- 
 tary functions are abundantly supplied with arteries, and conse- 
 quently, must be subject to the same class of diseases as all other 
 parts into wjiich arterial blood penetrates, particularly inflammation 
 and its terminations. All the cases of pulsation in the epigastrium 
 detailed in 'this chapter were evidently owing to local determination, 
 and relieved by antiphlogistic remedies. 
 
 CASE 6. Morbid sensibility of the stomach, with epigastric pulsation. 
 
 A lady labouring under hepatic disease became affected, during 
 its progress, with pain after taking food, occasional vomiting, and 
 tenderness in the epigastrium of a slight character. There was a 
 strong pulsation at all times visible to the eye, and communicating 
 a powerful impulse to the hand laid upon it. Her dyspeptic symp- 
 toms and the pulsation disappeared after one or two applications of 
 leeches, succeeded by blisters. 
 
 CASE 7. Morbid sensibility with great mental distress, succeeding fever. 
 
 A lady, after an attack of typhous fever, became affected, during 
 her period of convalescence, with constant pain after taking food, 
 and occasional vomiting; the stomach at length became so irritable 
 that it would not retain either food or medicine. The mental un- 
 easiness accompanying this state was distressing in the extreme. 
 She rolled from one side of the bed to the other, constantly com- 
 plaining of her stomach, and this state continued, night and day, 
 for weeks. The tongue was clean, the pulse quiet, the skin cool, 
 arid there was no pain whatever in the epigastrium when it was 
 examined by pressure. Opiates, alkalies, and tonics, all aggravated 
 her state of distress and increased the uneasiness. I once ventured 
 to administer a few grains of the carbonate of iron, but its effects 
 were frightful, and the accession of burning pain after it intolerable. 
 Medicines were at length omitted altogether, the patient was removed 
 into the country, and the mildest food given in very small quantity, 
 from time to time. Under this plan, after a long period, she at 
 length recovered. 
 
DERANGEMENTS OF ITS SENSIBILITY. 47 
 
 CASE 8. Morbid sensibility, with great despondency, succeeding fever. 
 
 A lady, after an attack of typhous fever, which had prostrated her 
 whole family, and from which she had lost a favourite child, became 
 affected with pain after taking food, accompanied by a burning 
 sensation, and its occasional rejection by vomiting. There was 
 extreme mental uneasiness and great despondency. The tongue 
 was clean and moist, the pulse soft and quiet, and there was no 
 epigastric tenderness. Medicines and food of all kinds aggravated 
 her condition and increased her distress. The former were laid 
 aside, small portions of farinaceous food were given from time to 
 time, and blisters applied over the stomach. This disease con- 
 tinued a long time, but the patient, under a continuance of 
 the farinaceous diet and blisters the only plan which afforded 
 any relief at length was restored to her accustomed health. 
 
 Cases five, seven, and eight, are examples of that extraordinary 
 state of mental wretchedness dependent upon morbid irritability of 
 the stomach. Case five differs from seven and eight in being 
 accompanied by considerable local vascular excitement, whilst in 
 the two latter it was entirely absent. The first case succeeding to 
 profuse uterine discharges, whilst the latter are set up during con- 
 valescence from acute diseases. Broussais and the pupils of his 
 school attribute, as is well known, all these affections to chronic or 
 snbacute forms of gastro-enteritic inflammation ; his opinions on 
 this head are detailed in his one hundred and forty-fifth aphorism. 1 
 Although the brain becomes secondarily affected from the irrita- 
 bility of the stomach, it appears that there must be some peculiar 
 organisation on the part of the former, some unusual degree of irri- 
 tability, which renders it so liable to be thrown into a state of mor- 
 bid sympathy with diseases in other organs. That these forms of 
 stomach disease are dependent universally upon inflammatory 
 action, I conceive to be a highly dangerous opinion to entertain. I 
 have seen patients leeched again and again, without the least bene- 
 fit, in such states. I do not mean to deny that increased local vas- 
 cular action is not occasionally present ; I believe it is, and was so 
 in case five but not in seven and eight. Where this is present with 
 great mental uneasiness, in such states as those described, it will 
 generally be accompanied by epigastric pulsation. The great point 
 in the treatment of these affections is to remove all sources of irri- 
 tation from the stomach, both in the form of food and medicine. 
 The smallest portions of the former should at first be tried, and 
 gradually increased : a table-spoonful of gruel, or of Hard's farina- 
 ceous food, made with water, and not milk, which is commonly 
 rejected immediately, in form of curd, may be given at longer or 
 shorter intervals, as the stomach will bear it. The best medicines, 
 
 1 Examen des Doctrines Medicales, tome i. 
 
48 
 
 PARKER ON THE STOMACH. 
 
 if the stomach will bear any, which it sometimes will not, are a few 
 drops of the liq. opii sedativus in lime water, or a quarter or a sixth 
 of a grain of the acetate of morphia, with a few grains of carbonate 
 of soda. With these remedies blisters should be successively 
 applied to the epigastrium; they should be small and suffered to 
 heal, and then reapplied. I have seen much mischief occasioned 
 by large and irritating blisters, but particularly by the tartar-emetic 
 ointment and plaster. These add to the irritation ; and I have seen 
 many instances in which they were productive of decided harm. 
 On the other hand, blisters of small size, frequently repeated, are 
 the best remedies I know of in diminishing the irritability of the 
 stomach ; and the moment this viscus begins to regain its tone the 
 patient's mind becomes more settled and composed. In these 
 instances, as in that before mentioned, the extremely irritable mind 
 and morbid state of feeling of the patient should never be lost sight 
 of, dependent as they are upon the stomach disease, arid aggravated 
 by every cause which increases it. Too much caution cannot be 
 employed, the diet cannot be too unstimulating, or the plan of medi- 
 cation too unirritating and simple. Cases five, seven, and eight, 
 are, as I have before said, examples of mental affections depen- 
 dent, no doubt, upon some cerebral irritation, which was called 
 into action by derangement of the sensibility of the nerves of the 
 stomach and its vicinity. Broussais in the commentary to his one 
 hundred and seventh proposition, 1 tells us that the sensibilities of 
 the viscera are infinitely variable, impressions which are not sen- 
 sible, to one person, becoming, to another, stimuli, which are the 
 source of various morbid actions; but that these impressions should 
 so act he admits a peculiar idiosyncrasy, to which he gives the 
 name of " nevropathie" and which consists in a peculiar and ex- 
 cessive irritability of the nervous system. The opinion appears 
 founded in truth and nature ; it is the true nervous temperament 
 at its full development. What in another person would produce 
 bodily pain, here is productive of mental disturbance. Insanity is 
 a common termination of prolonged irritation in the abdominal 
 viscera of such patients, particularly in the stomach. I know two 
 instances in my own practice, besides the one I have mentioned. 
 
 It is of the greatest consequence, as regards the treatment of dis- 
 eases of the stomach, both in their primary and advanced stages, to 
 ascertain whether the symptoms they exhibit are dependent upon 
 nervous or vascular irritation, whether the affection be unaccom- 
 panied by inflammatory action, or whether the nervous symptoms 
 which are manifested during the progress of the disease depend 
 upon inflammation or not, I believe that, in a great majority of 
 instances, an increased fulness of blood in the mucous membrane 
 of the stomach is present, at least during the paroxysm of the 
 attack ; yet we must be extremely cautious how we take such an 
 
 1 Comraentaire des Propositions de Pathologic, tome i., p. 117. Paris, 
 1829. 
 
DERANGEMENT OF ITS SENSIBILITY. 
 
 49 
 
 opinion as the sole basis of our treatment. The degree of nervous 
 irritation exhibited, whether this consist in actual pain, in mental 
 despondency or irritation, in anomalous feelings attended by various 
 exalted or diminished states of the sensibility must be examined in 
 relation to the actual state of vascular excitement with which they 
 are or are not accompanied, and the treatment proportioned accord- 
 ingly. The relative proportions which these two states of excite- 
 ment bear to each other, and the degree in which each is developed, 
 must form the basis of all rational treatment, both medicinal and 
 dietetic. Occasionally the symptoms dependent upon an inflamed 
 state of the mucous coat of the bowels are confined almost entirely 
 to those which are called nervous i. e., phenomena which are 
 attributed entire'y to the nervous system alone are those merely 
 which are found as indicative of inflammatory disease. I shall lake 
 the table arranged by Jolly for the basis of the distinctions between 
 these two states, making comments upon it, as I proceed, where I 
 think the symptoms of difference are inaccurate or not to be 
 depended on. 
 
 SYMPTOMS OF THE NERVOUS 
 
 AFFECTIONS OF THE 
 
 STOMACH. 
 
 Pain. 1 Acute, tearing 
 Intermittent 
 Diminished by pressure 
 And by taking food 
 More frequently coming 
 
 on in the morning. 
 Tongue. Sometimes coated 2 
 Broad 
 Clean 
 
 Appetite. Morbidly increased 3 
 Depraved. 
 
 Wish for high-seasoned 
 meats and alcoholic 
 drinks. 
 
 SYMPTOMS OF THE INFLAMMA- 
 TORY AFFECTIONS OF 
 THE STOMACH. 
 
 Pain. 1 Dull, obscure 
 
 Constant 
 
 Augmented by pressure 
 
 And by food 
 
 Increasing towards the 
 
 evening 
 Tongue. Almost always red 3 
 
 Contracted 
 
 Thickly coated 
 Appetite. Wanting 3 
 
 Never depraved 
 
 Aversion to both 
 
 1 The two characters of pain described by Jolly cannot be depended upon 
 as showing any certain distinction between inflammatory and nervous dis- 
 ease of the stomach, that of the nervous kind is so constantly associated 
 with, produces, and succeeds to, partial inflammations of the mucous coat. 
 
 2 The state of the tongue is infinitely variable in the different forms of 
 disease. The observations of Louis and Andral, and my own cases, show 
 that it may remain clean in aggravated forms of inflammatory disease, even 
 where change of structure has been produced. It may be foul, and even 
 aphlhous, where the gastric inflammation is not urgent or well-marked. 
 
 'Boulimia, 01 morbidly increased appetite, is a symptom commonly attend- 
 ant on an inflamed condition of the mucous coat of the stomach. Total loss 
 of appetiie may also be present, and, again, this function may remain unim- 
 paired. We see how uncertain are all these rational signs of disease. A 
 10 b park 4 
 
50 
 
 PARKER ON THE STOMACH. 
 
 SYMPTOMS OF THE NERVOUS 
 
 AFFECTIONS OF THE 
 
 STOMACH. 
 
 Taste. Metallic 
 
 Acid 
 
 Vomiting of mucous discharges 
 Alternations of Heat and Cold 
 
 in the abdomen 
 Thirst. Not increased 
 
 Wish for drinks some- 
 times hot, at others cold 
 Constipation. Frequent 1 
 Stools. Natural 
 
 . Not offensive 
 
 Pulsations in the Epigastrium. 
 Intermittent 
 
 Not synchronous with 
 
 those of the heart 
 No Fever 
 
 Or intermittent 
 Increase of Disease. Early in 
 
 the day 
 Urine. Clear* 
 
 Abundant 
 
 Heat of Skin. Natural 
 No Progressive Emaciation 
 Physiognomy. Natural 
 
 Temper. Morose, fearful, irri- 
 table 
 
 Diagnostic. Sometimes ob- 
 scure 
 
 Prognostic. Less dangerous 
 Anatomical Characters. Equi- 
 vocal, or altogether 
 wanting. 
 
 SYMPTOMS OF THE INFLAMMA- 
 TORY AFFECTION8 OF 
 THE STOMACH. 
 
 Taste. Bitter 
 Clammy 
 
 Vomiting of food 
 Constant Heat 
 
 Thirst. Increased 
 
 Constant desire for cold 
 
 drinks 
 
 Diarrhoea. Frequent 1 
 Evacuations. Bilious, mucous, 
 or bloody 
 
 Offensive 
 
 Pulsations in the Epigastrium. 
 Natural, continual 
 
 Synchronous with the 
 
 heart 
 
 Fever. Frequent 
 Continued 
 Increase of Disease. In the 
 
 evening 
 Urine. High coloured 2 
 
 Scanty 
 
 Heat of Skin. Augmented 
 Progressive Emaciation. 
 Face. Pale, sallow, or sunk and 
 
 anxious 
 Temper. Little altered 
 
 Diagnostic. More manifest 
 
 Prognostic. More dangerous 
 Anatomical Characters. Con- 
 stant, but varied. 
 
 remarkable case of morbidly increased appetite, attendant upon cancer of 
 the stomach, is detailed in the Lancet of October 1, 1836. 
 
 'Constipation is a symptom almost invariably accompanying both forms 
 of disease. DiarrhoBa is certainly present in some instances of the inflam- 
 matory affections, even in the commencement of disease; in the advanced 
 stages, where complaint has extended to the bowels, it is of more frequent 
 occurrence. 
 
 1 Dezeimeris has related some cases where diabetes appeared dependent 
 upon chronic gastritis, at least the cure of the gastritis completely removed the 
 diabetes. Andral has also detailed a case where diabetes coincided with 
 chronic gastritis ; the former disease was removed by curing the latter. 
 Clinique Medicale, by Spillan, p. 869. 
 
DERANGEMENT OF ITS SENSIBILITY. 
 
 51 
 
 The symptoms of vascular and nervous irritation of the stomach 
 are sometimes so similar that the most experienced practitioner in 
 diseases of this kind is occasionally at a loss to decide upon their 
 precise pathologic character. I attended a patient, for two years, 
 with all the symptoms of chronic gastritis, which were accompanied 
 by progressive emaciation ; the peculiarity of the lancinating pains 
 which Were occasionally felt in the epigastrium, and the clean state 
 of the tongue, made me suspect some cancerous affection of the 
 stomach. The extreme restlessness of his nights led to the admi- 
 nistration of opiates in the evening, after the disease had continued 
 for eighteen months, when he was become much emaciated. From 
 this time the signs of gastric disease began to decline, and at the 
 end of some months after, having continued the opiates for the 
 whole time, the patient had gained much strength, and was actually 
 become fat. This, then, was evidently a disease of sensibility, pre- 
 senting all the symptoms of a chronic inflammatory state. Two 
 very remarkable cases in the Clinique Medicale, at pages 871 
 and 876 of Spillan's edition, are likewise examples of diseases 
 of a nervous character assuming the type of inflammatory affec- 
 tions in the chronic form. These nervous affections may con- 
 sist sometimes in excitement (erethism), at others in diminished 
 tone (atony), of the nervous influence of the stomach. They re- 
 semble, however, sometimes so closely the inflammatory affections, 
 that the results of treatment are occasionally our only guides as to 
 their nature. "Let us not be astonished if, in a considerable 
 number of patients, we see symptoms more or less similar to those 
 which characterise chronic gastritis become permanent, and even 
 aggravated, by a pure antiphlogistic treatment, and yield, on the 
 contrary, to medicines of another description. It is because those 
 symptoms were riot produced by gastritis, but by other morbid 
 states of the stomach/' 1 There is another form of disease, to 
 which Barras has given the name of "complication de la gastro- 
 enteralgie avec la gastro-enterite," in which there is. a constant 
 blending of the symptoms noticed in the preceding table. Thus, 
 we have the symptoms of gastritis presenting themselves, sometimes, 
 with an exaltation of the nervous sensibility of the stomach. These 
 symptoms of a morbid state of the sensibility of the stomach may 
 be combined with inflammatory disease during it progress, render- 
 ing the diagnosis difficult and the treatment embarrassing. They 
 may precede the inflammatory symptoms; these may become added 
 to the nervous after the continuance of the disease, in this form, for 
 some time; or, in the last place, the gastritis makes its appearance, 
 and derangements of the sensibility subsequently come on. 
 
 'Andraljp. 873. 
 
52 PARKER ON THE STOMACH. 
 
 CHAPTER VI. 
 
 ON AFFECTIONS OF THE STOMACH CHARACTERISED BY MORBID 
 STATES OF ITS SECRETIONS. 
 
 I have described, in the preceding chapters, two primitive morbid 
 stales of the stomach ; the first of^an inflammatory character, and 
 a second which is chiefly characterised by a morbid condition of 
 its sensibility. There is, however, a third form of primitive morbid 
 state of the stomach, resembling", in some measure, in its symp- 
 toms, the other two, but differing from them in its pathologic cha- 
 racter, and aggravated by either of the modes of treatment appro- 
 priate to the two first forms of disease. This disease has attracted 
 the attention of various writers. Mr. Abernethy has termed it a 
 disordered state of the digestive organs or of the chylopoietic vis- 
 cera, and he opposed to it mercurial purges, with solutions of neu- 
 tral salts in some bitter infusions. The late Dr. Hamilton, of 
 Edinburgh, in his work on Purgative Medicines, recognises the 
 morbid state of which I am about to speak. This kind of primitive 
 morbid state of the stomach consists in a disordered state of secre- 
 tions poured out by the mucous surfaces of the stomach and first 
 passages, or by those glands whose products are necessary to the 
 completion of the digestive process, of which the liver is the chief. 
 The pathologists and physicians of the continent have recognised 
 this state of the stomach. Stoll, in his Ratio Medendi and other 
 works, has given numerous examples of it ; Tissot, Finke, De 
 Larrroque, and Andral, have also described and admitted it as a 
 state of disease distinct from inflammation and not dependent upon 
 it, although in many instances associated with it. Broussais and 
 the pupils of his school deny its existence, except as a secondary 
 affection, the consequence of inflammation. Every-day experience, 
 however, must convince those who have paid attention to the sub- 
 ject that there is a form of irritation in the stomach which may 
 be taken as the type of a certain number of cases of indigestion 
 which is not relieved by leeches to the epigastrium, although epi- 
 gastric pain and tenderness be present, nor is it mitigated by seda- 
 tives or tonics, but gives way to aperients, and occasionally is only 
 cured by emetics. This disease, then, recognises for its cause a 
 morbid condition of the secretions of the stomach and the liver, 
 which, in this condition, acting upon the peculiar sensibility of the 
 mucous surfaces of the stomach, produce various forms of disease 
 more or less acute, either in this organ itself or, by sympathetic 
 irritations, in other parts, more particularly the brain, lungs, and 
 heart. 
 
 To this form of gastric irritation some of the French pathologists 
 apply the term "embarras gastrique," whilst by others, as the 
 Broussaists, this term is applied to a state of disease which they 
 consider the first form of inflammation ; by others this is termed a 
 
MORBID STATES OP ITS SECRETIONS. 
 
 53 
 
 sabtirral state of the stomach, because the persons employing this 
 term fancy the stomach or first passages to be loaded by a mass of 
 morbid secretions which are termed saburrae. In this country the 
 comprehensive term indigestion is applied indiscriminately to this 
 as well as the other morbid states of the stomach which I have 
 already mentioned. 1 
 
 In this affection, as I have before said, a morbid condition of the 
 secretions is the predominant feature of the disease. Professor 
 Recamier 2 has detailed accounts of the dissection of several subjects 
 who have sunk from aggravated diseases of this character. He 
 found, in these cases, the liver pale and voluminous, the gall-bladder 
 full of black bile, which was extravasated in large quantities in the 
 duodenum, jejunum, and ileum; the stomach and duodenum were 
 likewise coated with thick viscid secretions, under which the 
 mucous membrane did riot present the least trace of inflammation 
 or congestion. Andral has also described a disease under the name 
 of gastrorrhosa, in which he considers this state of the secretions, as 
 a predominant and primitive feature of disease, to be as well esta- 
 blished as any other point of pathology. 
 
 In enquiring into the symptoms which denote or accompany these 
 forms of secretory irritation, we shall find them, in some measure, 
 resembling those of hypcrsemia, or active congestion of the mucous 
 membrane, or some forms of inflammation. They are of two 
 classes, referable, in the first instance, to the stomach itself, and 
 secondly, exhibited in various sympathetic affections of other 
 organs. 
 
 In secretory irritation of the stomach, the two first points that 
 demand our attention are the state of the tongue, and that of the 
 epigastric and hypochondriac regions. The tongue is generally 
 broad, rather pale and moist, not contracted, and without increased 
 redness at its point or edges. The papillae are not elevated, 
 enlarged, nor very vivid in their appearance ; the coating of the 
 tongue is thick, and of a dirty white or yellowish colour. The 
 epigastric region is full, but indolent ; hardly sensible or tender on 
 pressure, unless the disease be of long standing. If the complaint 
 have been long in existence it occasionally produces or becomes 
 associated with, increased vascularity of the mucous membrane of 
 
 '11 faut se rappeller que 1'estcmac secrete deux especes de liquides: une 
 mucosite qui est produite par les glandes de Brunner, et une humeur acide 
 qui est proprement le sue gastrique ; en outre. Porifice pylorique est tel lenient 
 dispose qu'il n'empeche pas le reflux de la bile dans la cavite du ventricule. 
 Faut il attribuer a la secretion de, ces diflferens liquides un r6le dans la pro- 
 duction de 1'ernharras gastrique ? ou bien faut il n'y voir qu'un certain degre, 
 ou une certain forme de 1'initation de Pestomac? Littre, Diction, de Mede- 
 cine, 2d edit., art. Gastrique (fievre et embarras). It is plain that the word 
 irritation here used is not to be understood in the sense generally applied to 
 it by the French writers, that of a certain degree of inflammation, since, in 
 the forms of disease of which we are speaking, an antiphlogistic treatment 
 is commonly totally inefficacious, and sometimes positively hurtful. 
 
 2 Quoted in De Larroque, Op. cit., p. 307. 
 
54 PARKER ON THE STOMACH. 
 
 the stomach ; and in such instances the epigastrium and hypochon- 
 dria acquire increased heat, and become more sensible and tender 
 on pressure. Both De Larroque and Andral have noticed this 
 complication of inflammation, or active congestion, with various 
 forms of disorder of the secretions of the stomach and first passages. 
 " On opening bodies," writes the latter of these authors, "one is 
 sometimes struck with the prodigious quantity of mucus on the in- 
 ternal su rface of the stomach and intestines. This often forms a thick 
 layer extending over a great portion of the intestine, which, at first 
 sight, might be taken for the mucous membrane itself, and that, too, 
 white and healthy. Beneath this layer of mucus the internal 
 surface of the canal may appear in two opposite states. In the first 
 place the mucous membrane may be of a bright-red colour, and this 
 is even the most usual case ; but it may also be pale and without 
 the least trace of injection, the increase of a secretion not necessarily 
 inferring the formation of a sanguineous congestion in the secreting 
 organ. The mucous membrane that lines the superior surface of 
 the tongue presents, in this respect, the greatest analogy with what 
 is found, on opening the body, in that part of the alimentary canal 
 that is concealed from view during life. Thus at the same time 
 that it is loaded with an unusual quantity of mucus, it is itself 
 sometimes of a bright-red, sometimes of its natural colour, and, 
 lastly, at times even paler than natural." 1 
 
 When the secretory irritation becomes combined with active 
 congestion or inflammation, there is generally a change in the 
 symptoms which indicate it. Thus, the tongue, which was ori- 
 ginally pale, broad, moist, and coated, becomes contracted, red at 
 its point and ed^es, the papillae vivid and enlarged. At the same 
 time various other symptoms indicative of gastric hyperemia, or 
 inflammation are ushered in; to enumerate these would be to re- 
 capitulate what has been said on this subject in chapter the third, 
 to which I refer the reader. 
 
 As a disordered condition of the secretions of the stomach may be 
 combined with congestion or inflammation, in some instances, so 
 may it in others be associated with a variety Of nervous symptoms 
 which are totally different from those indicating inci eased deter- 
 mination of blood, either to the stomach or parts sympathetically 
 affected. Thus, many cases of stomach disease occasionally pre- 
 sent themselves where nausea and occasional vomiting are. present, 
 bad taste in the mouth, with uneasiness and weight in the epigas- 
 trium. Sometimes the patients vomit daily, and are never free 
 from sickness, except for a short time after the stomach has dis- 
 charged its food, or a considerable quantity of bile or mucus. 
 There is extreme mental despondency or irritability, stupor and 
 weight in the head, with severe pain over the forehead, quickened 
 breathing, and a dry cough. Occasionally diarrhoea accompanies 
 
 1 A Treatise on Pathological Anatomy, translated by Drs. Townsendand 
 West. Tome i., p. 170. Dublin, 1831. 
 
MORBID STATES OF ITS SECRETIONS. 55 
 
 these states, or there is an alternation of constipation and looseness. 
 That these symptoms arise from the presence of an increased 
 quantity or morbid quality of the secretions of the stomach, acting 
 upon the peculiar sensibility of its lining membrane, is evident from 
 many reasons. The stomach affection and its sympathetic diseases 
 are not relieved in these states either by bleeding, counter-irritation, 
 opiates, or even, in many instances, by aperients, though these 
 are generally very serviceable. I shall detail some cases in illus- 
 tration. 
 
 CASE 1. A lady, aged twenty-nine, one year married, had 
 suffered for three months prior to her consulting me from total loss 
 of appetite, weight and uneasiness in the epigastrium, constant 
 nausea, with frequent vomiting of food, and mucous discharges. 
 She had constant headach, seated in the forehead and temples, and 
 a total indisposition to sleep. The breathing was quickened, and 
 there was a short, dry, frequent cough. The lungs, on examination, 
 afforded no evidence of disease. Leeches, blisters, and counter- 
 irritants, had been applied to the epigastrium, with the effect rather 
 of aggravating than relieving any of the symptoms of stomach dis- 
 order. Aperients, in various forms, had been tried to their fullest 
 extent; opiates had also been administered, with a view of pro- 
 curing some rest ; but all had failed. The patient actually passed 
 night after night without closing her eyes. Leeches, were now 
 applied to the temples and behind the ears, and these were succeeded 
 by blisters; these remedies aggravated the pain in the head, and 
 brought on delirium. The stomach still continued in the same 
 state, in spite of all that had been done; whilst the sympathetic 
 irritation of the head and chest were worse. I now reflected 
 whether I had not to treat one of those diseases which depend upon 
 the accumulation of a mass of morbid secretions in the stomach and 
 first passages, and which, though admitted as a fruitful source of 
 disease by "Stoll, Tissot, Finke, Porame, De Larroque, and others, 
 had been almost ridiculed out of the domain of pathology by the 
 doctrine of irritation substituted by Broussais, in which all these 
 secretory disorders are considered as the result of inflammatory 
 action. Finding that local depletion, blisters, counter-irritants, and 
 aperients had failed, whilst the state of the patient, the heat of skin, 
 and arterial excitement, completely prohibited the exhibition of 
 tonics, I determined to try the effects of the tartar emetic, from 
 which vast benefit had been derived in such instances, by De 
 Larroque andAndral. Two grains of this substance were adminis- 
 tered. The patient vomited an immense quantity of bilious and 
 mucous fluids ; the stomach became comfortable, the sickness and 
 nausea disappeared, and for two days the head remained free from 
 pain. In a few days the symptoms returned in a milder form. The 
 remedy was again employed ; vomiting of the same discharges to a 
 much less extent. After a third repetition there was no more return 
 of complaint; the patient became perfectly convalescent. 
 
 Remarks. This case exhibits two or three points which it is 
 
56 PARKER ON THE STOMACH. 
 
 important to notice : 1st. That secretory irritations of this kind 
 may continue for an indefinite period without being accompanied 
 with any real inflammatory action of the stomach. 2d\y. The 
 sympathetic affections which they excite are sometimes of a purely 
 nervous character and aggravated by all antiphlogistic treatment, 
 as the present case shows. We need only refer to the effects of 
 treatment to establish this. Occasionally those states of the head 
 which succeed to such forms of irritation in the stomach, terminate 
 in stupor, serous apoplexy, or fatal forms of cerebral congestion; 
 but effusion of serum is more common than the latter state. In 
 speaking of the diseases of the brain which succeed to different forms 
 of gastric irritation, we shall enter into this more fully. 
 
 I shall now bring forward a case to show that these forms of 
 disease in the stomach may assume a purely chronic form, and 
 sirnilate confirmed inflammatory disease, yet consist entirely in a 
 disordered state of the secretions. 
 
 CASE 2. A lady, thirty-seven years of age, in consequence of 
 a series of calamities, became troubled with an affection of the 
 stomach, characterised by the following symptoms: Pain after 
 taking even the simpler kinds of food, which was accompanied by 
 a convulsive cough that continued till what was taken had been 
 rejected by vomiting ; the more severe the pain which followed a 
 meal the more troublesome and intense was the cough. She had 
 nausea, flatulence, uneasy feelings in the region of the stomach, and 
 sudden flushings of the face ; she had no appetite, a broad coated 
 tongue, offering no traces of redness at its point or edges, although, 
 considerable pain existed in the epigastrium and in the right hypo- 
 chondrium. There was an alternation of constipation and diarrhoea, 
 the pulse a little frequent, the urine scanty, sleep disturbed, and the 
 temper morose and irritable. These symptoms had existed for four 
 years with little variation, during which time the patient had ema- 
 ciated considerably. 
 
 The medical attendants of this lady, concluding that she 
 laboured under some obscure and chronic inflammatory affection 
 of the stomach, recommended the application of fifteen leeches to 
 the epigastrium. 
 
 This local bleeding aggravated all the symptoms, the pains con- 
 nected with the stomach and the process of digestion were con- 
 siderably increased, the appetite rendered worse, whilst the cough 
 became more frequent and hoarser than before the application of 
 the leeches. 
 
 Blisters, aperients, and various other remedies had been tried 
 without success, or at least with but temporary benefit. M. De 
 Larroque, under whose care the patient was placed in an advanced 
 stage of her disease, on closely analysing the symptoms and reflect- 
 ing on the failure of the remedies previously employed, was led to 
 suppose that the irritation in the stomach might be of the secretory 
 kind, and probably a recourse to the use of emetics might be of 
 service. Constipation was present, and the patient had experienced 
 
MORBID STATES OF ITS SECRETIONS. 57 
 
 a partial relief of her symptoms from the use of aperients ; but the 
 disease had soon become as distressing as ever. 
 
 At this period the patient was ordered twenty-four grains of ipe- 
 cacuanha to be taken at two doses. She threw up an enormous 
 quantity of bile and mucus; the cough diminished with all the 
 other symptoms ; a recourse was now had to purgative medicines, 
 which in a few weeks completely restored the patient. 1 
 
 Remarks. In this case we observe the disease to have assumed 
 a more chronic form than in the last; it had existed four years 
 when placed under M. de Larroque's care, was accompanied by 
 emaciation, and certainly assumed all the appearance of an organic 
 affection of the stomach. We witness here the failure of bleeding 
 and counter-irritation over the epigastric region, as also of pur- 
 gative medicines; with regard, however, to the latter, it is most 
 probable that a judicious administration of mercurial aperients, or 
 alteratives with warm stomachics and aloetics might have accom- 
 plished a cure, since we see that castor oil, the only remedy used as 
 an aperient, was productive of partial benefit, and after the use of 
 the emetic was singularly useful in forwarding the cure. The 
 alternation of diarrhoea with constipation, in such affections as the 
 present, does not contra-indicate the treatment either by purgatives 
 or emetics. Andral has recorded some cases of the successful 
 treatment of bilious diarrhoeas by emetics. 2 
 
 In this case we observe, also, a chronic affection of the respiratory 
 organs supervene upon that of the stomach, accompanied by a con- 
 vulsive cough. I have detailed in a subsequent part of this work 
 many cases where affections of the lungs have succeeded to those 
 of the stomach of the inflammatory kind. Those morbid states of 
 the stomach, however, which consist in a disordered state of its 
 secretions are not less productive of disease in the respiratory 
 apparatus. 
 
 These affections of the organs of respiration may exhibit them- 
 selves in various forms ; in acute pains in the chest, resembling 
 those of pleurisy ; in various morbid conditions of the respiration, 
 which may be hurried or irregular ; in cough ; in frothy, mucous, 
 or bloody expectoration, to so great an extent as to lead to the 
 belief that they are actually dependent on organic disease of the 
 lung. 
 
 CASE 3. A mason, aged twenty, resident in Paris for a year, felt, 
 during the last fifteen days, a pain under the left breast ; it was 
 increased by percussion and strong inspiration. He had no cough 
 and breathed freely. For the last ten or twelve days he had some 
 purging; his tongue was covered with a thick yellowish coat ; he 
 had no fever. 
 
 1 J. B. de Larroque, op. cit., 2me Section de 1'etat saburral des premieres 
 voies, &c., ch. 1., Observation 5me. 
 
 2 Clinique Medicale, &c., by Spillan, p. 709, Case 60. 
 
68 
 
 PARKER ON THE STOMACH. 
 
 The day after, the 8th of May, he took twelve grains of ipe- 
 cacuanha and a grain of tartar e'metic. He vomited once a great 
 quantity of bile and thick mucus. 
 
 On the 9th the pain of the side was entirely gone ; the tongue 
 had become clean. 
 
 On the 10th the diarrhoea had disappeared. The patient was 
 perfectly restored. 
 
 A new circumstance presented itself to us in this case, namely, 
 the administration of an emetic whilst there was diarrhoea, and the 
 cessation of this diarrhoea. after the vomiting. 
 
 This slight disease presents several traits of resemblance to an 
 affection described by Stoll under the term of "bilious pleurisy:" 
 loss of appetite, bitter taste in the mouth, spontaneous vomiting, 
 thick coating of the tongue, purging, and at the same time a fixed 
 pain in a point of the thoracic parietes ; lastly the rapid disappear- 
 ance of the stitch in the side, and the other symptoms after the em- 
 ployment of an emetic. 1 
 
 CASE 4. A widow aged fifty-six years, who had previously 
 enjoyed the best health, gradually lost her appetite. She had a fre- 
 quent disposition to vomit, and constantly threw up her food, mixed 
 with a considerable quantity of tenacious ropy mucus. The tongue 
 was coated, the mouth bitter, the abdomen full, and slightly tender 
 on pressure; the bowels were confined, the stools, when passed, 
 hard and dry. At the same time she suffered from a considerable 
 difficulty of breathing; the respirations were drawn with great 
 difficulty, accompanied with a strong whistling noise, as in some 
 asthmatic patients. She was unable to lie down or sleep, and 
 passed the night in her chair. 
 
 This patient, experienced a temporary relief from injections, but 
 the stomach derangement, and that of the respiration, soon became 
 as violent as before. She was now recommended to take two scru- 
 ples- of ipecacuanha with one grain of emetic tartar. This pro- 
 duced an enormous discharge of bilio-mucous fluids: the stomach 
 was relieved, the breathing more free; she slept. Several relapses, 
 though by no means to the primitive degree of complaint, succeeded. 
 These were subdued by the alternate use of emetics and aperients; 
 and in a short time the patient became perfectly convalescent. 2 
 
 CASE 5. A little boy, aged ten, previously in good health, gra- 
 dually lost his appetite, and was occasionally sick. The tongue 
 was loaded with a thick fur, but offered no traces of increased red- 
 ness, either on the borders, the apex, or the papillae!. He complained 
 of pain in the epigastric region ; but there was no heat in this 
 situation, neither was it sensible to pressure. The bowels 
 were alternately relaxed and confined; the stools were offensive, 
 green, and thin. Some time after the commencement of these 
 gastro-intestinal symptoms, he began to be harassed with incessant 
 
 1 Clinique Mdicale, Spillan's translation, Case 59, p. 708. 
 8 Stoll, Ratio Medendi. 
 
MORBID STATES OF ITS SECRETIONS. 59 
 
 cough, which tormented him night and day. He was hardly free 
 from it a moment; it continued week after week. The child ema- 
 ciated, and appeared to be in the last stage of an organic disease. 
 It was evident that the cough was gastric, for the lungs, on the 
 most repeated and careful examination, afforded no evidence of any 
 morbid action. Still, however, the nature of the gastric affection 
 was misconceived: it was suppposed to be inflammatory. Leeches 
 were applied day after day; they relieved the cough, gastric symp- 
 toms, vomiting, &c., for a time, but in a few hours they returned 
 with increased intensity. He was now treated with emetics. Im- 
 mense discharges of mucus mixed with bile were thrown up; the 
 cough diminished, the sickness left him. The administration of a 
 few mercurial aperients completely restored the patient. 
 
 This case, very similar to several related by M. de Larroque, is 
 very instructive. It shows us, as some of the preceding ones do, 
 a disease, in many of its features, resembling chronic inflammation 
 of the stomach; yet we find it does not yield to antiphlogistic treat- 
 ment. We see here the patient wasting with total loss of appetite 
 and occasional sickness, with pain in the region of the stomach, 
 which assumes all the features of an organic affection, yet quickly 
 relieved by the discharge of a quantity of bilio-mucous fluids from 
 the stomach and first passages. In pure inflammatory disease of 
 this organ, accompanied by vomiting, food only is rejected, the 
 mucous membrane of the stomach bein^ dry. In the forms of dis- 
 ease of which we are speaking, the patient generally vomits quan- 
 tities of bile and mucus, which for a time relieve him. This is the 
 gastrorrhoea of Andral. itself one form of secretory irritation. 
 
 We notice, in the history of this case, the effects of bleeding. 
 For a few hours after the application of leeches the symptoms were 
 ameliorated, but they invariably returned with greater intensity the 
 next day; so that, in fact, the patient was always rendered worse 
 by them, and they were always more deleterious, as they were ac- 
 companied by a greater loss of blood. Precisely the same effects 
 took place -in all the patients treated in this way by M. de Larroque 
 who were ultimately cured by emetics and aperients. 1 
 
 CASE 6. A married lady consulted me for an affection of the sto- 
 mach which had harassed her for some years, and which, at its first 
 commencement, had been relieved by blue pill and warm aperients. 
 These remedies had now ceased to afford her relief, at least it was 
 so transitory and partial that it could hardly be called relief. She 
 suffered, at the period of her consulting me, from constant nausea, 
 occasional fits of vomiting, which discharged large quantities of 
 slimy sour mucus, not food, and came on chiefly at those periods 
 when the stomach was empty. There existed a feeling of pain 
 and constriction across the epigastrium, which was hot and slightly 
 
 1 See Cases 1, 2, 3, 4, and 5, of the treatise of M. de Larroque, De quel- 
 ques maladies abdominales, &c., Sec. 2dj De 1'etat saburral des premieres 
 voies, &c. Page 255, et suivantes. 
 
60 PARKER ON THE STOMACH. 
 
 tender on pressure; in addition to these symptoms, there was a 
 teasing cough and some diarrhoea. The tongue was not contracted 
 but coated, and inclined to redness. 
 
 Believing that, in this case, the disease was combined with, and 
 dependent upon, a state of hyperemia, or active congestion, if not 
 an inflamed state of the mucous coat of the stomach, ten leeches 
 were applied over the epigastrium, and the patient was recommended 
 to take the mist. creta3 with hydrocyanic acid, with a view of ab- 
 sorbing and correcting the acidity of the secretions. These reme- 
 dies afforded considerable relief, and for a time the patient was 
 tolerably well. The local depletion had entirely removed the epi- 
 gastric pain and constriction, the patient ceased to vomit, and was 
 no longer tormented with nausea or vomiting of mucous discharges. 
 Some time afterwards she became a^ain ill, with the same symp- 
 toms. Leeches now afforded no relief; she was constantly sick; 
 uneasiness and weight existed in the epigastrium; the tongue was 
 not so red as before, and the symptoms of increased determination 
 of blood to the coats of the stomach did not appear strongly marked. 
 I should mention that aperients now rather increased the complaint 
 than at all relieved it; they brought on distressing loosenes when 
 administered in very small doses. I now determined to administer 
 an emetic, and consequently two grains of the tartar emetic were 
 given. A large quantity of slimy mucus, mixed with bile, was 
 vomited; the sickness disappeared, with the weight in the epigas- 
 trium, and diarrhoea; the patient was restored to a degree of health 
 she had not for some time enjoyed. 
 
 Remarks. This case is an example of secretory irritation of 
 the stomach accompanied by increased fulness of blood in it mu- 
 cous coat, upon which, most probably, the increased quantity and 
 morbid state of the secretions was dependent. It was evident from 
 the effects of remedies that, on my first seeing this patient, such 
 was the case: hence the success of the treatment. This case pre- 
 sents several symptoms which do not correspond with a state of 
 ordinary inflammation the character of the discharges by vomit- 
 ing, and the period of their occurrence, viz., when the stomach was 
 empty, and not after a meal. Still we find symptoms which lead 
 us to suppose that an undue fulness of blood in the vessels and 
 coats of the stomach was present; such are heat, pain, and tender- 
 ness in the epigastrium. The indications of treatment in such 
 forms of combination are, to diminish the fulness of the vessels of 
 the stomach, to improve the qualities of its secretions, and to lessen 
 its irritability. For this purpose I know of no plan of treatment 
 more efficacious than that detailed in the management of this case, 
 in the earlier periods of the disease. The existence of diarrhoea 
 precludes the use of aperients; for I have constantly found, in such 
 forms of disease, that they readily produce hypercatharsis, however 
 mild they may be. The mist, cretas with hydrocyanic acid is the 
 best remedy I know of in such states; it frequently affords the 
 patient vast relief. 
 
MORBID STATES OF ITS SECRETIONS. 61 
 
 When I last saw this patient the secretory irritation appeared 
 uncombined with hyperemia, and I then ventured to use an emetic: 
 it was of great service. These remedies, however, cannot be used 
 with too great caution ; since many forms of inflammation in the 
 stomach are so insidious that they may escape an upractised ob- 
 server. They should only be used when the disease is most per- 
 fectly uncombined with hyperemia or inflammation, and then not 
 till all other remedies have failed; since we find many examples of 
 their exhibition, in different forms of irritation of the stomach, to 
 have produced fatal inflammatory disease. When any form of irri- 
 tation exists in the stomach, it appears more prone to become 
 inflamed from the exhibition of stimulants, either medicinal or 
 dietetic, than if no such irritation existed. Hence, many diseases 
 of this organ purely nervous or atonic in their commencement, are 
 rendered in the sequel inflammatory. 
 
 I have shown that secretory irritation of the stomach exists with 
 two totally opposite pathological conditions of its mucous coat: 
 one in which this membrane is of its natural and healthy colour, 
 or even paler than natural; and a second in which it exhibits marks 
 of active congestion or inflammation. The last case detailed was 
 of the latter character, at least in its commencement. I shall now 
 bring forward a case related in the Dublin Journal of Medical 
 Science for July, 1837, which well exhibits the latter form of dis- 
 ease, and shows us how careful we should be in our examination 
 of the patient before determining upon the plan of treatment; since 
 a disease evidenced by symptoms closely resembling each other 
 may depend upon two states of irritation in the organ affected, of 
 totally opposite characters, and requiring different modes of treat- 
 ment. 
 
 CASE 7. A woman, named Hutchinson, was admitted into Sir 
 Patrick Dun's Hospital on the 26th of March, 1820, complaining 
 of headach, pain in the left side, nausea, and soreness of the throat. 
 These symptoms increased, with constant retchings, waterbrash, 
 heartburn, and hysterical paroxysms. On the 15th of April food 
 only remained a quarter of an hour on the stomach; an acid fluid 
 was discharged in quantities of a dark coffee-ground colour, with 
 burning heat of the stomach, excoriation of the mouth and fauces, 
 and obstinate costiveness. She received no benefit from the treat- 
 ment, which consisted in a mercurial course pushed to salivation, 
 and bleeding. In fact, the remedies appear to have done harm: 
 the vomitings continued: she was pale, but not emaciated. In 
 1823 her disease is thus described by Dr. Graves: "The fits of 
 vomiting last, from ten to fourteen days, recurring at intervals of 
 about five weeks; the attacks preceded and accompanied by acute 
 pain, and tenderness in the epigastrium. When she swallows, it is, 
 for the most part, instantly rejected, and her sufferings continue 
 day and night, without intermission. Quantity of fluid amounting 
 to several basinfuls daily rejected; so acrid as to excoriate throat, 
 tongue, and fauces: 'with a constant exudation of blood from the 
 
62 PARKER ON THE STOMACH. 
 
 whole inner surface of the month. This fluid often contained a 
 large proportion of mucous flocculi of a dark colour, which im- 
 parted to the whole the appearance of being mixed with a blackish 
 colouring matter." In 1849 a seton was placed over the stomach, 
 which at first gave vent to a yellowish fluid, but subsequently to a 
 large quantity of a fetid inky or dark-blue fluid. Whilst the seton 
 continued to discharge the vomitings ceased, but on its being dried 
 up they returned, and the patient could not be prevailed upon to 
 have a new drain opened. She was then treated with repeated 
 blisters over the part, cupping, leeching, or general bleeding, with 
 injections, and calcined magnesia in cinnamon water: the carbonate 
 of magnesia always gave intense pain when substituted. These 
 remedies acted well for three years, and the attacks were lessened 
 to three or four in the year. Very small doses of calomel and 
 opium were tried instead of magnesia, which seemed to have lost 
 its effect; a few grains caused salivation in two or three days, and 
 the relief was remarkable and immediate. Some aperient pills 
 and soda water (after its effervescence had subsided) then kept the 
 bowels free and checked the vomiting, which generally ceased or 
 lessened as soon as they acted regularly. 
 
 She died suddenly, after drinking part of a glass of whisky. 
 On examination after death the mucous membrane of the stomach 
 was found intensely inflamed, the cardiac orifice especially, which 
 was of a deep red colour ; pyloric orifice quite sound. Duodenum 
 highly inflamed, its mucous membrane red and rough. A quantity 
 of creamy mucus adhered to the mucous membrane of the duode- 
 num and jejunum, bloody effusion under the mucous membrane in 
 spots, which were of a dark colour; and in some situations bloody 
 mucus. Ascending and descending colon highly inflamed ; trans- 
 verse arch not so much so; bladder and rectum healthy. 1 
 
 Remarks. This case presents some peculiarities which demand 
 particular attention; they relate to the duration of the disease, its 
 character, and mode of treatment. I have shown, in that part of 
 the subject of this book which treats of "Affections of the Stomach 
 characterised by Derangements of its Sensibility," that secretory 
 irritations of this kind will sometimes take place tinder the influence 
 of mere nervous irritation; and Case 4, page 41, affords a remark- 
 able example of this. In the example before us, however, the 
 morbid state of the secretions was evidently combined with inflam- 
 mation, at least in the latter years of disease, though, perhaps, not 
 strictly dependent upon it: I certainly think not. The best plan 
 of treatment that could have been adopted would have been to have 
 given her large quantities of chalk with morphia or hydrocyanic 
 acid, or the ponderous carbonate of magnesia with the sub-nitrate 
 of bismuth and morphia: at the same time to have applied small 
 
 '"Case of long-continued Vomiting, &c., attended by some Remarkable 
 Circumstances," by C. P. Croker, M. B., &c. in the Dublin Journal ol Medica i 
 Science for July, 1837. 
 
MORBID STATES OF ITS SECRETIONS. 
 
 63 
 
 numbers of leeches to the epigastric region ; to have followed them 
 up by blisters, the surfaces of which should have been dusted with 
 the muriate of morphia. We have not, in such instances, to treat 
 merely an inflammatory disease, but, combined with inflammation, 
 a peculiar morbid condition of the secretions, which as often appears 
 uncombined with inflammation as it does with it. I am inclined 
 to suppose that the inflammation itself may be the result of the 
 constant irritation kept up by such acrid secretions upon the mucous 
 coat of the stomach, containing as they most commonly do, in 
 such instances, large quantities of free hydrochloric and acetic 
 acids. I refer the reader for further detail on this subject to the 
 remarks to Case 4, page 41. 
 
 OF GASTRORRHCEA. 1 
 
 A morbid condition of the stomach has been described, under 
 this title, by Andral and Roche, which consists in the secretion of 
 an excessive quantity of mucus from the lining membrane of the 
 stomach. This secretion may be merely increased in quantity, or, 
 in addition to this, it may present various alterations in its chemical 
 compositition. 
 
 Anatomical characters of the disease. Andral thus describes 
 them : " On opening bodies, we commonly find a thick layer of 
 adhesive slimy mucus exhaled on the surface of the mucous mem- 
 brane of the stomach, whilst this membrane does not present the 
 least traces of inflammation. Thus, we find gastrorrhoea existing 
 apart from any inflammatory action ; but again, in certain circum- 
 stances, it succeeds to it: and here the mucous membrane of the 
 stomach comes under the influence of that law in pathology in 
 virtue of which all inflammations of mucous membranes, when 
 arrived at a certain period, assume the character of a simple flux. 
 We observe this in the mucous surfaces of the bronchige, of the 
 urethra, arid of the vagina. In some cases, also, the augmentation 
 of the secretion of the mucous membrane of the stomach is depend- 
 ent on, or coincides with, a true inflammation." 2 
 
 Gastrorrhoea may appear, however, in other conditions of the 
 stomach beside those specified by Andral ; and hence we occasion- 
 ally find it accompanying purely nervous diseases of the stomach, 
 as gastralgfia and others. It is then, as in the instances in which 
 it succeeds to, or is combined with, inflammation, not a disease, 
 but a symptom, requiring, it is true, a particular mode of treatment, 
 but not one to be adopted apart from, and without regard to, the 
 primitive affection with which it is combined. It is only to be 
 considered a primitive morbid state when it exists without any 
 
 1 " Catarrh Chronique de PEstomac," Roche. -Dictionnaire de Medecine 
 et de Chirurgie Pratique. " Flux Muqueux de PEstoraac," Andral 
 Cours de Pathologic Interne. 
 
 * See Cours de Pathologie, &c., p. 84, et suivantes. 
 
64 PARKER ON THE STOMACH. 
 
 appreciable vascular or nervous irritation, and as such it is com- 
 monly met with. 
 
 Symptoms. These are to he sought for in the stomach itself, 
 and in the sympathetic affections of other organs. In patients 
 labouring under gastrorrhoea we find the epigastric region some- 
 times indolent, at others, hot and tender; weight and constricting 
 pains exist in the stomach, and a nausea, varying in its duration 
 and the period of its occurrence : it may come on after meals or 
 between them, may continue for an hour or two, or be present 
 during the whole day. Jn many persons this nausea is relieved 
 by eating, particularly of high-seasoned dishes; and it only again 
 recurs when the period of digestion is finished. One of the most 
 common attendants upon this disease is a vomiting of quantities of 
 adhesive slimy mucus; this commonly takes place early in the 
 morning, and many persons are unable to take food till the stomach 
 has discharged the mucus secreted during the night. Again, the 
 vomiting comes on at various periods during the day; but its most 
 ordinary appearance is when the stomach is empty, between meals, 
 and not immediately after them. This vomiting may continue for 
 a long period, and not appear to be attended with any serious con- 
 sequences. I have known it occur daily for months, and the 
 patient preserve the appetite and not grow thin. 
 
 The tongue is generally broad, pale, and flabby, or loaded with 
 a thick fur. It may assume a red appearance, and become con- 
 tracted, if the disease be combined with vascular irritation or in- 
 flammation. Constipation may be present, or the patient harassed 
 with a teazing diarrhoea; sometimes these states alternate one with 
 the other. 
 
 The pulse is scarcely affected in the simpler forms of this affec- 
 tion, and the sympathetic irritations, with the exception of cough, 
 which is commonly an attendant symptom, are not so well marked 
 as in other forms of gastric disease. 
 
 In many forms of gastrorrhosa the secretions do not offer any 
 marked change' in their character ; but there are other conditions 
 in which they are intensely acid, and contain large proportions of 
 acetic and muriatic acids. For examples of these forms I refer the 
 reader to Case 4, page 41, for an example of this combination with 
 a nervous affection of the stomach ; and to Case 7, in the last sec- 
 tion, for a similar combination with inflammation. 
 
 Gastrorrhoea is a disease peculiar to adult age, and hence its 
 causes are to be sought for in circumstances which act upon us at 
 this period, and which do not influence the constitution of the 
 child or the youth, in whom it is never or very rarely found. 
 These causes are, moral impressions, and an over-stimulating or too 
 relaxing a diet. I have frequently noticed that anxiety, or strong 
 mental impression, or excessive bodily fatigue, would produce this 
 affection in persons liable to it. Roche assures us that it is more 
 frequent in persons addicted to the use of wines or spirituous 
 liquors, particularly those who are in the habit of taking them 
 
MORBID STATES OF ITS SECRETIONS. 65 
 
 fasting. In such cases the stomach, whose irritability and tone 
 are, in a great measure, destroyed, does not inflame under the 
 repeated action of stimuli, but assumes another form of irritation 
 in secreting, sometimes to an enormous extent, fluids, of the cha- 
 racter of which we have been speaking. 
 
 The treatment of gastrorrhoea must be varied to suit the parti- 
 cular form it assumes, and the nature of its combinations. Should 
 it appear as a primitive affection, uncombined with either nervous 
 or vascular irritation, it commonly gives way to warm aperients, 
 followed up by bitters and the mineral acids. In some instances 
 purgatives are totally useless, particularly when diarrhoea is an 
 accompanying symptom ; then emetics are often found signally 
 beneficial, as the cases detailed by Stoll, Andral, De Larroque, 
 Roche, and myself, sufficiently prove. Roche has recommended 
 opiates and magnesia, calomel, the balsams of tolu and copaiba. 
 If the superabundant secretion be dependent upon, or associated 
 with, morbid conditions of the sensibility of the stomach, the latter 
 symptoms will demand our first attention ; and in most instances 
 of this kind neither emetics nor violent aperients are admissible. 
 In such cases the combination of magnesia or chalk with calumba 
 bismuth or morphia, are most useful. I have generally found the 
 prepared chalk, given with the hydrocyanic acid or morphia, more 
 useful in such states than almost any other remedy. 
 
 When the disease is manifestly combined with inflammation or 
 hyperemia, our first indications are to remove the local determina- 
 tion of blood, to correct the morbid states of the secretions by such 
 mild remedies as those recommended above, and, when the inflam- 
 mation has subsided, to administer freely the mineral acids or 
 quinine, with a view of correcting the disposition to a recurrence 
 of the disease. 
 
 M. Rene Prus and Andral have recommended the daily exhibi- 
 tion of opiates in some forms of gastrorrhoea in which habitual 
 vomiting was present. The practice, in their hands, appears to 
 have been successful. I have commonly seen one single dose 
 check a vomiting which has been daily present for weeks. 
 
 Besides its customary follicular and mucous fluids, the stomach 
 secretes air, a certain quantity of which is constantly found, but 
 which, in various states of the economy and of the stomach, some- 
 times accumulates to so great an extent as to render this symptom 
 a special object of attention. This, like most of the other symp- 
 toms indicative of either lesions of function or structure in the 
 stomach or its coats, may occur in every possible condition of the 
 mucous membrane, and also when the vascular and nervous sys- 
 tems of the stomach are in two opposite conditions of derangement. 
 The accumulations of air in the stomach are sometimes so great 
 that the degree of distension produced by them contracts the cavity 
 of t}ie chest by pushing upwards the diaphragm; and hence we 
 observe various changes from the natural character of the breath- 
 ing, and irregularities in the action of the heart. This disposition 
 10 c park 5 
 
66 PARKER ON THE STOMACH. 
 
 to the excessive secretion of air must be treated in relation to the 
 exact pathologic condition of the mucous membrane upon which it 
 appears to depend. If a symptom of a nervous affection it may 
 depend either upon atony or erethism of the nerves of the sto- 
 mach ; we may find it, also, equally present with an increased or 
 diminished quantity of blood. This distension from gaseous or 
 aeriform accumulation is, to many persons, most distressing, but it 
 gives way with the particular morbid state upon which it depends. 
 In some instances it is cured by leeches, blisters, or warm aperi- 
 ents ; in others, yields only to quinine and the preparations of 
 iron. 
 
 CHAPTER VII. 
 
 ON THE INFLUENCE OF THE STOMACH UPON OTHER ORGANS. 
 
 I. On the Influence of the Stomach upon the Liver. 
 
 The function of digestion is performed by the concurrent action 
 of the secretions of the stomach, and the fluids poured out by cer- 
 tain glands into the first portions of the alimentary canal. These 
 glands are the salivary, the pancreas, and the liver. For the per- 
 fect digestion of food it is necessary that the substances taken as 
 aliment should exercise a certain degree of stimulus on the coats of 
 the stomach, to enable it to throw out a secretion sufficiently pow- 
 erful and plentiful for their digestion. The degree of the solvent 
 qualities of the gastric fluids secreted during digestion is in direct 
 relation to the stimulating character of the food, as the researches 
 of Drs. Prout and Beaumont, Tiedemann and Gmelin, Lauret and 
 Lassaigne, have sufficiently established. If the stimulating cha- 
 racter of the food pass a certain point, a degree of irritation is pro- 
 duced, which assumes the inflammatory form, and which deter- 
 mining an undue quantity of blood into the mucous coat of the 
 stomach, reacts upon the heart, quickens its pulsations, and deter- 
 mines a temporary febrile state of greater or less intensity, and of 
 longer or shorter duration. To this morbid state Andral has 
 applied the term " gastric hyperemia ;" among the French gene- 
 rally it is termed " embarras gastrique," and by the English " in- 
 digestion." Both the latter terms, however, are vague and indefi- 
 nite, and may be applied to many morbid states in which fulness of 
 blood is not a pathognomonic character of the disease. The writers 
 of the French physiological school consider this condition of the 
 stomach as a first and evanescent form of inflammation ; and many 
 modern writers of the English school admit the inflammatory form 
 of indigestion, which has become permanent from a too frequent 
 
ITS INFUENCE UPON OTHER ORGANS. 67 
 
 repetition of the causes which have determined, in the first in- 
 stance, this form and degree of gastric irritation. Such is the 
 state of things as far as the stomach is concerned ; but, from the 
 intimate connection of the stomach with other organs, the nature 
 and peculiarity of those connections, a'nd the character of its func- 
 tions and sympathies, we find that, in a great majority of in- 
 stances, the irritation once produced is not limited to the stomach, 
 but is transmitted, in a manner about to be mentioned, to other 
 organs. The first organ which demands our attention in this en- 
 quiry is the liver. The liver is more immediately connected with 
 the stomach by similarity of function than any other organ, though 
 its actions are not limited strictly to the secretion of ile. Hence, 
 the greater the demands made upon the powers of the stomach 
 during digestion, the more is the secreting power of the liver aug- 
 mented. Increased secretion rarely goes on without an increased 
 determination of blood to the secreting organ ; from this circum- 
 stance an undue secretion of bile is accompanied generally by a 
 local determination of blood to the liver. This is another primitive 
 morbid state, and to it Andral has applied the name of " bilious 
 hyperemia." 
 
 It is difficult to conceive of any impressions being made upon 
 our organs, except through the medium of the skin without or the 
 mucous membranes within. Hence the impression of a sapid sub- 
 stance of the tongue determines an increased secretion from the 
 salivary glands ; and in the same manner the presence of stimu- 
 lating or irritating substances on the mucous surfaces of the sto- 
 mach and duodenum necessarily induce an increase in the secretion 
 of the bile. The mode of transmission of irritation from the sto- 
 mach and duodenum to the liver is evidently in that way which 
 John Hunter named "continuous sympathy" i.e. from the mu- 
 cous surfaces of the stomach to those of the duodenum, and thence 
 through the common and hepatic ducts to the liver. 
 
 "The liver," says Broussais, 1 "is only affected consecutively to 
 the stomach, the small intestines, and the duodenum." Thus the 
 increased secretion from this organ is produced, during the conti- 
 nuance of inflammatory or hyperemic affections of the mucous sur- 
 faces of the stomach and duodenum, in the same manner as during 
 the act of digestion by irritation or stimulus of these parts spread- 
 ing thence to the liver. " When the pyloric portion of the stomach 
 or the duodenum are in a state of inflammatory irritation, the liver 
 is more influenced than when this irritation exists in any other 
 part of the alimentary canal." 3 By referring to the chapter on the 
 co-existing pathologic conditions of these two organs, we shall see 
 that cancerous diseases of the pylorus and liver are commonly 
 found together. The explanation given by Broussais of the causes 
 of hepatic diseases, although borne out by facts, and receiving the 
 
 1 Coraraentaires des Propositions de Pathologic, Prop. 149, 150. 
 
 2 Broussais, Op. cit. 
 
68 PARKER ON THE STOMACH. 
 
 support of many pathologisfs, does not fully or completely explain 
 the mode in which a diseased or irritated stomach influences the 
 liver. M. Ribes, whose opinions have been corroborated by An- 
 dral and Cruveilhier, discovered that inflammatory irritation of the 
 stomach was sometimes propagated from the stomach to the liver, 
 through the medium of the veins. It may be readily conceived 
 how excitement habitually produced in the digestive organs may 
 extend by continuity of tissue to the mucous membrane of the 
 excretory bile ducts, and thence to the substance of the liver. 
 Again, it would be possible that, under the circumstances of 
 habitual stimulus, the irritation might extend from the stomach 
 and intestines to the liver, through the medium of venous inflam- 
 mat on. 1 M. Ribes thinks that in gastro-intestinal inflammations, 
 the veins which arise on the surface of the mucous membrane 
 of the stomach would first be attacked by inflammation, and that 
 this might extend from the small mesaraic veins to the trunk of 
 the vena portse, and thus to the substance of the liver. Andral 
 and Cruveilhier have both met with cases confirming this view. 
 The same opinions are supported by Broussais in his Cours de 
 Pathologic et de Therapeutique Generates 2 Persons in the habit 
 of consuming 'arge quantities of food keep the mucous surfaces of 
 the stomach constantly turgid with blood. This state is the first 
 form of inflammation, and explains the remark made by Portal, 
 that great eaters have invariably large or hypertrophied livers. In 
 such cases the tongue is generally dry arid foul, its papillae deve- 
 loped, and the epigastric region hot and tender. 
 
 II. On the Physiological Action of the Stomach upon the Lungs. 
 
 The chemical functions of respiration, and the function of diges- 
 tion, which is strictly chemical in one part of its process, go on 
 under the influence of nerves derived from the same source, which 
 are principally destined to the stomach and lungs. Owing to this 
 anatomical fact, we sometimes find that irritation of the gastric 
 portion of the vagus nerve commonly produces a correspoding irri- 
 tation in the parts of this nerve which supply the lung; hence we 
 have hurried breathing, cough, and various disturbances of the 
 function of respiration, consequent upon stomach affections, whe- 
 ther these consist in inflammation, in nervous irritability, or from 
 the accidental presence of a worm in the stomach. These func- 
 tional disturbances are sometimes followed by actual states of dis- 
 ease. Thus, Andy 3 has reported a case of pleurisy caused by the 
 presence of a worm in the stomach ; De Larroque 4 one from large 
 
 1 See Andral, Clinique Medicate, by Spillan, p. 918. 
 
 2 Tome iii, p. 302. 
 
 3 De la Generation des Vers, p. 130. 
 
 4 De Q,uelques Maladies Abdominales qui simulent, &c., Maladies de 
 Poitrine. Paris, 1831. 
 
ITS INFLUENCE UPON OTHER ORGANS. 69 
 
 doses of the oxymuriate of mercury ; Lombard 1 has recorded several 
 cases of cancer of the stomach in which the whole pulmonary 
 branches of the pneumo-gastric nerve were enlarged to a consider- 
 able extent; Lobstein 2 others in which the branches of this nerve 
 were inflamed, either in consequence of, or simultaneously with, a 
 similar condition of the mucous coat of the stomach. From these 
 facts it appears that the integrity of the lung may be affected, in 
 the first instance, by- mere irritation of the gastric; extremities of 
 the pneumo-gastric nerve, which may not be limited to this state, 
 but actually progress into disease of the inflammatory kind, or 
 terminate in change of structure of the nervous trunk itself. The 
 respiration is generally quickened after a hearty meal, at the same 
 time that the circulation is accelerated. Cough, at other times 
 absent, is commonly then brought on. This arises from the 
 mechanical distension of the stomach by food or the gases evolved 
 during the progress of digestion, which, pressing upwards the dia- 
 phragm, and impeding the free admission of air to the lungs, thus 
 becomes a source of irritation during the period it lasts. The im- 
 mense distension of the stomach by wind in hysterical and hypo- 
 chondriacal persons thus acts upon the chest. Irritating or indi- 
 gestible food, by troubling the functions of the stomach, are 
 productive of the same consequences; hence the importance of a 
 properly regulated diet in diseases* of the lungs, and hence the 
 inutility of certain medicines, as juleps, syrups, balsams, and olea- 
 ginous mixtures, given in affections of the chest. These com- 
 pounds, being acted upon with difficulty by the powers of the 
 stomach, are sometimes actually hurtful to the affection of the lung, 
 from the gastric irritation they create. Andral has remarked their 
 inutility in phthisis, and De Larroque details many cases of their 
 positive injury, in increasing the cough and pectoral disturbance 
 they were given to allay. In all pulmo'nary diseases the medicines, 
 as well as the food, should be easily digestible. 
 
 Irritation of the diaphragm, the result of gastric derangement, 
 becomes a frequent source of disorder to the function of respiration. 
 De Larroque records a case where its peritoneal surface was in- 
 flamed from long continued stomach disease. "Les melancholiques 
 eprouvent un resserrement opiniatre de la poitrine, et respirent avec 
 peine, quoiqu'ils aient les poumons parfaitment sains. Chez eux, 
 1'irritation du diaphragme est tellement augmentee, qu'ils eprouvent 
 des tiraillements incommodes dans le cieux de 1'estomac, et dans 
 les hypochondres, et que la respiration est genee ou tres precipitee." 3 
 
 No symptom is more commonly attendant on an inflamed or irri- 
 tated state of the stomach than a dry cough. If we peruse the 
 work of M. de Larroque on those abdominal diseases which resem- 
 
 1 "Clinique Medicale de l'H6pital Civil et Militaire de Geneve." Gazette 
 Medicale de Paris. Janvier, 1837. 
 
 2 De Nervi Sympathetic! Fabric^, Usu, et Morbis, Commentatio, &c. 
 'Portal, Cours d'Anatomie Medicale, tome iv., p. 135. 
 
70 PARKER ON THE STOMACH. 
 
 ble, produce, or keep up, diseases of the chest, we shall at once see 
 that many of the forms of cough which are supposed to be pectoral 
 are actually of gastric origin. The first effect of this constant and 
 repeated irritation of the chest, occasioned by violent fits of cough- 
 ing, is, to produce a certain degree of congestion of blood in the 
 mucous membrane of the bronchise, and subsequently in the pul- 
 monary vesicles. This is the first stage of pneumonia, bronchitis, 
 and their consequences; and hence many of these affections, at 
 first the result of mere irritation of the gastric branches of the 
 pneu mo-gastric nerve, produce irritation of the lungs, followed by 
 cough, by congestion of blood, inflammatory or organic disease. 
 This is the mechanism of the production of pulmonary diseases 
 which have their origin in the stomach. The dissection of patients 
 dying from gastric diseases accompanied by cough shows us the 
 lungs or bronchia in this state; a congestion of blood in the 
 mucous membrane in the latter, and also in the substance of the 
 former. 1 The bilious pneumonia spoken of first by Stoll, and 
 noticed subsequently by Andral and Bouillnud, has evidently this 
 origin. In this manner are irritations which commence in the 
 nervous system succeeded by congestion and inflammation, thus 
 are the "lesions of innervation followed by those of circulation," 
 and in this manner may a simple indigestion, apparently so trivial, 
 lay the foundation of organic disease of the lungs. 2 The most 
 common source of pulmonary irritation commencing in the stomach 
 is evidently nervous irritation, which, determining an increased 
 quantity of blood into the coats of the stomach, terminates in con- 
 gestion or inflammation. The affections of the mucous membrane 
 of the lungs, which succeed to those of the stomach, are, again, 
 produced under the influence of that law which disposes diseases 
 to spread by similarity of tissue. Thus, we hardly ever see a pro- 
 tracted affection of the mucous coat of the stomach without an irri- 
 table or inflamed state of that of the lungs. Those parts of the 
 body which are of a similar anatomical organisation have a natural 
 tendency to sympathise with each other more freely than others in 
 which no similarity of organisation exists ; they also exhibit a tend- 
 ency to be acted upon by the same irritating causes. Hence we 
 observe that those persons who exhibit a natural tendency to intes- 
 tinal irritation, under the form of repeated diarrhoeas, arising from 
 slight dietetic errors, have at the same time a similar tendency to 
 irritation of the mucous surfaces of the lungs, which often termi- 
 nate in phthisis, of which this intestinal irritation is the first indi- 
 cation. This is also well exemplified in the sympathies of the 
 mucous membranes of the lungs with those of the digestive passages, 
 and also in the frequent and simultaneous origin of disease in both, 
 
 *See Broussais, Traite de Physiologie appliquee a la Pathologie, tome ii., 
 p. 70, et suivautes. 
 
 1 See the Remarks of Portal, Op. cit., torne v., p. 194, and the corroborative 
 testimony of Lieutaud, Morgagni, and Storck. 
 
ITS INFLUENCE UPON OTHER ORGANS. 71 
 
 as noticed by Copland and others. The same cause which produces 
 a gastritis will, at the same time, produce a bronchitis ; the conti- 
 nuation of inflammation of the mucous membrane of the stomach 
 for a certain period is, in many individuals, followed by acute or 
 chronic disease of the same parts in the lungs, as my own cases, 
 with those of Andral, Larroque, and Broussais, sufficiently prove. 1 
 
 These are the modes in which the sympathies existing between 
 the lungs and stomach are exercised, and these sympathies may be 
 called forth from several sources of irritation in the stomach; from 
 the presence of foreign bodies, as worms, from indigestible food or 
 medicine, or from varied forms of actually existing disease. 
 
 There are. however, other ways in which the stomach influences 
 the lung; these, however, are rather mechanical than vital. Thus, 
 the distension of this viscus by an undue quantity of food, the gases 
 evolved during the progress of digestion, the vast collections of 
 wind which occur in hysterical and hypochondriacal persons, by 
 pressing upon and contracting the cavity of the thorax, and irritat- 
 ing the diaphram, become a fruitful and a frequent source of 
 derangement in the functions of the organs of respiration. 
 
 III. Of the Physiological Action of the Stomach upon the Heart. 
 
 The heart, like the lungs, is influenced by the stomach in the 
 customary integrity of its functions, in two ways, mechanically and 
 vitally. The distension of the stomach by food or gases, contract- 
 ing the cavity of the chest, and preventing the free discharge of 
 blood from the right side of the heart, naturally deranges the action 
 of this organ: and hence, from this cause, we observe laboured, 
 quickened, or irregular action of the heart, frequently come on, 
 where the stomach is free from complaint, after a meal. The 
 quantity of food which may be taken without exciting the heart's 
 action is variable, and may depend, in many instances, upon the 
 size of the stomach, no organ being so variable in its capacity as 
 this. I have been frequently consulted by a gentleman who pre- 
 sents none of the physical signs of disease of the heart in whom a 
 tea-cupful of common groat gruel will excite the action of the 
 heart to a very distressing degree, whilst a less quantity does not 
 do so. The position of the body after a meal, when the stomach is 
 full, has a marked effect upon the action of the heart. Portal 2 
 remarks that in persons whose occupations lead them to work with 
 the stomach pressed against a desk or counter as literary men, 
 and some mechanics or those who sit with the body doubled for 
 
 ^Lallemand details some instructive examples of the simultaneous and 
 consecutive occurrence of disease in the serous membranes of the abdomen, 
 l!ie chest, and the head. See Recherches, &c., de 1'Encephale, Lettre 2me. 
 Des tissues de meme nature, remplissant des fonctions semblables, soumis a 
 la meme influence, doivent etre egalement exposes a contracter la meme 
 maladie Page 155. 
 
 2 Op. cit., tome viii., p. 101. 
 
72 PARKER ON THE STOMACH. 
 
 wards as tailors or shoemakers the stomach is pressed, by the 
 position of the body, against the diaphragm ; the capacity of the 
 chest is consequently contracted, and the passage of the blood 
 through the heart impeded. To this circumstance this author 
 attributes frequent dilatations of this organ. Precisely similar 
 effects are produced by tight lacing, which, preventing the usual 
 motion of the stomach forwards when it becomes distended by food, 
 forces it upwards against the diaphragm, and, preventing the free 
 discharge of blood from the heart, gives rise to palpitations and 
 irregular actions, which sometimes terminate in organic disease. 
 It is this mechanical distension of the stomach which becomes so 
 dangerous to persons affected with organic diseases of the heart; 
 and we commonly observe it to produce a fatal embarrassment of 
 its actions. We often see persons carrying about them these dis- 
 eases die suddenly, from this cause, after a full meal. I have for 
 some time attended a gentleman who at first consulted me for dis- 
 tressing palpitations, which came on after his meals. On examin- 
 ing the heart physical signs of valvular disease, evidenced by a 
 strong "bruit de soufflet," were detected. By depriving him of 
 stimulants, and limiting him to a small quantity of food at a time, 
 the palpitations have disappeared, although the physical signs of 
 disease remain. It is thus that we may retard or prevent the fatal 
 termination of diseases, if aware of their true nature, and the in- 
 fluence of other organs upon the one diseased. I have seen several 
 other patients, in precisely similar states, relieved to such an extent 
 by the same means, and occasionally leeching the epigastrium and 
 region of the heart, as occasion might require, that they have fancied 
 themselves perfectly free from complaint. 
 
 The first effect of eating, as we have before said, alluding to the 
 physiologi9al action of the stomach upon the liver, is to determine 
 an increased quantity of blood to the mucous coat of the stomach, 
 and also to all the organs concerned in the function of digestion. 
 This determination of blood is produced by the food stimulating 
 the stomach. If a hearty meal be taken, the action of the heart is 
 accelerated to a greater or less degree, its pulsations are quickened, 
 the heat of the skin is slightly augmented, and a temporary degree 
 of arterial excitement is produced, which continues whilst the period 
 of digestion lasts. The degree of this excitement depends upon 
 the degree of irritability which the stomach naturally possesses, 
 and also upon that with which the heart is endued: we shall see, 
 by reference to the cases in the pathologic part of this work, that indi- 
 viduals vary extremely in the degree of irritability of these two 
 organs. So far digestion does not affect the heart or arterial system, 
 further than by producing a slight, but regular, increase of their pul- 
 sations. Under the influence, however, of an undue quantity of 
 food, of too stimulating or indigestible character, we find a degree 
 of irritation set up, from which the mucous coat becomes still fuller 
 of blood, the heart more excited than in the first state, and its bsats 
 hurried or irregular. In many individuals we may observe that 
 
ITS INFLUENCE UPON OTHER ORGANS. 
 
 73 
 
 the pulse constantly intermits whilst the period of digestion lasts; 
 and in others the increase of the .heats of the heart during the con- 
 tinuance of this function amounts to a distressing state of palpita- 
 tion. In both these instances careful examination by auscultation 
 can detect no evidence of disease in the heart, although it appears, 
 from the ease with which its functions are made irregular and its 
 rythm disturbed, that a predisposition to disease exists. Some phy- 
 siologists, amongst whom are Broussais and Andral, attribute this 
 irritability of the heart to a preternatural thickness of its walls, or 
 an over-excitable state of the nervous system distributed to it. How 
 often are such symptoms the first indications of hypertrophy, of 
 softening, of valvular disease, or affections of the investing or 
 lining membranes of this organ! 
 
 In many persons who die of gastric diseases, we notice the peri- 
 cardium intimately adherent to the muscular substance of the heart; 
 in others, this substance pale and softened ; whilst in a third 
 series varied forms of disease in its lining membrane arid valves are 
 present. 
 
 What we observe to take place during the period of digestion, 
 when the stomach is healthy, also occurs from other modes of 
 excitement, and also during the progress of many forms of disease; 
 amongst the former, moral causes play a prominent and important 
 part. In the various forms of gastritis, or gastric hyperemia, 
 occurring idiopathically or in conjunction with various morbid 
 states of the economy, particularly those noticed at the commence- 
 ment of various forms of fever, we observe the heart thus excited or 
 irregular. I have detailed many peculiar forms of these affections 
 in the subsequent pages. That these irregular or excessive actions 
 of the heart and arteries are dependent upon gastric irritation, and 
 not upon the general morbid state of the economy existing at the 
 time when they occur, is evident from their commonly subsiding 
 under the use of local depletions from the epigastrium, whilst the 
 general disease, as fever, runs its usual course. The heart, when 
 once rendered tumultuous or irregular by the irritation existing in 
 the stomach, reacts upon this organ through the medium of the 
 liver, and produces congestion of blood in the whole venous system 
 of the abdomen. When the heart's action is rendered irregular and 
 hurried from gastric irritation, or from other causes, the first effect 
 produced is an impediment to the free passage of blood through its 
 cavities. This may arise from contraction of its cavities from spasm 
 during the fits of palpitation, as some physiologists seem disposed to 
 admit, or from other causes. Whatever these may be, we find that, 
 during the continuance of the irregular action of the heart, there is 
 an impediment offered to the passage of blood through it as 
 long as the fits of palpitation or irregular action last. Hence the 
 sense of suffocation, the inability to lie down, the difficulty of 
 breathing, and other symptoms which attend them ; and hence is it 
 that we see the symptoms dependent upon actual organic disease of 
 the heart aggravated during the continuance of gastric irritation, of 
 
74 PARKER ON THE STOMACH. 
 
 which we shall see many examples under this division of our 
 subject. The impediment offered by the heart to the passage of 
 blood through it produces a mechanical congestion of this fluid in 
 the liver, and consequently in the veins of the mucous surfaces of 
 the stomach and duodenum. With the accumulation of blood in 
 these organs we commonly find an exalted state of the sensibility ; 
 the hepatic region is commonly full, and that of the epigastrium hot 
 and tender. It is the production of this state of stomach during 
 these states of the heart's action that renders the exhibition of certain 
 remedies, in such circumstances, inadmissible. 1 
 
 IV. On the Physiological Action of the Siomach upon the Brain. 
 
 The mass of nervous matter existing in the cranium, and that 
 assemblage of ganglia and plexuses placed in the epigastric region, 
 behind the stomach, to which Lobstein has applied the term 
 u Cerebrum abdominale," bear a strict relation to each other, and 
 are connected by certain sympathies which it is important to note, 
 both in health and in disease. The sensibilities of the nervous 
 centres of the epigastrium appear to be excited chiefly through the 
 medium of the mucous surfaces of the stomach ; and the sympathies 
 which connect this portion of the nervous system with others are 
 exercised, in a great majority of instances, through the means of 
 impressions made upon this organ. " The stomach," says Broussais, 
 " is a curious organ ; it is destined always to be irritated." 2 He 
 should rather have said, it is destined always to be stimulated ; for 
 if stimulus amount to irritation, -the condition of the organ has 
 passed from a state of health to the first commencement of disease. 
 All organs require a certain degree of stimulus to preserve them in 
 action ; without this stimulus they languish and become weak, with 
 an excess of it they become irritated and diseased. Independent of 
 the external stimuli which act upon our several organs, as light 
 upon the eye, sounds upon the ear, sapid bodies upon the tongue, 
 <fcc., every organ requires that a certain proportion of healthy 
 arterial blood be distributed to it, in order that it may properly act; 
 and whether this blood be furnished in excess or diminution, in a 
 greater or less quantity than is necessary to the due fulfilment of 
 the functions of the organ, a diseased condition is the result. This 
 is precisely the case with the stomach in many of its primitive 
 morbid states, and their influence upon the brain. I have given 
 some cases in this work illustrative of the symptoms of diseases 
 of the stomach subsequent to large losses of blood from the 
 uterus, &c., in their character precisely resembling inflammatory 
 diseases, yet which yieldefl quickly to the exhibition of iron and 
 
 1 The two hundred and twelfth aphorism of Broussais, and his commen- 
 tary upon it in his Commentaires des Propositions de Pathologic, merit par- 
 ticular attention on this point. 
 
 2 Physiologic appliquee a la Pathologic. 
 
ITS INFLUENCE UPON OTHER ORGANS. 75 
 
 other tonics. The brain, from the peculiarity of its constitution, 
 receives its stimuli from many sources ; from moral impressions, 
 and from the external stimuli, which affect it through the medium 
 of its organs of sense. The great nervous system of the abdomen, 
 however, which, in conjunction with many physiologists, I must 
 consider as the agent of sensibilities peculiar to itself, receives its 
 impression chiefly through the medium of the mucous surfaces of 
 the stomach, not considering it, as Bichat did, the seat of the 
 passions, nor admitting, with regard to it, any moral impression 
 further than is conveyed to it through the medium of the brain. 
 We have here two centres of sensation, the brain and the nervous 
 centres of the epigastrium, to which all sensations, both external 
 and internal, are referred. These may affect one centre alone, or 
 be transmitted from one to the other. The phenomena produced 
 by hunger and repletion are the first which demand our attention. 
 After trie stomach has been deprived for a certain time of the 
 presence of food, it contracts upon itself, its mucous membrane 
 becomes pale, and the circulation in this organ, as well as in the 
 general system languid ; the same effect is produced upon the brain. 
 This organ now receives sufficient biood for the due performance 
 of its functions, and no more ; the mind is clear, the operations of 
 the senses lively and acute, and the intellectual powers can be most 
 powerfully and judiciously exercised. If the abstinence be pro- 
 longed, another effect is produced : the mucous surfaces of the 
 stomach become dry, red, and inflamed, and a degree of mental dis- 
 tress is induced proportionate to the physical suffering of the patient. 
 I have remarked conditions of the stomach resembling this produced 
 from excessive discharges of blood during abortions, or after 
 delivery. In some of these instances, which I have detailed, there 
 has been intense acidity, and acute pain in the epigastrium, which 
 was hot, tender, and highly sensible. These cases have, as I have 
 before stated, yielded quickly to nutritious diet and tonics ; during 
 their continuance, anxiety and restlessness were present. In one 
 lady, who had aborted with alarming haemorrhage, profound coma 
 succeeded the discharges ; the skin was perfectly insensible ; she 
 exhibited no sensibility to pain, unless the epigastrium were pressed ; 
 this occasioned great uneasiness, evidenced by her countenance, 
 and convulsive motions of the limbs. After a moderate meal, taken 
 in a perfectly healthy state of the stomach and economy at large, 
 there is a general sentiment of ease and mental quietude induced ; 
 if annoyances had previously irritated us this has a wonderful effect 
 in allaying them, and restoring the mind to its customary tone. 
 
 The circulation is now slightly accelerated, the force of the 
 heart's action increased, and a disposition to drowsiness, and aver- 
 sion to the exercise of the mind comes on. If the meal be full it 
 induces, in many people, a frontal headach during the period of 
 digestion. 
 
 When the sensibility of the mucous surfaces of the stomach 
 becomes deranged from fulness of blood (hyperemia), from chronic 
 
76 
 
 PARKER ON THE STOMACH. 
 
 inflammation, or from other causes, the influence upon the brain 
 becomes much more varied and marked. In such instances we 
 have occasionally, after a full meal, a loss of some or the whole of 
 the mental powers; in some, depression; in others, fits of excite- 
 ment. The functions of the senses become impaired or exalted; 
 some see spectres or visions, and others are profoundly stupid. In 
 many instances apoplexy, epilepsy, or effusion, succeed to the gas- 
 tric irritation. Of all these forms of sympathetic affections of the 
 brain I have seen, and shall detail, examples. 2 
 
 "It is notorious," says Cabanis, "that in certain states of the 
 digestive organs we are more or less capable of exercising the in- 
 tellectual faculties." In the sympathetic affections of other organs 
 which accompany diseased conditions of the lining membrane of 
 the stomach, varied conditions of the mental powers are some of the 
 most frequent. In some persons where the powers of the mind are 
 naturally acute, they are singularly depressed after a full meal ; 
 some lose the faculty of thinking at all, others become deficient in 
 judgment, and in others, again, memory is quite lost. I was called 
 to the case of a gentleman, in the course of last year, who was 
 suffering from a subacute inflammatory affection of the stomach, 
 who completely lost the faculty of memory after taking a teacupful 
 of food; yet this patient was remarkable for his mechanical genius. 
 A less portion of food did not impair his mind, which invariably 
 became more powerful and clear from leeching or fomenting the 
 epigastrium. 
 
 So intimate is the connection between the brain and stomach, 
 that it is rare not to see some change produced in the functions of 
 the former by every impression made upon the mucous membrane 
 of the latter ; these changes, however, vary with the natural con- 
 stitution of the mind, and the varied states into which it is thrown 
 by the circumstances which act upon it. 
 
 Extreme mental depression is one of the most frequent attend- 
 ants upon chronic or subacute inflammation of the stomach, or 
 upon that congested or excited state of its mucous membrane which 
 follows the ingestion of aliment bad in quality or excessive in 
 quantity. Sometimes these states of mind continue during the 
 whole progress of the gastric disease ; at other times they succed to, 
 or are aggravated by, a meal; and, again, I have frequently seen 
 
 1 Les maladies de 1'estomac changent, troublent, intervertissent entiere- 
 ment 1'ordre habituel des sentimens, et des idees. Des appetits extraordi- 
 naires et bizarres se developpent: des images inconnues assiegent 1'esprit: 
 des affections nouvelles s'emparent de la volonte; et ce qu'il y a de plus re- 
 marquable, c'est que souvent 1'intelligence peut acquerir plus d'energie, 
 d'elevation, d'eclat, et Pame se nourrir d'affections plus touchante ou mieux 
 dirigees. Ainsi done, les idees riantes ou sombres, les sentimens doux ou 
 cruels, tiennent alors directement a la maniere dont certains visceres ab- 
 dominaux exercent leurs fonctions, c'est a dire a la maniere dont ils percoi- 
 vent les impressions. Richond, Influence de 1'Estomac sur la Production 
 d'Apoplexie. Paris, 1824. 
 
ITS INFLUENCE UPON OTHER ORGANS. 77 
 
 them induced by strong 1 aperient medicines. Fits of great mental 
 excitement, on the contrary, occasionally succeed to diseases of this 
 character ; and where the disease is protracted, in mental constitu- 
 tions so predisposed, infrequently terminates in confirmed insanity. 
 I have detailed one or two remarkable instances of this kind in my 
 paper " On Stomach Diseases and their Sympathies," in the Dublin 
 Medical and Chemical Journal for September, 1835. In that paper 
 I have also related the case of a gentleman who had intense head- 
 ach dependent upon an inflammatory condition of the stomach, 
 who imagined that the paroxysms of pain were produced by a black 
 bird flying against his head. 
 
 The influence of the stomach upon the brain is not confined 
 merely to the waking state ; it is equally marked during sleep. 
 Persons thus suffering we find constantly troubled with dreams of 
 an extremely vivid and intense character; in fact, so perfect are 
 the scenes of many of these dreams, that they appear to the patient 
 rather the impressions of a waking hour than the delusions of a 
 dream. 
 
 Let us examine for a moment the state of the organs in which 
 these functional derangements take place. Richon and others 
 assure us that, if the brains of persons dying from gastric diseases 
 be carefully examined, we shall find numerous pathologic changes; 
 the arachnoid thickened or injected, separated from the pia mater 
 by effusions of serum, pus, or blood ; the sinuses and veins of the 
 substance of the brain fuller of blood, and more numerous than in 
 the healthy state ; and the brain itself commonly altered in its 
 texture, being sometimes harder, at others softer, than in the natural 
 condition. 
 
 If we carry our enquiry to the examination of the functions of 
 organs during life, we shall find that increased vascular excitement 
 is commonly determined in the heart and great vessels, and conse- 
 quently in the brain, by diseased conditions of the stomach ; strong 
 beating in the epigastric region, increase of force though not always 
 of frequency, in the heart's actions, and a similar excitement in the 
 carotid and temporal arteries. This state of the circulation is 
 accompanied by increased heat of the head, and all the symptoms 
 become aggravated during the accession of those depending upon 
 the affection of the stomach. During fits of the deepest mental 
 despondency this increase in the force of action in the arterial 
 system is commonly present, vascular excitement by no means bears 
 a strict relation to mental excitement in these forms of disease; such 
 is the different effect produced by stimulus upon brains or minds 
 differently organised. 
 
 I must consider, as I have before said, the mucous membrane of 
 the stomach to be the seat of a peculiar sensibility, upon whose 
 healthy condition is dependent the integrity of all the other organs 
 of the economy. Many of the functions of this sensibility are, how- 
 ever, not perfect without the concurrent action of the brain. Thus, 
 some physiologists, as Bronssais, Desruelles, &c., consider the feel- 
 
78 PARKER ON THE STOMACH. 
 
 ing of hunger to be expressed through the medium of the nerves of 
 the stomach ; whilst Georget, Braschet, &c., contend that we are 
 made sensible of the wants of our organs through the medium of 
 the brain. There can be no question of the real truth of the case, 
 which is that the sensation of hunger is produced by the want of 
 stimulus which the coats of the stomach, in a perfectly healthy 
 condition, require ; and that this sensation is propagated from the 
 nervous centres of the epigastrium to the brain. A similar error 
 and controversy has arisen about the seat of the passions ; some, as 
 Bichat, placing them in the epigastrium, others in the brain. Here, 
 again, it is the sensation transmitted to the brain through the 
 medium of its senses, and thence to the nervous centres of the epi- 
 gastrium, that produces that sudden pain and those analogous sen- 
 sations we sometimes feel in the stomach from strong moral 
 impression. The application of a healthy stimulus is required, to 
 keep the nerves of the stomach in proper action, and, this done, the 
 functions of the brain remain healthy. Tf this stimulus be wanting 
 to the stomach, if it be morbid, if it be in excess, if it be in diminu- 
 tion, the brain instantly is aware of it through the sympathies which 
 connect these two nervous centres. Hence the varied condition of 
 the intellectual powers, the loss of mind, or of its separate parts 
 or faculties, their excess, their derangement, the displacement of 
 their consent and unity of action, which we observe during morbid 
 states of the sensibility of the epigastric centre. The stomach is 
 the seat of an internal sense which holds and keeps in a state 
 of equilibrium the actions of the brain, and which can only 
 transmit healthy sensations to the brain as long as itself is healthy. 
 The first influence of one upon the other is nervous, the second 
 vascular. 
 
 CHAPTER VIII. 
 
 ON THE INFLUENCE OP MORBID STATES OF THE STOMACH UPON 
 THE ORIGIN, PROGRESS, AND TERMINATION, OF DISEASES OF 
 THE LIVER. 
 
 I. On the Primary Symptoms of Disease of the Liver. 
 
 The symptoms which mark the commencement and progress of 
 hypertrophy of the liver are sometimes continued through a long 
 series of years without attracting in any marked manner, the at- 
 tention of the subject of them. He is constantly suffering, but 
 never seriously ill, till the occurrence of severe vomiting, diarrhoea, 
 swelling of the legs, or an attack of jaundice, attract his serious 
 notice and alarm. The patients who, in after or middle life, fall 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 79 
 
 victims to hepatic diseases, have generally been subject from youth 
 to great irritability of the stomach. 1 have closely questioned per- 
 sons who have come under my care with marked hypertrophy of 
 the liver in advanced or middle life, and have invariably found that 
 they could not recollect the period when they were not the subjects 
 of some form of indigestion. These persons have been females as 
 well as males, and the symptoms of gastric irritation have developed 
 themselves under circumstances and at periods so early that they 
 have appeared to depend entirely upon the natural organisation of 
 the stomach, and not to have been called into existence by the pro- 
 longed or excessive use of stimuli of any kind. "There are some- 
 times," says Andral, "persons to be met with who have the stomach 
 constantly irritable." These persons have commonly a sallow 
 countenance, a tongue habitually loaded and dry, and seldom pass 
 many days without haying nausea or diarrhoea. 
 
 In enumerating the causes which produce diseases of the liver, 
 Ferrus and P. tL Berard, the latest writers on the subject, quoting 
 the authority of Portal, attribute simple hypertrophy or enlargement 
 of the liver to an over-stimulating diet ; the liver being found 
 invariably in persons thus indulging; the constant irritation kept 
 up in the stomach by large quantities of food received into it deter- 
 mining an. increased quantity of blood into all the organs con- 
 cerned in digestion, which lays the foundation for most of their 
 diseases. 
 
 The state of stomach, however, which is the greatest source of 
 irritation to the liver, is that in which there is a permanent excess 
 of blood in its mucous coat, whether under the form of mere hyper- 
 emia (excess of blood), or an actual state of chronic or acute 
 inflammation. As the mere evanescent form of irritation caused by 
 an embarrassed digestion of food excessive in quantity or of bad 
 quality tends to disturb the functions of the liver, and at length to 
 terminate in its chronic inflammation and enlargement, so far 
 greater must be the evil when this is permanent, as a degree of 
 complaint in the mucous membrane such as I have described would 
 make it. "Facts abound," says Berard, "to prove this state of 
 stomach to be the real origin of a vast majority of diseases of the 
 liver." We need not refer to the writings of Andral, Louis, Cru- 
 veilhier, Broussais, Bonet, or a host of others, for corroborative testi- 
 timony, not a testimony drawn from opinions, but from the rigid 
 and cold observance of facts. To pass in review the symptoms 
 which mark the invasion of hepatic disease, will almost be to re- 
 capitulate these which are indicative of a diseased condition of the 
 mucous coat of the stomach ; for, apart from the physical signs fur- 
 nished by the liver itself, we have hardly any other symptoms which 
 are not proper to chronic inflammation of the latter orcran. 
 
 Pains in the region of the liver, shooting to various parts of the 
 chest, to the arms, shoulders, and even to the fingers, are commonly 
 attendant on the incipient stages of disease of the liver. These 
 pains may be fixed in the right hypochondrium or in the epigas- 
 
80 
 
 PARKER ON THE STOMACH. 
 
 trium ; they may be more acute in the shoulder, in the neck, 
 between the scapulae, or on any point of the surface of the chest ; 
 they may be lancinating and acute, or merely a dull, heavy, uneasy 
 sensation. In persons of bilious temperament subject to that form 
 of morbid increase in the formation of bile which Andral has 
 described under the term "hyperemie bilieuse," these pains, in 
 whatever situation they may be seated, are constantly recurring 
 every time the secretions of the liver become deranged or unduly 
 augmented ; in other terms, whenever the patient becomes bilious, or 
 is troubled with nausea or diarrhoea. At these times the patient 
 frequently experiences a dragging or sensation of weight in the 
 region of the liver, which coexists with the pains felt in various 
 parts of the thoracic parietes. 
 
 These pains bear a great similarity to those which are dependent 
 upon disease of the stomach alone, where no affection of the 
 liver can be detected or is supposed to be in existence. I have 
 shown, when speaking of the symptoms of inflammatory irritation 
 of the stomach, that pains in various parts of the chest are some- 
 times the chief symptoms by which such affections are character- 
 ised. Andral mentions the case of a man who died from cancer 
 of the liver, in whom the pains extended down the arms into the 
 hands. I have now a lady under my care with confirmed chronic 
 inflammation of the stomach ; among other symptoms she has con- 
 stant pain in the right arm, shooting down to the third and fourth 
 fingers of the hand, the sensibilities of which are considerably im- 
 paired. Another lady, who has the physical signs of incipient 
 hypertrophy of the liver, and who is for weeks in perfect health, is 
 subject to pains in the shoulder and neck so acute, whenever the 
 secretions of the liver become impaired or unduly augmented, that 
 she is totally unable to move the head from side to side. In the 
 case of a second lady, of about twenty-two years of age. who has 
 laboured under the symptoms of chronic inflammation of the sto- 
 mach for two or three years, but who has never suffered from bili- 
 ary affections, the neck will become fixed in the same way when- 
 ever the stomach affection becomes aggravated : the pain and stiff- 
 ness of the neck disappears as the stomach disease gives way. The 
 pains which have been described by Annesley, Andral, Ferrein, 
 and Portal, as symptomatic of disease of th liver, and which coexist 
 with distinct physical signs of affections of this organ, are also found 
 to attend the various forms of neuralgic and inflammatory affections 
 of the stomach, and are commonly met with in such diseases when 
 no affection of the liver, ascertainable by the usual means of diag- 
 nosis, can possibly be shown to exist. 
 
 Of whatever character diseases of the liver may be, whether they 
 consist in changes of nutrition merely, in enlargement or diminu- 
 tion of its subsfance, in chronic inflammation or its consequences, 
 no symptoms are so invariably attendant upon the progress of such 
 diseases as those which are connected with derangements in the 
 functions of the organs of digestion. 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 81 
 
 The forms of disease in the stomach which attend the incipient 
 stages of disease in the liver are of various kinds; they may con- 
 sist in mere hyperemia of the rnncous membrane of the stomach, 
 an increase of blood in its mucous coat, characterised by the usual 
 symptoms of an attack of indigestion of the inflammatory kind, the 
 more common attendants on which are nausea, flatulence, disten- 
 sion, tenderness in the epigastrium, loss of appetite, a loaded 
 tongue, with occasional vomiting, and a bitter, sour or clammy 
 condition of the mouth. Sometimes these symptoms are occasioned 
 by what is termed "a bilious attack," a morbid increase in the 
 secretion of the liver without any assignable cause; the impression 
 of which secretion on the mucous surfaces of the stomach and duo- 
 denum occasions the derangements observed at these periods in the 
 functions of the stomach. "Dans plusieurs circon stances, sans 
 qinl y ait hepatite ou hyperemie du foie, sans qu'il y ait gaslro- 
 enterite, la seule maladie qu'existe est une augmentation inexpli- 
 cable dans la secretion biliaire." 1 
 
 1 Andral, Cours de Pathologic Interne, p. 215. Bonet (Monographic 
 complete des Maladies du Foie) admits two primitive conditions of hepatic 
 derangement, the result of irritation in the stomach; these are, a morbid 
 increase in the secretion of the liver, not amounting to an inflammatory 
 condition ; and a true inflammatory state, the symptoms of which are not 
 well marked; on account of its slight character. The first state, that termed, 
 in common language, biliary derangement, is one in which the natural 
 function of the liver is exalted, under the influence of an irritating cause; 
 and though the symptoms of inflammation are frequently absent, they are 
 again, in a great number of instances, present, and the increased secretion 
 appears dependent upon a slightly inflamed condition of the organ, or at 
 least upon one in which a preternatural fulness of blood is determined to 
 the liver: hence the name, given to it by Andral, of "bilious hyperemia." 
 Sometimes this form of disease is unaccompanied by local symptoms, and 
 is only evidenced by the sympathetic affections it produces; in other in- 
 stances the symptoms of increased determination of blood are present; the 
 tongue is dry and red, the skin hot, and the epigastrium and right hypochon- 
 drium painful and tender to the touch. We find this form of disease 
 ushered in from the operation of two classes of causes, from dietetic errors 
 and from moral causes, which, first affecting the stomach, secondarily act 
 upon the liver. In these circumstances, whatever be the nature of the irri- 
 tating cause acting upon the liver, its most prominent feature is an inordidate 
 secretion of bile: and hence we see complete jaundice produced frequently 
 without the symptoms of inflammation being urgent, or even well or strongly 
 marked. This condition of the liver is produced, in many persons, from the 
 most trivial exciting cause ; from a slight mental impression, or from errors 
 in diet hardly perceptible. As some have the stomach habitually sick (of 
 which I have given instances in other parts of this work), so have others the 
 liver constantly disposed to irritability ; and hence a succession of irrita- 
 tions, frequently repeated, at length induce confirmed hypertrophy or chronic 
 inflammation. In some persons we find a constant state of indigestion of 
 the inflammatory kind, the tongue always coated and red, the epigastrium 
 always tender : the mucous coat of the stomach is here habitually in a con- 
 gested state. The same pathological condition exists in the liver in tb 
 circumstances of continued biliary derangement. "II y a des individus chez 
 qui le foie est, dans 1'etat normal, plus volumineux, plus irritable, plus 
 susceptible de devenir malade, que chez les autres hommes. La gastro- 
 
 park 6 
 
82 PARKER ON THE STOMACH. 
 
 These attacks of stomach disease are perpetually occurring, in 
 some persons without any errors or excess in diet. They may 
 continue for some time, even for years, without appearing to be ac- 
 companied by, or to be productive of, any other affection ; at 
 length, however, pain and dragging, with weight and uneasiness 
 in the right hypochondrium, are complained of, and on carefully 
 examining the region of the liver we discover a distinct tumour, 
 tender to the touch. In a second form, the affection of the sto- 
 mach which accompanies the primary symptoms of hepatic disease 
 assumes more distinctly the form of a pure gastritis, or gastro- 
 enteritis. Instead of having merely nausea, flatulence, a loaded 
 tongue, with loss of appetite and confined bowels, we have violent 
 vomiting, with considerable fever, a dry red tongue, a sallow coun- 
 tenance, with scanty turbid urine, occasionally diarrhoea to a con- 
 siderable extent, with pain and great tenderness in the epigastrium. 
 
 These symptoms of inflammation of the stomach attract chiefly 
 the patient's attention ; the slight uneasiness in the right side is 
 lost sight of in the more acute symptoms which have been added 
 to it. 
 
 In tracing the symptoms of incipient disease in the liver which 
 are found in the derangements of the organs of digestion, we find 
 every variety in the latter affections, from mere flatulence to peri- 
 odical attacks of acute gastritis. To give instances of these 
 varieties : 
 
 A gentleman had complained of flatulence for many years; it 
 distressed him exceedingly after taking food. No hepatic disease 
 was suspected, but he has now a distinct enlargement to some 
 extent in the right hypochondrium. The only disturbance of his 
 digestive organs is the distressing flatulence, which still continues. 
 
 A second gentleman, of middle age, has been subject to flatulence, 
 nausea, and great fulness after food, with considerable pain. Of 
 late years these occasionally terminate in acute pain in the epigas- 
 tric region, with vomiting and purging of thin frothy matter, re- 
 sembling barm. He has distinct enlargement, with induration, of 
 the liver. 
 
 At other times the digestive functions are constantly disturbed, 
 but their derangements are not of so acute a character. A lady, of 
 middle age, who has suffered from the symptoms of inflammatory 
 indigestion for some years, and who, for the last twelve months, 
 has had some tenderness in the right hypochondrium. is seldom a 
 day free from nausea, and once or twice in the week has slight 
 diarrhoea: the nausea seldom terminates in vomiting. The tongue 
 is generally dry and slightly coated, with the edges and point con- 
 tracted and vividly red. 
 
 entente la plus legere suffit alors pour determiner tant6t une secretion 
 abondante de bile, tantdt une veritable hepatite et il n'y a pas de raisoa 
 pour que celle-ci, une fois developpee, ne s'accroisse indefiniment." Bonet, 
 Op. cit. p. 126. 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 83 
 
 The varieties in the affections of the organs of digestion which 
 accompany the primary forms of hepatic diseases, are those which 
 depend on an excited state of the vascular system of the stomach, 
 which may be reduced to three divisions. 1st. The condition cha- 
 racterised by mere hyperemia; 2d. A state of chronic or sub-acute 
 inflammation; and 3d. One of acute inflammation. In persons 
 addicted to the excessive and continued use of alcoholic liquors, 
 the symptoms of hepatic enlargement and inflammation are quickly 
 ushered in, subsequent to an attack of acute inflammation of the 
 mucous membrane of the stomach. Again, these attacks of acute 
 inflammation sometimes supervene upon a long-continued state of 
 chronic disease. 
 
 The rapid development of hepatic diseases under the use of 
 alcoholic liquors is attributed by Andral, in some instances, to the sti- 
 mulus which the spirit gives to the coats of the veins of the stomach, 
 thence exciting in them a pure state of inflammation, which extends 
 to the portal system and to its ramifications in the substance of the 
 liver. This inflammation of the veins of the stomach explains 
 one way in which irritation is propagated from the stomach to the 
 liver, and the manner in which disease in one organ produces a 
 corresponding morbid state in another. The Clinique Medicale 
 contains accounts of the dissections of two cases in which this 
 pathologic state was found. 
 
 In examining the bodies of patients who have died from gastric 
 inflammations and their consequences, I have frequently noticed 
 the immensely distended state of the veins of the sub-mucous cellu- 
 lar coat of the stomach ; they are sometimes as much distended 
 with black, grumous, coagulated blood, as though they had been 
 injected. I have occasionally noticed the vasa brevia in this state. 
 All cases of gastric inflammation which terminate fatally are not, 
 however, attended by this condition of the venous system of the 
 stomach. 
 
 II. On some of the Symptoms attendant on advanced stages of 
 Diseases of the Liver. 
 
 The rational and physical signs which denote the existence of 
 hepatic diseases, consisting in hypertrophy or chronic inflammation, 
 may continue for a great length of time without affecting in a very 
 serious degree the constitution of the patient, if he be tolerably 
 guarded, aware of the true character of his disease, and the nature 
 of its complications with affections of the digestive organs. The 
 symptoms which accompany the more advanced stages of disease 
 in the liver are drawn as much from the affections of other organs 
 which, during the long continuance of disease, have become asso- 
 ciated with the primitive affection, as from the liver itself. Whe- 
 ther hypertrophy and chronic inflammation of the liver, or any of 
 its component parts, be diseases consecutive to, and produced by, 
 continued irritation of the stomach and duodenum (an opinion to 
 
84 PARKER ON THE STOMACH. 
 
 which facts would seem to lead us) or not, it is a matter of certainty 
 that active or passive hyperemia, or pure gastritis in its varied forms, 
 almost always complicates disease of the liver in its more advanced 
 states. The inflammation of the stomach thus set up produces its 
 own influence on the integrity of other organs; and thus the latter 
 stages of hepatic diseases are accompanied by varied morbid condi- 
 tions of many organs, among which the disease of the liver itself 
 sometimes becomes secondary. The organs which chiefly suffer, 
 and whose affections thus accompany and add to the difficulty of 
 the treatment in such cases, are the stomach, the heart, the lungs, 
 and the brain. Sympathetic diseases in -one or other of these 
 organs are seldom altogether absent. 
 
 III. On the State of the Digestive Organs in the latter stages 
 of Disease of the Liver. 
 
 In another part of this treatise, we have shown the pathologic 
 condition of the stomach and intestines, as recognised after death, 
 in diseases of the liver. We shall now pass in review the symp- 
 toms of diseased conditions of the digestive organs which are 
 observed, in the progress of diseases of the liver, during life. In 
 persons perishing from hepatic diseases, it, is a very rare thing to 
 find the stomach and intestines free from lesion in some variety or 
 another; and it commonly happens that pathologic changes of the 
 same character as those observed in the liver are found, at the 
 same time, in the stomach. Thus, as far as the subject of cancer 
 merely is concerned, Berard has proved, from his researches, that 
 the disease commonly co-exists in the two organs. 
 
 The most common affections of the digestive functions observed 
 during life in diseases of the liver are, attacks of acute or sub-acute 
 gastritis. Sometimes these attacks supervene upon a state of chro- 
 nic gastritis which has accompanied the affection of the liver from 
 its commencement. Again, we find that violent vomiting, with 
 fever, and a vividly red and contracted tongue, with much pain and 
 tenderness in the epigastrium, occur from slight dietetic errors, and 
 in many instances without such errors having been committed. 
 After these attacks have been subdued by appropriate treatment, we 
 observe a constant disposition to their recurrence. In these in- 
 stances the stomach may suffer secondarily from that general febrile 
 state induced in the system by the disease of the liver, or from the 
 sympathies existing between the two organs ; or, again, the gastritis 
 maybe a mere exaltation of that vascular irritation which primitively 
 existed in the stomach, and from which the hepatic disease origi- 
 nally sprung. 
 
 IV. On the Symptoms observed in Disturbances of the 
 Circulation. 
 
 The circulation and its central organ, the heart, do not, in all 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 85 
 
 cases of confirmed disease of the liver, afford any marked symp- 
 toms of peculiar disturbance of their functions, except that mere 
 increase of frequency in pulsation which is observed more or less 
 in all feverish or inflammatory diseases. There are, however, cer- 
 tain cases in which great peculiarities are observed in the action of 
 the heart during the course of hepatic, diseases, which it becomes 
 necessary to notice. These disturbances may vary from an in- 
 creased and tumultuous impulse of the heart to great irregularities 
 in its action, which would almost lead to the supposition that the 
 organ itself was diseased. Occasionally the pulse presents a great 
 degree of sharpness, and the stethoscope applied over the heart 
 detects an unusual force in its impulse. In one case of this kind, 
 which commenced with a series of dyspeptic symptoms two years 
 before its fatal termination, the pulse offered a peculiar sharpness, 
 and auscultation detected a strong, tumultuous impulse of the heart; 
 the pulse never intermitted, although the two sounds of the heart 
 were lost in one strong pulsation. This patient had general adhe- 
 sion of the pericardium, with softening of the substance of the 
 heart; abscess of the liver, an aggravated state of gastritis, with a 
 highly congested state of the veins of the sub-mucous coat of the 
 stomach, which were filled with black grumous blood. 1 This pa- 
 tient had ascites. I have at the present moment under my care a 
 gentleman with an immense hepatic tumour, accompanied by 
 ascites. The pulse offers the same peculiar sharpness, arid the 
 action of the heart is inordinately strong. In this person there are 
 periodical attacks of acute gastritis or gastro-enteritis ; for the 
 vomiting is frequently accompanied by severe diarrhoea, and the 
 stools are sometimes of a bloody cast. During the prevalence of 
 the gastric affection, the symptoms of disturbance in the action of 
 the heart were always much more acute, occasionally to the extent 
 of requiring local abstraction of blood from the region of the heart 
 in order to subdue them. In the section on the influence of the 
 stomach upon the heart, I have shown that there is great reason to 
 suppose that, in many instances, organic changes in the heart are 
 the result of continued gastric derangement. It is certain, as 
 Broussais has remarked, that a state of softening of the heart is 
 commonly the result of prolonged gastro-enteric disease, in which 
 the liver and the spleen frequently offer (he same pathologic change. 
 Portal has shown how frequently affections of the heart are com- 
 plicated with diseases of the liver. 2 
 
 1 Adhesions of the pericardium with the substance of the heart are not 
 unusually found on dissection after death from diseases of the liver, or of 
 this organ and the stomach conjointly. Among others, the case of a fisher- 
 man of Venice related by Morgagni (Letter 5, Obs. 19), is worthy of atten- 
 tion. This man had some old-standing dyspeptic symptoms, during an ag- 
 gravated condition of which he died suddenly. On examination, the sto- 
 mach, intestines, and liver, presented evidences of inflammatory disease; 
 the pericardium was every where adherent to the heart. 
 
 *"De 1'etat du Foie apres les Palpitations, &c.," Art. xii. Du Traite des 
 Maladies du Foie. 
 
86 PARKER ON THE STOMACH. 
 
 In several instances of hepatic disease, however, the circulation 
 in so much embarrassed, the pulse so unsteady, and the action of the 
 heart so irregular, that, when those symptoms are observed to co- 
 exist with anasarca or asciles. we are sometimes led to attribute 
 them to valvular disease of the heart, independent of any other 
 affection. An old lady, aged sixty, came under my care, in the 
 latter part of last year, with all the symptoms of an organic affec- 
 tion of the heart. The pulse at the wrist was merely a tremulous 
 motion of the artery, hardly to be called pulsation. Auscultation 
 ot the heart detected a tumultuous undulation, but no distinct rhythm 
 or sound. The face was livid and swollen, and the legs anasar- 
 cous; all food occasioned great pain, and was immediately rejected 
 by vomiting; the epigastric and right hypochondriac regions highly 
 sensible to pressure. On examination after death the liver was 
 found greatly hypertrophied, pale, and hard; the stomach one mass 
 of inflammation, its submucous veins much dilated, and full of dark 
 coagulated blood; the heart healthy, as regards the disposition of 
 its investing and lining membranes and the condition of its valves; 
 its substance was very pale, and soft. 
 
 In addition to any organic changes which may exist in the heart, 
 and which may complicate diseases of the liver, we may observe 
 occasionally a most irregular condition of the circulation existing 
 without any organic change in the heart itself. In the section on 
 the influence of the stomach upon the heart, I have quoted a case 
 from Cruveilhier, 1 in which the circulation was so unsteady, and the 
 signs afforded by auscultation so seemingly certain, that an organic 
 change was suspected in the heart. On examination after death 
 the heart was found perfectly healthy, but cancerous disease existed 
 both in the stomach and liver. I have there also adduced another 
 case, from my own practice, in which great irregularity of the cir- 
 culation was present; but dissection showed nothing but an en- 
 larged and hard liver, with inflammatory disease of the stomach. 
 Although these derangements in the heart's action are met with 
 daring the progress of diseases of the liver, still they are also found 
 co-existing with various forms of disease of the stomach when the 
 liver is perfectly healthy, or presents so little alteration that it cannot 
 be supposed to influence materially the condition of the heart. 
 
 V. On the Symptoms observed in Disturbances of the Organs 
 
 of Respiration. 
 
 During the progress of hepatic diseases, we commonly observe 
 that the respiratory organs deviate more or less from their natural 
 state, whether these deviations are observed merely in functional 
 derangements, such as hurried breathing or spasmodic cough, or in 
 an actually inflamed condition of the lung, the pleura, or the bron- 
 chice. These disturbances result from the volume of the liver 
 
 'Anatoinie Pathologique du Corps Humaine. 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 
 
 pressing upward the lungs and contracting the cavity of the chest, 
 or from irritation propagated from the liver to the lung, independent 
 of an increased, bulk in the former. If we examine the cases de- 
 tailed by M. de Larroque, 1 we shall find many examples of affections 
 of the chest thus produced during the progress of hepatic diseases. 
 The affections of the organs of respiration which accompany he- 
 patic diseases are of various kinds ; they may consist merely in a 
 short dry cough, in continued fits of coughing without expectora- 
 tion, or in cough followed by expectoration of frothy, mucous, 
 purulent, or sanguineous matter. 
 
 A lady of middle age, the mother of one child, had been affected 
 with constant dry cough, for some months, during the continuance 
 of which she had emaciated much. The most repeated examina- 
 tion of the chest convinced me that all the organs contained in it 
 were healthy. The conjunctivee had a yellow tinge, the counte- 
 nance was sallow, the tongue clean, but red, its papillae injected 
 and elevated. This lady had been subject to dyspeptic symptoms, 
 with occasional vomiting, for some time. On examining the ab- 
 domen, a distinct tumefaction was observed in the hepatic region, 
 extending downwards to some distance; it was tender to the touch ; 
 the epigastric region also hot and tender, and the seat of strong 
 pulsation. The cough ceased from the application of several relays 
 of leeches over the stomach and liver, and the patient recovered 
 her usual health. 
 
 A second lady, whose case is mentioned by Larroque, 2 had a severe 
 attack of gastritis. After the acute symptoms had disappeared, there 
 remained daily vomiting, difficult digestion accompanied by flatu- 
 lence, obstinate constipation, a dry, short constant cough with con- 
 siderable difficulty of breathing, augmented to a sense of suffoca- 
 tion by taking food. On examining the abdomen, three months 
 after the appearance of these symptoms, a considerable hepatic 
 tumour was discovered, extending into the left hypochondrium, 
 and downwards below the umbilicus. The patient complained 
 constantly of her stomach; the cough seemed to arise from that 
 point, or rather the irritation producing it. Every species of aliment, 
 even simple gruel or broth, increased the uneasiness, the cough, 
 and hurried breathing. This lady recovered under the use of 
 bleeding and mercurial frictions. 
 
 These two cases are examples of diseases of the liver accompa- 
 nied by functional derangements of the organs of respiration. 
 Both the cases, however, appear to have commenced in affections 
 of the stomach. The dyspeptic symptoms, depending evidently on 
 inflammatory irritation of the mucous membrane of this organ, 
 were severe during the whole progress of disease in both cases, and 
 the symptoms observed in the disordered condition of the organs 
 
 1 De Q,uelques Maladies Abdominales qui simulent, provoquent ou entre- 
 tiennent, des Maladies de Poitrine. 
 Op. cit., Obs. 4, p. 482. 
 
88 PARKER ON THE STOMACH. 
 
 of respiration appear to have depended as much upon the latter 
 affection as upon the state of the liver. This will be more evident 
 by referring to the chapter "On the Influence of the Stomach on 
 the Respiratory Organs." 
 
 In some instances the symptoms observed in the chest, during 
 the course of hepatic diseases, amount to actual organic lesions 
 observed in an inflammatory condition of one or other of its con- 
 tained organs. "A gentleman, forty-five years of age, accustomed 
 to indulgence in the pleasures of the table, had been subject for 
 some time to dyspeptic symptoms, which were shown in severe 
 attacks of colic, preceeded by obstinate constipation, and accom- 
 panied by a jaundiced and dry condition of the skin, with occa- 
 sional pains in the right hypochondriac and epigastric regions. To 
 these symptoms were added, some time subsequently, cough, with 
 difficult respiration and expectoration of mucous, yellowish or gray 
 sputa of bitter taste, sometimes streaked with blood ; at the same 
 time the tongue was coated, red at its point and edges, and the 
 mucous membrane of the mouth and fauces inflamed, and a jaun- 
 diced tint upon the skin. The expectoration amounted to a pint 
 in the course of the day. He had, also, severe bilious diarrhoea. 
 The examination at this period of his disease detected the existence 
 of a large hepatic tumour. Mucilaginous arid anodyne medicines, 
 with blisters upon the chest, were productive of no benefit in the 
 alleviation of these symptoms; the uneasiness in the regions of the 
 stomach and liver, with the fulness of the pulse, led to the application 
 of leeches to the anus. After this the expectoration ceased to be 
 bloody, and the diarrhoea diminished, but the pains in the regions 
 of the stomach and liver still continued. Some time after, the ex- 
 pectoration suddenly ceased, and the patient sunk with the symp- 
 toms of effusion into the chest. On examination after death, the 
 bag of the right pleura was found to contain about a pint of bloody 
 serum. The inferior lobe of this lung was adherent to the dia- 
 phragm, through which it communicated with a large abscess which 
 occupied nearly the whole substance of the liver, part of the walls 
 of the abscess being formed by a portion of the lung itself. The 
 mucous membrane of the stomach and colon were both in an in- 
 flamed state." 1 
 
 In examining the history of this case, we observe it to have 
 commenced in symptoms of gastric disturbance, evidently of the 
 inflammatory kind, thence progressing to the liver, and ultimately 
 to the lungs. The progress of the symptoms is explained by the 
 pathologic changes after death. It is thus that we often find dis- 
 eases, which commence in mere symptoms of gastric derangement, 
 terminate, in after-life, in others whose more prominent features 
 mark the original affection to which they owe their origin. 
 
 Bronchial affections frequently make their appearance during an 
 aggravated state of the symptoms of diseases of the liver, and the 
 
 'Portal, Memoires sur plusieurs Maladies, t. iii. 
 
INFLUENCE OP ITS MORBID STATES ON THE LIVER. 89 
 
 affections of the stomach which accompany them, and disappear 
 when these symptoms are subdued by appropriate treatment. A 
 gentleman, a free liver, indulging in the pleasures of the table, had 
 suffered from symptoms of gastritis for many months, accompany- 
 ing which he had a large hepatic tumour. The skin was jaundiced, 
 the tongue intensely red, the epigastric region hot and tender, and 
 the action of the heart inordinately strong. After a day of more 
 than usual indulgence severe vomiting set in, with diarrhoea, cough, 
 hurried breathing, and expectoration of muco-purulent fluid, which 
 increased till he spat from two to three pints in the course of the 
 day. Leeches were applied freely over the hepatic and epigastric 
 regions, and occasional doses of blue pill and opium were given 
 with the hydrocyanic acid. By this treatment the inflammatory 
 symptoms were subdued, and with them the cough and expectora- 
 tion also disappeared. It is an established fact that gastric irrita- 
 tion has the power of producing disease of the liver ; and it is also 
 certain that the irritation produced in the latter organ is frequently 
 propagated to the chest, and is productive of many of its diseases, 
 as pleurisy, pneumonia, and bronchitis; so that in many instances, 
 we observe diseases of the liver, stomach, and lungs, coexisting as 
 in the two former cases. 
 
 In the midst of many diseased organs, it is of importance to trace 
 the commencement of the affection, and determine the relative im- 
 portance of each in the mass of mischief : where the stomach pre- 
 sents symptoms of lesion, this organ always demands particular 
 attention. Although, in the forms of disease of wrricji we are 
 speaking, the stomach is often the source of mischief, still there are 
 other complications of diseases of the liver with those of the organs 
 of respiration in which the stomach is found perfectly healthy. In 
 many of these instances the inflammation commences in the lungs 
 or their investing membrane, and is thence propagated to the liver. 
 I have seen two instances of pneumonia terminating in abscess 
 which have commenced in the inferior lobe of the right lung, and 
 have ultimately involved the liver in the disease. In both these 
 cases the stomach was healthy. Andral 1 has recorded another in- 
 stance of this mode of extension of disease from the lung to the liver. 
 Regnault 2 has also noted several instances of pleurisy producing 
 hepatitis. 
 
 PARTICULAR CASES. 
 
 CASE 1. Symptoms of indigestion of the inflammatory kind for twenty- 
 five years. Sub-acute inflammation of the stomach. Hypertrophy, with 
 sanguineous congestion of the liver. 
 
 In June, 1834, 1 was requested to visit Mrs. C . She was a 
 delicate woman, and had laboured under severe dyspeptic symptoms 
 
 J Clinique Medicale, tome iv., Obs. 23. 
 
 2 Memoires sur les alterations, et 1'influence du Foie dans plusieurs Mala- 
 dies, et sur les moyens curatifs qu'elles reclament. Par P. G. R. Regnault. 
 
90 PARKER ON THE STOMACH. 
 
 for twenty-five years. During this period she had almost constantly 
 pain and tenderness in the epigastrium, with occasional vomiting 
 of food. 
 
 June 24, 1834. The patient so weak as to be unable to sit up 
 in bed. General uneasiness of the belly, which is tender on pres- 
 sure in the right hypochondriac and epigastric regions; sensibility 
 greatest in the epigastric. All food is constantly rejected; occa- 
 sionally blood is thrown up. Bowels obstinately constipated. Ab- 
 domen full, but not tympanitic. Pulse small, sharp, easily com- 
 pressed, but steady, and at ninety-five. Tongue dry and shining, 
 and of a reddish-brown colour. Urine scanty; has not been 
 voided till to-day for fifty hours. No cough or hurried breathing. 
 Had epistaxis two days since; it has returned again to-day. 
 
 As the patient appeared to be sinking, she was ordered merely 
 two grains of calomel and half a grain of opium to allay her dis- 
 tressing sickness, and to have a domestic enema. 
 
 June 26. Gradually sinking; voided some blood by stool, and 
 died in the evening. In addition to the symptoms above detailed, 
 I learned, on to-day's visit, that the stools for some days past had 
 been of a chalky whiteness. There had been occasional pain in the 
 right hypochondrium, which region was hard and full. The 
 greatest and most constant pain was always referred by the patient 
 to the left part of the epigastrium. 
 
 Post-mortem examination, thirty-six hours after death. Hody 
 not much emaciated, of a deep-jaundiced colour. The liver ex- 
 tended downwards nearly to the pelvis; upwards it was much en- 
 larged, compressing the right lung. It extended across the epigas- 
 trium, and left hypochondrium, intimately adhering, by its peritoneal 
 coat, to the spleen. It adhered also to the transverse arch of the 
 colon. The gall-bladder was amalgamated, by thickened adhesions, 
 to the liver. It contained two large gall-stones, as large as nut- 
 megs; and a third, of the same size, was found in its duct. The 
 internal structure of the liver was very dark; a good deal of dark- 
 coloured blood exuded when it was cut into. The thoracic viscera 
 presented no pathologic state worthy of note. 
 
 The cardiac portion of the stomach was highly vascular, studded 
 with red points, and patches of an arborescent appearance, intensely 
 red. The pyloric portion was one mass of pink injection, covered 
 by a thick layer of bloody mucus. The mucous surfaces of the 
 duodenum and small and large intestines were stained with bile, 
 but otherwise healthy: the bladder full of dark-brown urine. 
 
 Remarks. On looking back over the history of this case, we 
 find the subject of it to have been troubled with painful and labori- 
 ous digestion for twenty-five years, which symptoms were, in the 
 onset, probably dependent upon a congested or active hyperemic 
 state of the mucous membrane of the stomach. To relieve herself 
 she occasionally drank gin or brandy, and lately had become a great 
 taker of laudanum. Under this continued gastric irritation, there 
 is no doubt that the enlargement and chronic inflammation observed 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 
 
 91 
 
 in the liver and its membranes commenced, and the disease 
 of the stomach assumed the form of confirmed chronic gas- 
 tritis. For the last seven months of the patient's life we find 
 her constantly vomiting food, and often blood: this marks the in- 
 vasion of a more acute form of gastritis. We find, in conjunction 
 with the disease of the stomach, the liver hypertrophied to a great 
 extent; the sequelae of chronic inflammation in its peritoneal coat, 
 and concretions in the gall-bladder: these evidently the consequence 
 of some change in the character of the bile, dependent upon dis- 
 ease in the organ secreting it. The spontaneous occurrence of 
 epistaxis in this case is worthy of remark, as hemorrhage of this 
 character frequently occurs during protracted inflammatory diseases 
 of the gastro-enteric mucous surfaces. 
 
 We observe in this case a mere enlargement of the liver, without 
 any change in the density of its substance. These conditions of 
 hypertrophy may also be attended with an increase or decrease of 
 the density of the substance of the liver, under the form of indura- 
 tion or softening. On the former of these two states ascites is 
 commonly attendant, though it does not exist in every instance. 
 The attentive examination of the history of this case brings us to 
 the* conclusion that the disease of the liver was, in this instance, 
 produced under the influence of the gastric irritation, which deter- 
 mined to all the organs concerned in digestion an increased quan- 
 tity of blood. The details of this case very much resemble one in 
 the Clinique Medicale, in which the patient sunk from hypertrophy 
 of the liver six years after the use of extremely irritating medicines, 
 which had disturbed his digestive powers to an extent which they 
 had never recovered. In this instance, Andral considers that the 
 enlargement of the liver was consecutive to the inflammation of 
 the stomach, and the result of an inflammatory process. 1 The 
 general principles of pathology likewise recognise increased deter- 
 mination of blood, under the influence of an irritating cause, as one 
 source of the hypertrophy of organs. "Some enlargements of this 
 character are owing to chronic determination of blood. In such 
 cases the hypertrophy is sometimes confined to the tissue which 
 was primarily irritated or congested, whilst, again, after the tissue 
 originally affected has returned to its natural healthy condition, the 
 adjacent tissues (or organs) retain a chronic form of disease, and 
 become hypertrophied." 2 We may conceive of hypertrophy of the 
 liver, in this form of disease, taking place much as that of the heart 
 does from inflammation of its endocarde or lining membrane. In 
 the same manner we daily observe true hypertrophy of the sub- 
 maxillary chain of lymphatic glands to take place from chronic 
 inflammation, or ulceration existing about the lips or lower parts of 
 the face. I do not know an instance where this species of hyper- 
 
 1 Clinique Medicale, by Spillan, Case 6, p. 940. 
 
 3 A Treatise on Pathological Anatomy, by G. Andral, translated by Drs. 
 Townsend and West, tome i., p. 224. 
 
92 PARKER ON THE STOMACH. 
 
 trophy, coinciding with gastritis or gastro-duodenitis, is not owing to 
 a chronic form of hyperemia or inflammation. In some instances we 
 find purulent collections in the centre of livers thus hypertrophied, 
 or some parts of their structure completely disorganised. Generally, 
 however, where this organ is hypertrophied to a great extent, it is 
 harder and paler in its structure than in its healthy state. Where 
 softening and abscess are the chief lesions the liver is not so much 
 enlarged. A less acute degree of morbid action than that accom- 
 panying the second form of disease appears to be present in the 
 first. 
 
 In some instances, affections of the liver are developed quickly 
 under the influence of an acute or subacute attack of gastric inflam- 
 mation, instead of being produced, as in the preceding cases, by 
 chronic irritation of the digestive organs. 
 
 CASE 2.' Subacute inflammation of the stomach and bowels succeeding the 
 sudden disappearance of a cutaneous eruption Sudden appearance of dis- 
 ease of the liver Tumour in the right hypochondrium. 
 
 A sempstress, aged 16, caused to disappear suddenly an eruption 
 with which she had been troubled for some time. A few days 
 afterwards a slight diarrhoea made its appearance, accompanied by 
 pains in the stomach, total loss of appetite, and constant disposition 
 to vomit. She was treated by emetics. The pains in the stomach 
 and the diarrhoea continued, the sensibility of the epigastric region 
 increased, and the distaste for food was carried to such an extent 
 that the mere appearance of it produced an attempt to vomit. The 
 menses being suppressed, she was now treated by emmenagogues 
 for three months. Under this plan she still continued to get worse; 
 emaciation proceeded rapidly, a jaundiced tint appeared upon the 
 skin, the nausea terminated in periodical vomiting ; whilst at the 
 same time a regular paroxysm of fever came on every evening. 
 Being examined by M. Bonet at this period of her complaint, he 
 ascertained that, in addition to the stomach affection, there existed 
 extensive disease of the liver. This viscus was so large that it 
 extended three or four fingers' breadth below the false ribs, and 
 formed a considerable tumour in the right hypochondrium. The 
 patient sunk into an extreme degree of marasmus. The body was 
 not examined. 
 
 Remarks. Although, in this case, the body was not examined 
 after death, the physical signs of hepatic disease succeeding to the 
 gastric render it a matter of certainty that the irritation which first 
 appeared in the stomach and bowels ultimately extended to the 
 liver, under the influence of treatment calculated rather to exaspe- 
 rate than to allay the primitive disease. As these cases show that 
 irritation of the stomach, whether acute or chronic, may ultimately 
 extend to the liver and produce disease in that organ, and as the 
 
 1 Bonet, Monographic complete sur les Maladies du Foie, p. 107. 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 93 
 
 history of the last case exhibits more particularly the fatal termi- 
 nation of such cases accelerated under the influence of a treatment 
 calculated to keep up or increase the irritation already existing in 
 the stomach, so the details of the following case will show that an 
 appropriate plan of treatment, adopted with a view to the removal 
 of gastric or gastro-enteric inflammation, co-existing with hepatic 
 disease, will arrest the progress of the latter, even when it has pro- 
 ceeded to a great extent. 
 
 CASE 3. Symptoms of chronic gastritis of long standing occasionally 
 becoming acute Scirrhous hardness and great enlargement of the liver 
 Great relief afforded by exclusive attention to the stomach disease. 
 
 I have been occasionally consulted by a gentleman, during the last 
 three years, for dyspeptic symptoms, attended with loss of appetite, 
 pain and distension after meals, with much flatulence and occasional 
 vomiting. I was sent for suddenly one evening, and found him 
 labouring under an attack of acute gastritis. He had constant 
 vomiting of sour and bilious fluids, with purging of thin white- 
 coloured matter. Acute epigastric pain, increased to agony by 
 pressure. Rapid, thin, unsteady pulse, cold skin, and an intensely 
 red tongue. The constant recurrence of these symptoms without 
 any assignable cause, led rne to examine the hepatic region very 
 carefully. I found it dull on percussion for a very considerable 
 extent downwards, nearly to the ilium, extending across the epi- 
 gastrium into the left hypochondrium, and nearly to the umbilicus. 
 This space was occupied by a resisting tumour, which could be 
 defined with great ease; it had a scirrhous hardness, and an 
 uneven tuberous surface, presenting to manual examination that 
 pathologic state of the liver termed by Cruveilhier " Cancer by dis- 
 seminated masses : hard variety." 1 After the subsidence of the 
 acute attack, the epigastrium continued sensible to pressure when 
 the patient was placed in the recumbent position ; but no pain was 
 experienced on hard pressure in this region when he leaned for- 
 ward. Considerable pain followed the taking of food, accompanied 
 by fulness, nausea, and distressing flatulence. The tongue coated 
 posteriorly, vividly red at the point, edges, and on the uncoated 
 surface; papillae much devoloped. There was no cough, and the 
 pulse was soft, steady, and hardly at all accelerated. The patient 
 was put upon a strict milk and farinaceous diet, relays of leeches in 
 small numbers, proportionate to the powers of the constitution, 
 were applied every two days, and small doses of blue pill and rhu- 
 barb, with the ponderous carbonate of magnesia, combined occa- 
 sionally with bitters and aloetics, were administered to obviate the 
 costiveness, which was obstinate. 
 
 This plan was continued for four months, with hardly any vari- 
 
 1 " Cancer au foie par masses disseminees ; variete dure." Cruveilhier, 
 Anatomic Pathologique, 12me. livraison, p. 8. 
 
94 PARKER ON THE STOMACH. 
 
 ation. At the end of this period all the heat and pain in the epi- 
 gastrium had disappeared, the emaciation, which had commenced, 
 was arrested. The fulness of the bowels, which at one time I 
 feared would have terminated in ascites, was reduced; they became 
 soft, free from uneasiness, and acted freely without medicine. The 
 appetite also was much improved. I recommended that the diet 
 should be adhered to, and the bowels regulated occasionally by in- 
 jections of warm water, with the addition of a little castor oil, if 
 necessary, being unwilling to distress the stomach by any medicine 
 whatever, if it could be avoided. The state of the liver, as far as 
 it could be ascertained, remained the same. 
 
 Remarks. This case is an example of the arrest of the progress 
 of organic disease in one organ, by the removal, or at least the miti- 
 gation of the disease it produces in another with which it is nearly 
 allied in function and sympathy. Here we have scirrhous hardness 
 of the liver, with an uneven tuberous surface, presenting all the 
 features of disseminated cancer, with which is associated disease of 
 the stomach, assuming at times the form of acute, and ultimately 
 the symptoms of confirmed chronic gastritis. Diseases of this 
 character are commonly treated with courses of mercury, sarsa- 
 parillaj and nitric acid; and what is the consequence? The 
 patients continue to emaciate, and fall victims to this plan of treat- 
 ment ; if it had been different, their lives, probably, might have been 
 prolonged for years. I have seen numerous instances of these forms 
 of disease whether of the tuberous kind, simple hypertrophy, or 
 chronic inflammation, in which the patients have sunk during 
 courses of mercury. The evil appears to rest in considering the 
 hepatic disease as a pure entity, over which mercury exerts some 
 specific power, without taking into consideration the pathologic 
 state which the disease of the liver produces in other organs, par- 
 ticularly in the stomach ; the latter disease being much more serious 
 and alarming and more certainly and speedily fatal than the hepatic 
 which produced or is associated with it. The remark of Louis is 
 here of great value, " That, during the course of any disease ac- 
 companied by febrile action, the gastric and gastro-enteric mucous 
 surfaces are liable to put on a chronic or subacute form of inflam- 
 mation, which is, in a great majority of instances, of actually more 
 importance than the primitive disease, and which becomes the more 
 immediate cause of the patient's death." 1 The detail of the above 
 case exemplifies the truth of this remark, for we observe that, 
 although no impression is made upon the hepatic disease, still the 
 patient is restored to a tolerable degree of health from attention to 
 the state of the stomach alone. I could multiply instances of 
 this kind. I am at present atttending a lady, in whom per- 
 cussion indicates considerable enlargement of the liver, which 
 produces periodical attacks of gastritis, during the accession of 
 which she is alarmingly ill. A mild antiphlogistic plan, with 
 
 1 De la Gastro-enierite, &c. 
 
INFLUENCE OP ITS MORBID STATES ON THE LIVER. 95 
 
 hardly any other medicine than the ponderous carbonate of mag- 
 nesia with morphia, have hitherto succeeded in speedily restoring 
 her, whilst the hepatic disease hardly appears to make any inroad 
 upon her constitution. 
 
 The mere coincidence of inflammatory diseases of the stomach, 
 duodenum, or intestines with diseases of the liver, whether these 
 consist in simple hypertrophy, induration, softening, cancerous 
 deposits, vascular turgescence, or inflammation and its terminations, 
 would be a powerful argument against the employment of a treat- 
 ment exclusively directed to the removal of hepatic disease, when 
 this treatment generally consists in the employment of remedies 
 decidedly hurtful to the affections of the mucous surfaces of the 
 stomach and duodenum, and we recollect that the patients generally 
 fall victims to diseases either primarily or secondarily established in 
 the mucous surfaces of these organs. 
 
 If, by the careful examination of the history of diseases, the 
 results of treatment, and post-mortem researches, we can establish 
 any direct connection between the diseases of the two organs, the 
 influence of one upon the other, or of each separately upon the 
 economy at large, we may hope to arrive at a more rational and 
 certain plan of treatment, and, consequently, one more successful 
 than has yet been adopted. 
 
 The pathological researches of Andral, contained in the Clinique 
 Medicale, extend to examinations of forty-five cases of various forms 
 of hepatic disease of the mucous coats of the stomach, duodenum, 
 and small and large intestines, but chiefly of the two former : and 
 the forms of disease observed were chiefly chronic or subacute in- 
 flammation and its consequences. Gastritis almost invariably co- 
 incided with induration and hypertrophy, with softening and 
 abscess of the liver. Nine cases of cancer of the liver are given ; 
 in five the same disease existed in the stomach, and in the remain- 
 ing four aggravated chronic gastritis. Some cases detailed by Cru- 
 veilhier 1 are of the same character, who remarks that nothing is 
 more common than to observe cancerous disease of the liver 
 co-existing with the same disease in the stomach. Broussais, 2 
 Villela, 3 and Berard 4 also notice the almost invariable connection of 
 diseases in the two organs. 
 
 Having considered hypertrophy of the liver in conjunction with 
 an inflamed condition of the mucous membrane of the stomach, we 
 pass to the notice of more distinct forms of inflammatory disease in 
 the liver, under the characters of true hepatitis and abscess. 
 
 1 Anatomie Pathologique. 
 
 2 Histoire des Phlegmasies Chroniques, t. 3, art. Maladies du Foie. 
 
 3 Lettre a P. J. V. Broussais, Histoire des Phlegmasies Chroniques, t. 3, 
 p. 367. 
 
 * Dictionnaire de Medecine, 2de edition, art. Maladies du Foie, par 
 Ferrus, et P. Berard. 
 
96 PARKER ON THE STOMACH. 
 
 CASE 4, Gastroenteritis Softening and disorganisation of the liver in its 
 
 left lobe. 
 
 In November 1834, Mrs. D. was placed under my care. She 
 was mother of two children, and attributes the origin of her disease 
 to exposure during the puerperal state. She had been ill two years, 
 with daily vomiting of food, pain, weight, and distension in the 
 epigastrium, with, during the latter part of her illness, purging of 
 slimy and bloody fluids. 
 
 Nov. 11. Constant vomiting, the stomach retains nothing taken 
 into it. Four or five bloody evacuations daily. Great tenderness 
 in the epigastrium, which region, with the hepatic, is hard and 
 resisting. The tenderness exists, on pressure in other parts of the 
 belly, which is full and tumfd. Extreme emaciation. The lungs 
 and heart afford no evidence of disease. 
 
 This poor lady died a few days after she came under my care ; 
 her state at that time rendering her recovery hopeless. 
 
 Post-mortem examination, twenty hours after death. Liver 
 much enlarged, the left lobe occupying nearly the whole of the left 
 hypochondrium, and the right extending downwards many inches 
 below the convexities of the ribs; its texture tolerably firm on its 
 upper surface, the under breaking down every where under the 
 least pressure of the finger, particularly under the surface of the 
 left lobe; The peritoneum and great omentum generally pinky ; 
 no effusion of lymph or serum ; no adhesions. Pyloric portion of 
 the stomach uniformly red, with occasional clusters of deep red 
 points; in others patches of vivid arborescence ; a viscid muco- 
 sanguineous secretion covered the inflamed parts, with difficulty 
 separated from the mucous membrane. The redness increased 
 towards the pylorus, the whole of the duodenum of a deep florid 
 red, as well as the jejunum, the red points approaching here to 
 blackness, and the arborescence of a modena red. The membrane 
 of the ilium slightly pink, but approaching pretty much to its 
 natural state till near the ilioccecal valve, where it was uniformly in 
 a black gangrenous state ; this appearance extended through the 
 colon ; small patches of blood were effused here and there. Gall- 
 bladder distended with black viscid bile. 
 
 Remarks, The symptoms observed during the history of this 
 case point to the gastric mucous surfaces as the point of commence- 
 ment? of the disease. The progress of the inflammation from the 
 stomach and duodenum, through the small intestines, to the colon, 
 is well marked by the advance of the symptoms, the extension of 
 the tenderness from the epigastrium and right hypochondrium to 
 the abdomen generally, and ultimately the diarrhoea and bloody 
 evacuations. We find, on examining the liver, that it is hypertro- 
 phied, and some parts of its tissue disorganised, breaking down on 
 the least pressure. The left lobe was in a true state of softening, 
 the result evidently of the extension of a chronic inflammatory ac- 
 tion from the neighbouring mucous surfaces to the substance of the 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 97 
 
 liver itself. We have another point worthy of notice in this case 
 the change in the character of the bile. The secretions must 
 inevitably be deranged when the organs furnishing them are them- 
 selves diseased; hence the viscidity and dark colour of the bile, 
 with a probable alteration in its chemical as well as physical charac- 
 ters, the consequence of the pathologic state of the liver. 
 
 CASE 5. Gastritis, succeeded by hepatitis. Abscess of the liver. Dropsy. 
 Dyspeptic symptoms for two years. 
 
 In the month of August, 1834, 1 was requested to see Mr. R , 
 
 who had suffered from a train of what are called dyspeptic symp- 
 toms for two years. About that period prior to the present date he 
 had been suddenly seized with acute pain, which he referred to the 
 centre of the epigastrium; a sense of great uneasiness, nausea, and 
 pain followed each meal, and his food was occasionally vomited. 
 He was subjected to various plans of treatment for some time, but 
 with little real benefit. At length a spontaneous discharge of blood 
 took place from the anus, and the stomach was, in consequence, so 
 much relieved that he ceased to regard it, although it was occa- 
 sionally a source of great inconvenience to him. He has indulged 
 to a great extent in "dram-drinking, and has for years been subject 
 to distressing palpitations. 
 
 Present state. Constant pain referred by the patient to the epi- 
 gastrium, which region is hard, full, and resisting, and exceedingly 
 sensible to pressure. Peculiar sharpness of the pulse, which is 
 easily compressed. Examination of the heart by auscultation detects 
 merely a tumultuous and irregular beating, by which the two sounds 
 of the heart are completely hidden. This irregularity is not accom- 
 panied by any "bruit de soufflet." Soon after this report the patient 
 became ariasarcous, and subsequently ascitic. On September 2d 
 he was suddenly seized with difficulty of breathing, and expired. 
 
 Post-mortem examination, twenty-four hours after death. Tho- 
 rax. Several pints of bloody serum were effused into each side of 
 the chest. The bronchial mucous surfaces much injected. The peri- 
 cardium every where intimately adherent to the heart, from which it 
 was with difficulty partially separated. The muscular parietes of the 
 ventricles of the heart thin and flabby, their substance filled with ec- 
 chymoses. The aorta, at its origin, was dilated into a sac, which 
 would contain an orange. In several points the lining membrane 
 was softened and ulcerated, and the two external coats dilated; so 
 that a number of small aneurisms existed in the coats of the large 
 one. 
 
 Stomach. The whole internal surface of a deep-red colour, 
 towards the pylorus approaching to blackness; the large veins 
 running under the mucous coat were in a highly congested state. 
 Near the pylorus the papillae of the mucous membrane were en- 
 larged to the size of pins' heads, and considerably elevated above 
 11 f park 7 
 
98 PARKER ON THE STOMACH. 
 
 the surface. In places, chiefly near the pylorus, were disseminated 
 patches of arborescence intensely red, and accumulations of red 
 points in patches the size of a sixpence. The same appearances 
 were observed, with some slight modifications, throughout the duo- 
 denum. 
 
 The liver was enlarged, but not to a great extent; its substance 
 softened, with small collections of pus in different parts. 
 
 Remarks. The history of this case clearly demonstrates the 
 commencement of the diseases of the abdominal viscera in the sto- 
 mach. We have here a person addicted to dram-drinking troubled 
 with dyspeptic symptoms, which suddenly assume the appearance 
 of gastritis ; this relieved, in its more serious symptoms, by a sudden 
 and spontaneous hemorrhage from the rectum, not dependent upon 
 hemorrhoidal disease. The symptoms still, however, continue in 
 a minor degree, which is evident from the painful digestion, with 
 the epigastric pain and tenderness. The patient, after a time, be- 
 comes anasarcous, ascitic, and dies from effusion into the chest. 
 The post-mortem appearances confirm the symptoms observed dur- 
 ing life; extensive inflammatory disease of the pyloric portion of 
 the stomach, proceeding along the duodenum to the liver, where it 
 terminates in suppuration, most probably from the propagation or 
 extension of the inflammatory action from the mucous membrane 
 of the duodenum to that lining the common and the hepatic ducts. 
 
 CASE 6. Dyspeptic symptoms for four years. Redness, with softening, of 
 the mucous membrane of the stomach. Abscess of the liver. 1 
 
 A patient, aged fifty years, had been subject for four years to a 
 class of symptoms which appeared to originate in the stomach, and 
 which had been produced by moral causes. During this period, 
 the appetite had been variable at times morbidly increased, at 
 others wanting altogether; nausea arid diarrhoea had occasionally 
 been present, accompanied by wandering pains in the right side. 
 Suddenly these symptoms had assumed a more acute type. Fever, 
 with shivering, had set in ; general yellowness of the skin ; total 
 loss of appetite; acute pains in the region of the stomach, but none 
 in the region of the liver; pains in the left side, with slight oppres- 
 sion : to which were subsequently added sickness, with looseness 
 of the bowels. At a period of his disease still more advanced, the 
 jaundiced colour of the skin became deeper. He had intense 
 headach ; the respiration was accelerated, hurried, and irregular. 
 On examining the region of the liver, a resistance was observed 
 which extended from under the false ribs on the right side into; the 
 epigastric region. In this point, acute lancinating, or obtuse pains, 
 variable in their intensity and duration, were complained of during 
 the continuance of his disease. During the last three days of his 
 
 1 Louis, Memoires sur diverses Maladies. Abces du Foie. Case iv. p. 
 386. 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 99 
 
 disease the tongue was in a natural state; previous to this it had 
 been much loaded. He sunk, and died in a state of delirium on 
 the 30th of October, fifteen days after the invasion of the acute 
 symptoms. 
 
 Post-mortem examination, seventeen hours after death. The 
 stomach presented several pathologic changes worthy of remark. 
 In its greater curvature the mucous membrane was covered with 
 red points, and much softened. The pyloric portion was perfectly 
 healthy; the intermediate space presented a gray colour, slightly 
 injected. Disseminated over this part of its surface were numerous 
 small ulcerations. The mucous membrane was here much thick- 
 ened. The liver was in all parts considerably softened. Its in- 
 terior, more particularly the substance of its obtuse border contained 
 a number of small abscesses. The gall-bladder .was small, con- 
 tained a li'ttle mucous, and was obliterated at its neck; the cystic 
 duct contained a small calculus, the mucous membrane and sub- 
 mucous cellular tissue were thickened and slightly indurated. 
 
 Remarks. In this case we have an example of abscess of the 
 liver terminating a long series of dyspeptic symptoms, which are 
 explained by the state in which the mucous membrane of the 
 stomach is fouod after death. Louis details five cases of abscess 
 of the liver, all of which commenced with a class of symptoms 
 referable to the stomach and bowels, and four of these cases exhi- 
 bited inflammatory conditions of the mucous membrane of these 
 organs, when examined after death. In the fifth case, although no 
 inflammatory condition of the mucous membrane of the stomach 
 was present, it was much thickened. In the six cases related by 
 Andral in the Clinique Medicare, all but the first were preceded by 
 a class of symptoms dependent on a morbid state of the same parts. 
 Some of the cases were preceded by derangements proper to the 
 lower portion of the alimentary canal ; others, again, and these by 
 far the greater number, followed affections of the upper part, as the 
 stomach and duodenum. 
 
 Of all the affections of the liver in which this organ presents 
 any change in its structure, perhaps that lesion termed "cancer," 
 whether in its hard or soft form, is most invariably preceded or ac- 
 companied by symptoms of a morbid condition of the mucous mem- 
 brane of the stomach; and most commonly, in examinations after 
 death, is the change found to exist simultaneously in both organs, 
 as the researches of Cruveilhier, Berard, and others, most certainly 
 prove. "As well as the other diseases of the liver, already men- 
 tioned, cancer of this organ is most frequently accompanied during 
 life by gastro-intestinal symptoms; and frequently, though not 
 always, traces of inflammation are found in the digestive tube, and 
 particularly in the stomach." 1 
 
 1 Andral. Clinique Medicale, p. 967. 
 
100 PARKER ON THE STOMACH. 
 
 CASE 7. 1 Cancer of the liver. Chronic inflammation of the stomach 
 
 and duodenum. 
 
 A public writer, thirty-seven years of age, who had previously 
 enjoyed a good state of health, after having been exposed to a cur- 
 rent of cold air when in a state of perspiration, was suddenly seized 
 with the symptoms of cholera morbus. These disappeared in a 
 few days, but from this moment he felt a difficulty in digesting his 
 food hitherto unknown to him; the presence of food excited in him 
 a feeling of fulness and abdominal distension. He had also, at 
 times, some looseness of the bowels. Three years passed on in 
 this way ; he then became jaundiced. 
 
 On being examined at this period a body was discovered in the 
 right hypochondrium, with an uneven surface, which. terminated 
 in a thin edge a little above the umbilicus, and extended into the 
 epigastrium a little beyond the xyphoid cartilage. The patient did 
 not feel Jhe presence of this tumour; he had never felt the least 
 pain in it, neither did pressure produce any. For a long time back 
 the patient had lost all appetite; when he took the least aliment, 
 solid or fluid, into the stomach, he experienced a general indisposi- 
 tion, and at the same time a swelling at the epigastrium, but never 
 any real pain. A great quantity of gas was voided by the mouth; 
 he had scarcely vomited two or three times when his digestion be- 
 gan to be deranged. He complained of often feeling pulsations of 
 the heart, preceded by rather an acute pain in the prsecordial 
 region. He also experienced from time to time very distressing 
 headachs, disturbances of vision, formications in the hands and 
 feet, and temporary contractions of the different muscles. For 
 several months back the frequent diarrhoeas to which he had been 
 subject were succeeded by obstinate constipation ; the latter set in 
 at about the time the jaundice appeared. The pulse was uniformly 
 frequent, the palms of the hands burning hot, the skin always dry; 
 and the patient complained of very troublesome itching. 
 
 No remark is made upon the plan of treatment adopted, further 
 than the exhibition of some Yichy water. "This had no other 
 effect than that of lighting up fever, and of exciting pains in the 
 epigastrium which the patient had not previously felt." Shortly 
 after this symptom of inflammation of the lung and pleura of the 
 right side set in, of which the patient died. 
 
 Post-mortem examination. The liver formed in the abdomen 
 a large tumour. On cutting into its interior it was found to contain 
 a number of whitish masses, hard and soft, reduced to a pap ; several 
 streaked with reddish lines, which left between them certain areolae, 
 varying in form and size ; others had blood effused into the midst 
 of them. There was bile in the gall-bladder. 
 
 The internal surface of the stomach presented, through its entire 
 
 1 Andral, Clinique Medicale, "Maladies du Foie," Case 23. 
 
. 
 
 INFLUENCE OF ITS MORBID STATES ON THE LIVER. 101 
 
 extent, a slate colour, the seat of which was in the mucous mem- 
 brane; this membrane was thickened, indurated, and uneven at its 
 surface. The same colour was continued into the duodenum, the 
 follicles of which were observed to be very much enlarged. Over 
 the rest of the digestive tube nothing was observed but large oval 
 patches, with black points towards the termination of the ileurr, 
 and a brown colour of the caecum. 
 
 Remarks. This case is instructive in many points. We ob- 
 serve, in the first place, the symptoms of acute inflammation of the 
 stomach and bowels, after which the digestive functions remain 
 permanently deranged. Three years after the commencement of 
 these symptoms jaundice appears, and at the same time examination 
 detects a tumour in the region of the liver. The derangement in 
 the stomach is explained by the state of this organ, as observed 
 after death. We then find a chronic state of inflammation, into 
 which the acute disease 'at first noticed had passed, and in which it 
 remained. The results of what little treatment was adopted are 
 worthy of remark. The exhibition of the Vichy water, which is 
 highly charged with carbonic acid, had no other effect than that of 
 lighting up fever and producing pain in the stomach. There can 
 be no question but that the disease observed in the liver after death 
 in this case was produced by the gastro-intestinal irritation, under 
 the influence of which the hepatic disease was called into existence. 
 In remarking upon the frequent coincidence of cancerous diseases 
 in the stomach and liver, Cruveilhier supposes that the disease may 
 be communicated to the stomach, when first developed in the liver, 
 through the medium of the veins of the portal system. I have 
 before shown that, in this manner, disease is frequently propagated 
 from the stomach to the liver. 
 
 The symptoms observed in the digestive functions, which pre- 
 cede the development of what are termed cancerous diseases, are 
 variable. Sometimes the symptoms of mere inflammatory indiges- 
 tion are alone present; such as distension and pain after food, acid 
 eructations, and occasional vomiting. Again, they are preceded 
 by long-continued diarrhoea, showing an habitual state of irritation 
 of the intestinal mucous surfaces. The inflammatory symptoms 
 observed in the mucous membrane of the stomach may succeed to 
 an injury of this organ, from the irritation of which disease of the 
 liver may be produced : of this mode of its origin Andral reports 
 an example. In a fourth form, hematemesis may be the first form 
 of stomach derangement observed. 
 
 Hydatids, acephalocysts, or serous cysts, are frequently develop- 
 ed in the liver, and constitute not the least frequent of its patholo- 
 gic states. These cysts may be formed under the influence of 
 gastro-intestinal irritation, or the latter affection may succeed to 
 them, and thus become the proximate cause of death. In no organ 
 are these so frequent as in the liver, and this is owing, says Cru- 
 veilhier, to the peculiar functions of the liver, viz., that it is the 
 centre towards which is determined, and through which passes, all 
 
102 PARKER ON THE STOMACH. 
 
 the venous blood of the abdomen. To mo-rbid states of this blood, 
 produced from aliment imperfectly elaborated, or molecules mixed 
 with it, but not assimilable to the structure of organs, this patholo- 
 gist attributes the origin of hydatids of the liver; hence a morbid 
 state of the digestive mucous surfaces is very likely to give rise to 
 the formation of blood possessing properties to which Cruveilhier 
 attributes the origin of hydatids of the liver. 
 
 VI. *On the Influence of morbid states of the Stomach upon 
 the formation of biliary Calculi. 
 
 It is hardily possible that a secreting organ like the liver, the 
 source of a product so necessary to the completion of the digestive 
 process, can be altered in any way without the bile which it se- 
 cretes becoming altered in its condition also. Again, we can 
 hardly say that the liver is perfectly healthy in any state where the 
 digestive mucous surfaces exhibit marked signs of disease. In 
 these circumstances we find the liver either harder or softer than 
 natural, or the seat of an unusual quantity of blood, thence called 
 sanguineous congestion of the liver. I believe that no case of in- 
 flammation or vascular irritation of the mucous membrane of the 
 stomach can occur without one of these states of disease in the 
 liver. This being established, we naturally look to the state of 
 the secretions produced under this condition of the secreting or- 
 gan; and in this enquiry we shall find that facts fully carry out the 
 opinions we had formed on these points. In most persons dying 
 from gastric diseases, or from other diseases in which there is a 
 serious complication of morbid conditions of the stomach, we find 
 the contents of the gall-bladder altered in their character, and very 
 commonly the lining membrane of this organ itself inflamed, soft- 
 ened, or otherwise diseased. In these states the contents of the 
 gall-bladder are generally of extreme viscidity ; the bile is black, 
 resinous, adhesive, much thicker than in its natural state, and of a 
 deep-black colour. I have noticed this condition of the bile in al- 
 most every instance I have examined after death from gastro-hepa- 
 tic disease. Similar facts have been noticed by Portal 1 and others. 
 
 CASE I. A young lady had been subject for some time to acute 
 pains in the bowels and stomach, which had terminated in hiccup 
 and obstinate vomiting. The patient died in a state of extreme 
 emaciation. On examination after death the liver was found larger 
 than natural, adherent to the diaphragm, and presented some livid 
 spots. The ^all-bladder contained bile as black as pitch. The 
 intestines were inflamed, the caecum approaching to a state of 
 gangrene. 2 
 
 If we enquire, for a moment, into the nature of the symptoms 
 
 1 Maladies du Foie, art. xiii., " De 1'etat du Foie dans quelques personnes 
 qui ont eprouve des Dyspepsies, &c." 
 
 2 Lieutaud, Historia Anatomico-Medica, lib. i., Obs. 441. 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 103 
 
 which precede the formation of biliary calculi, we shall find them, 
 in most instances, limited to those which indicate a disordered or 
 diseased condition of the stomach which characterise either vascu- 
 lar or nervous irritation of that organ. I possess notes of cases of 
 death produced by biliary calculi obstructing the cystic and common 
 ducts, which have been preceded by symptoms of inflammatory in- 
 digestion for twenty or thirty years. Sometimes the symptoms of 
 disease observed in the stomach are purely of the inflammatory 
 kind ; in others they are marked by attacks of acute pain, recurring 
 at longer or shorter intervals : but in all the cases I have had op- 
 portunities of examining after death, more or less disease of the 
 inflammatory kind has been observed in the stomach, as well as 
 the consequences of inflammation in the liver. Bonet 1 contends 
 for the gastric origin of biliary calculi, which he conceives to arise 
 from irritation originally seated in the stomach, thence propagated 
 to the liver, which, causing alterations in the nature of its secre- 
 tions, terminates in the formation of gall-stones. The same view 
 is sustained by Jolly, 2 who attributes their origin to alterations of 
 the secretions of the liver, determined by the inflammatory state of 
 the secreting organ. 
 
 CASE 2. The first case of this character which I shall notice 
 is that of a lady, aged forty, who had suffered severely from the 
 symptoms of indigestion of the inflammatory kind for twelve 
 months previous to my attendance upon her. These symptoms 
 had consisted in violent pain succeeding a meal, in nausea, fulness, 
 and vomiting. Sometimes the pain came on immediately after 
 taking food, at other times it did not supervene for an hour : when 
 the pain came on it produced sickness and vomiting, and the food 
 taken was rejected. The epigastrium was tender and painful, the 
 tongue coated and dry, and the bowels confined ; occasionally a 
 dark offensive evacution was discharged. These symptoms had 
 continued for a year, with little variation. They were materially 
 relieved by leeches, and blisters applied over the region of the sto- 
 mach, with warm aloetic aperients combined with morphia. From 
 a continuance of this plan for a few weeks the patient became con- 
 valescent ; she no longer complained of her stomach, the food was 
 taken with an appetite, and digested without pain or other incon- 
 venience. Suddenly she was seized with acute pain on the right 
 side, which was followed by the discharge, per anum, of a number 
 of calculous concretions possessing all the characters of gall- 
 stones. 
 
 CASE 3. A lady, aged fifty-three, had been subject to impaired 
 digestion of the inflammatory kind for twenty-five years. For 
 seven months previous to my attendance upon her she had daily 
 vomited her food, and the discharges from the stomach were occa- 
 sionally mixed with blood. She had a jaundiced state of skin, 
 
 1 Op. cit., p. 169. 
 
 2 Diet, de Med. et de Chirurg. Pratique, tome iv., p. 376. 
 
104 PARKER ON THE STOMACH. 
 
 and the stools were of a chalky whiteness, whilst general pain and 
 tenderness existed over the whole of the upper portion of the ab- 
 domen. The symptoms assumed an acute form, and she sunk 
 from what appeared to be violent inflammation of the mucous mem- 
 brane of the stomach. On examining 1 the body, thirty-six hours 
 after death, the stomach was found to be one mass of deep florid 
 redness, its lining membrane covered with bloody mucus. The 
 liver was harder, and much larger than in the natural state. The 
 gall-bladder amalgamated with its tissues ; its mucous membrane 
 inflamed and softened; the bile as thick and dark-coloured as 
 pitch. It contained two gall-stones, and a third was found in its 
 duct. 
 
 CASE 4 A gentleman, aged fifty-seven, began to suffer from 
 severe inflammatory indigestion at the age of twenty. Sometimes 
 this patient was troubled with pain after food; at. other times he 
 had attacks of vomiting. During the latter years of his disease, 
 the skin sometimes presented a jaundiced appearance, and the 
 stools were perfectly white. He was at times suddenly seized with 
 acute pain in the right hypochondriac region, with jaundice and 
 vomiting ; during these attacks the tongue generally assumed an 
 aphthous condition. These attacks had supervened at intervals 
 during the last two years of his life only ; they were, in several in- 
 stances, removed, but from one of more severe character than 
 usual the patient sunk. He had never, after these attacks, been 
 known to pass gall-stones, or other concretions, per anum. On 
 examining the body, twenty-four hours after death, the mucous 
 membrane of the stomach was found thickened and inflamed to a 
 great extent, its sub-mucous veins were turgid and full, vivid 
 patches of redness, approaching a dark colour in places, were dis- 
 seminated over the surface of the stomach ; these were more nu- 
 merous towards the pyloric portion. The liver was hard, hyper- 
 trophied to some extent, and united, by strong adhesions, to the 
 diaphragm. The mucous membrane of the gall-bladder highly 
 inflamed ; the bile of a dark pitchy appearance. It contained 
 masses of soft concretions, resembling clay, easily broken up be- 
 tween the fingers. The cystic and common ducts were largely 
 distended with the same matter, by which they were completely 
 obliterated. 
 
 CASE 5 A divine, between forty and fifty years of age, had for 
 some months experienced weight and uneasiness on the right side, 
 accompained by vomiting, which came on generally about four 
 hours after a meal ; with these symptoms were present others con- 
 nected with a disordered condition of his digestive powers. After 
 the exhibition of some pills composed of aloes, ammoniacum, and 
 the sulphate of potass, the patient became suddenly much worse ; 
 incessant vomiting set in, the pulse, previously unsteady, became 
 more so : and in this state he sunk. On examination of the body 
 after death the liver was found greatly hypertrophied, and full of 
 steatomatous tumours ; the gall-bladder contained a black bile and 
 
INFLUENCE OF ITS MORBID STATES ON THE LIVER. 105 
 
 some calculi. The internal surface of the stomach was covered 
 with dark-coloured patches ; in the vicinity of the pylorus its 
 coats were so much thickened that the stomach, in this part, would 
 not admit of its customary dilatation. 1 
 
 An illustrious princess, spoken of by Morgagni, had suffered 
 from a continual pain in the stomach and bowels; a diarrhoea 
 suddenly came on, -from which she died. On opening the body 
 the stomach was found to be in a gangrenous state ; the gall-blad- 
 der contained a calculus as large as a small pear. 2 
 
 CASE 6. A person, aged sixty, was seized with diarrhoea and 
 vomiting, the former of which was succeeded by obstinate consti- 
 pation. The vomiting continued, in spite of all that was done to 
 relieve it, and the patient died with all the symptoms of acute in- 
 flammation of the stomach and bowels. On examination of the 
 body after death the stomach and intestines were found to be vio- 
 lently inflamed, the gall-bladder scirrhous, and a large biliary 
 concretion completely obliterated the passage through the jejunum. 
 The cellular tissue between the liver and gall-bladder was the seat 
 of a chronic- suppuration. 3 
 
 CASE 7. A patient, aged sixty-three, had suffered for some 
 time from symptoms connected with a morbid state of the digestive 
 powers, which had commenced with bilious vomiting and diarrhoea 
 three months before. Appetite was nearly gone, and the little 
 food which was taken occasioned in the epigastric region a sense of 
 weight and heat, which lasted for several hours. A blister applied 
 over the epigastrium was of some use in assisting digestion ; leeches 
 had been applied without any advantage. He had jaundice ; the 
 stools were of an ash-gray colour ; he emaciated rapidly. One 
 morning he felt a tearing pain in the right side, which was followed 
 by acute and general pain all over the abdomen. He died with 
 these symptoms of peritoneal inflammation in the course of the 
 night. On examining the body after death, the gall-bladder, very 
 much reduced in size, was found ruptured near its fundus ; its coats 
 were remarkable for their extreme friability. The cystic and 
 common ducts were nearly obliterated by the thickening of their 
 parietes. The hepatic duct was very much dilated, and filled with 
 biliary concretions. The mucous membrane of the stomach was 
 of a slate colour, and very much thickened, as were also its sub- 
 jacent cellular and muscular tunics. 4 
 
 OBSERVATIONS ON THE PRECEDING CASES. 
 
 Broussais attributes the formation of biliary concretions to an 
 inflammatory condition of the liver and gall-bladder. We shall 
 find, by reference to the preceding cases, that a diseased condition 
 
 1 Morgagni, De Sedibus, &c., Epist xxx., No. 14. 
 
 * Op. cit., lib. 3, Epist. xxxv., Art. 18. 
 
 8 Annales de la Medecine Physiologique, Aout, 1827. 
 
 4 Andral, Clinique Medicale, by Spillan, Case 31, p. 984. 
 
106 PARKER ON THE STOMACH. 
 
 of the mucous membrane of the latter organ is the most uniform 
 organic change coinciding with the presence of concretions in its 
 interior. If we enquire carefully into the symptoms which precede 
 the formation of biliary concretions, or the existence of hepatic 
 irritation, we shall find them commencing with gastric affections, 
 evidenced by various symptoms connected with, and dependent 
 upon, inflammatory irritation of the mucous membrane of the 
 stomach ; and it is to the propagation of disease, by contiguity of 
 tissue, from the mucous membrane of the stomach to that of the 
 duodenum, and thence, through the common duct, to the cystic and 
 hepatic, that may be attributed many of the diseases of the excre- 
 tory passages oif the bile. We see, in all the preceding cases, 
 symptoms of gastric irritation preceding the formation of gall- 
 stones for a longer or shorter period. In the first case marked 
 symptoms of an inflammatory condition of the stomach had pre- 
 ceded the discharge of gall-stones per anum for twelve months. 
 In the second and third cases this state of the stomach had been 
 present for many years ; in the second case the patient had suffered 
 from stomach derangement for twenty-five years. The subject of 
 the third case commenced suffering at twenty; he died at the age 
 of fifty-seven, and had been seeking relief from his disease during 
 the whole of that time. For the last three or four years a week 
 did not pass without my seeing this patient, and I most minutely 
 questioned him on the whole history of his disease. In all the 
 other cases we find symptoms of a diseased condition of the lining 
 membrane of the stomach to have been first in existence. Loss of 
 appetite, pain, weight, and heat after food, vomiting, arid epigas- 
 tric tenderness, were more or less present in each case ; and though 
 the patients sunk from the secondary disease that of the gall- 
 bladder and its appendages we find extensive organic mischief, 
 in every single instance, in the stomach and first passages. Not 
 only do we notice the symptoms of stomach derangement during 
 life, but lesions in the suffering organ after death, by which the 
 symptoms observed during life are explained. The diseases of the 
 stomach which precede these formations are of the inflammatory 
 kind, most probably commencing in mere hyperemia of the sto- 
 mach, the result of over-stimulation, from moral or other causes, 
 and thence progressing into confirmed chronic gastritis, terminat- 
 ing, as in the fourth and sixth cases, in organic change. In the 
 third case the patient died from the stomach disease alone, by the 
 passage of the inflammation from the chronic to the acute state. 
 The existence of any biliary concretions was not suspected during 
 life, yet after death we find alterations in the character of the bile, 
 and several large concretions in the gall-bladder. In other in- 
 stances the terminations of gastric diseases are not in the organs 
 which produced them, as in some examples in the preceding cases. 
 Thus, in one instance we see the patient sinking from obstructions 
 of the gall-ducts ; in a second from a biliary concretion obstructing 
 the jejunum. These concretions were produced under derange- 
 
INFLUENCE OP ITS MORBID CONDITIONS ON DROPSY. 107 
 
 ments of the liver and its secretions which evidently originated in 
 the stomach, this organ furnishing symptoms of derangement for 
 years before any affection of the liver or its appendages was sus- 
 pected. It is this termination of inflammatory irritations of the 
 stomach in diseases of other organs which should render us so 
 watchful of their progress. 
 
 It is not the affection of the stomach in itself which ought to 
 demand our watchfulness, so much as the influence the latter exer- 
 cises over the origin, progress, and termination of diseases in other 
 organs. On the other hand, a knowledge of the nature and treat- 
 ment of the morbid conditions of the stomach is essentially neces- 
 sary towards the successful management of a vast number of dis- 
 eases, which, although of a more prominent character than mere 
 gastric irritations, are nevertheless produced by, and strictly depen- 
 dent upon, them. 
 
 CHAPTER IX. 
 
 ON THE INFLUENCE OF MORBID CONDITIONS OF THE STOMACH 
 UPON CERTAIN FORMS OF DROPSY. 
 
 Into the nature of dropsy it is not necessary for me, in this en- 
 quiry, to enter. I merely wish, in this place, to notice the influence 
 which inflamed conditions of the stomach exercise upon accumu- 
 lations of serum in the peritoneum and other parts, through the 
 medium of the organs upon which dropsy more immediately, in 
 these instances, depends. 
 
 Ascites may depend upon a change in the anatomical structure 
 of many organs, and commonly is owing to a mechanical obstacle 
 preventing the free return of venous bicod through the abdomen, 
 which may exist in the liver, the heart, or other organs. We may 
 consider the influence of the stomach upon ascites in two ways : 
 1st. In reference to the conditions of those organs upon which the 
 ascites depends ; and 2nd. As it regards the exhibition of diuretic 
 remedies. We have seen, from the facts brought forward in this 
 work, that an inflamed condition of the lining membrane of the 
 stomach commonly precedes disease in the liver and heart, and in 
 a great majority of instances accompanies both, either in a primary 
 or secondary form. In one form we observe hepatic disease, con- 
 sisting, perhaps, in hypertrophy, with induration of the liver, de- 
 veloped under a gastric inflammation which has existed for years. 
 Consequent upon the disease of the liver ascites comes on; the 
 disease in the liver, of whatever character it may be, when once 
 formed, re-acts upon the stomach ; and hence we so often observe, 
 during the progress of hepatic diseases, periodical attacks of acute 
 
108 
 
 PARKER ON THE STOMACH. 
 
 or sub-acute gastritis occurring. During the continuance of the 
 inflammation in the stomach, the hepatic parenchyma, already 
 diseased, of increased density, and already offering a mechanical 
 obstacle to the return of blood, becomes still more congested, and is 
 thrown into a state of active hyperemia; and, in this condition, 
 the mechanical obstacles become greater, and the accumulation in 
 the peritoneum is increased. As the symptoms of gastritis disap- 
 pear or are subdued, the ascites is reduced to the state in which it 
 existed prior to their occurrence. 
 
 I have, for the two last years, had a gentleman under my care 
 who has a large, hard, hepatic tumour, with an uneven surface, 
 occupying the epigastric and hypochondriac regions, and extending 
 nearly to the umbilicus. He is ascitic to some extent; the lower 
 limbs are also anasarcous. When he first applied to me he had 
 confirmed chronic gastritis ; the tongue was intensely red, the epi- 
 gastrium tender ; he had acid eructations, abdominal distension 
 after food, and almost daily vomiting. Sometimes these symptoms 
 put on the acute form ; and at these times the dropsical symptoms 
 were always increased. The action of remedies in this state is 
 also worthy of notice. Some infusion of broom was exhibited in 
 the interval of the acute attacks of gastritis, but before all the 
 symptoms of gastric inflammation had disappeared. This pro- 
 duced vomiting, increased the symptoms of disease in the stomach, 
 and instead of increasing the secretion of urine, this diminished 
 under its use, from the feverish state of the economy induced by 
 the inflammatory action in the stomach. Six or eight leeches 
 were now applied every other day over the epigastric region, and 
 small doses of the blue pill with opium were administered ; the 
 patient was confined also to a strict milk and farinaceous diet. By 
 these means the stomach disease was entirely subdued, though a 
 great disposition to its return always exists with such complica- 
 tions. What produced vomiting when the stomach was inflamed, 
 and under whose use the urinary secretion diminished, now in- 
 creases its flow to the amount of sometimes two quarts in the 
 course of a single night. Since the gastritis has been cured the 
 liver is softer, the ascites less, and diuretic medicines are well 
 borne, and answer the purposes for which they were prescribed. 
 In ascites, dependent upon hepatic disease, the state of the stomach 
 should always be carefully examined before the plan of treatment 
 is decided upon. The complication of sub-acute gastritis, duode- 
 nitis, or enteritis, with the affection of the liver, ought to modify 
 most materially our treatment in such cases; the gastritis, in what- 
 ever form it may appear, should be cured before stimulating diure- 
 tics are employed. 1 If diuretic remedies be administered with the 
 
 r ' l Sometimes we see diuretic remedies administered in ascites produce 
 vomiting. That these should be successful it is necessary that the abdomen 
 should not be painful, and that its contained viscera should be healthy. 
 Landre Beauvais, Diet, de Medecine, 1st. edit., art. Ascites. 
 
INFLUENCE OF ITS MORBID CONDITIONS ON DROPSY. 109 
 
 mucous membrane of these organs in an inflamed condition, the 
 accumulations of serum will be invariably augmented from an 
 increased congestion of the liver, produced by the irritation which 
 these remedies cause in the digestive mucous surfaces. 
 
 Where the mucous membrane of the stomach evinces signs of 
 disease, in complication with hepatic diseases associated with dropsy, 
 its susceptibility to impression is in many cases much changed. 
 Sometimes a mild aperient will, in these cases, produce a diarrhoea 
 which we find some difficulty in arresting ; or, again, the adminis- 
 tration of a diaphoretic or diuretic remedy may produce severe 
 vomiting. In these states, also, a single dose of mercury will 
 occasion profuse salivation. I have seen this the case in three 
 instances. Where the liver is extensively diseased, the pathologic 
 change accompanying it in the stomach may be not merely an 
 inflammatory condition, but one of malignant disease, or of ulcera- 
 tion, which would require the utmost caution in the use of remedies. 
 
 "A government -officer, -aged 58, addicted to the free use of 
 wine, who had some time previously received in battle a blow over 
 the stomach and liver, entered the Hospital Beaujon, in August, 
 1832. He had then general anasarca, ascites, and hydro-thorax, 
 with symptoms of enlargement of the heart. The region of the 
 liver and that of the stomach were painful and tender. He was 
 bled generally and locally, with relief, for the pains in the stomach, 
 &c. The use of digitalis was now commenced, to the extent of 
 two grains a day ; soon afterwards a relaxed state of bowel came 
 on, which rapidly increased till he had passed daily, by stool, five 
 or six pints of limpid serum. The dropsy disappeared ; but in 
 spite of all remedies the purging continued, and the patient died in 
 a state of extreme wasting. On examination after death, the liver 
 was found atrophied and hardened. A cancerous tumour existed 
 in the smaller curvature of the stomach." 1 In remarking upon 
 the use of hydragogue remedies in cases of various forms ol 
 dropsy, Martin-Solon very properly observes that we ought not to 
 prescribe them where the gastro-intestinal mucous membrane pre- 
 sents the symptoms of inflammation. In such states we are more 
 likely to produce disease in it than to cure the primitive affection. 
 
 In other kinds of dropsy, which depend upon disease of the 
 heart, an inflamed condition of the mucous membrane of the sto- 
 mach is not the least frequent of its complications, I have men- 
 tioned, in another part of this work, 2 the case of a lady who was 
 anasarcous, and who had valvular disease of the heart and an 
 inflamed condition of the mucous membrane of the stomach. After 
 leeching the epigastrium, in her case, elaterium was well borne and 
 afforded great relief to the dropsical symptoms. If exhibited with- 
 out first unloading the vessels of the stomach, distressing vomiting 
 was always produced, and the anasarca was not at all relieved. 
 
 1 Martin-Solon, Diet, de Med. et de Chir. Prat, art Hydragogues. 
 
 2 See the chapter on Diseases of the Heart. 
 
110 PARKER ON THE STOMACH. 
 
 "Different diseases which manifest themselves during the pro- 
 gress of an affection of the heart, sometimes exercise a remarkable 
 influence on the production of dropsy. In many instances, it is 
 during- a Castro-intestinal inflammation that the dropsy becomes 
 manifest." 1 
 
 A lady, who had for five years been subject to periodical vomit- 
 ing, accommpanied by the symptoms of valvular disease of the 
 heart, the chief physical symptom of which was an unusually loud 
 "bruit be soufftet,' became suddenly anasarcous. under an aggra- 
 vated attack of the stomach affection. The fever which accom- 
 panied the onset of these acute symptoms assumed a distinct inter- 
 mittent quotidian form. Quinine was administered for the relief 
 of the latter affection, without reference to the pathologic state of 
 the stomach or to the complications of the disease. The patient 
 died suddenly the third day of the treatment ? of effusion into the 
 chest. I am convinced that, in this case, the occurrence of the 
 acute disease in the stomach produced the anasarca, by still more 
 embarrassing the heart's action, and I am also strongly impressed 
 by the conviction that had free local depletion been made from the 
 region of the epigastrium, this patient's life might have been pro- 
 longed to an indefinite period. 
 
 In the complications of ascites and anasarca with diseases of the 
 heart, we commonly observe the ill effects following the adminis- 
 tration of digitalis ; whilst, in other instances, the exhibition of the 
 remedy is attended with the happiest consequences. This arises, 
 not from the varying effects of digitalis as a therapeutic agent, but 
 from the state in which the mucous membrane of the stomach is 
 found at the time of its exhibition. 
 
 A man, sixty years of age, entered the Hospital of La Charit<5 
 with the symptoms of an affection of the heart, to which had 
 succeeded a dropsical state of the legs, and, subsequently, of the 
 belly. The tincture of digitalis was administered to the extent of 
 thirty drops for a dose. It occasioned vomiting ', which ceased 
 spontaneously when its use was given up. This patient ultimately- 
 died of disease of the heart. On examining the body after death, 
 the digestive tube was found generally injected. 
 
 In remarking upon digitalis, as used for the purpose of relieving 
 dropsical effusions in affections of the heart, both Broussais 3 and 
 Andral 3 insist on the most careful attention being paid to the con- 
 dition of the gastric mucous surfaces. Before administering this 
 remedy, says the first of these authors, we must be assured that 
 there is no gastritis to interfere with its operation. When this 
 organ is prepared, by the removal of inflammation, for its adminis- 
 tration, we may have recourse to it with great hopes of success. 
 
 1 Andral Clinique Medicale, p. 271. 
 
 8 Cours de Pathologie, et Therapeutique Generates, t. iii. p. 144. 
 
 3 Clinique Medicale. 
 
INFLUENCE OF ITS MORBID STATES ON THE HEART. Ill 
 
 CHAPTER X. 
 
 ON THE INFLUENCE OF MORBID STATES OF THE STOMACH UPON 
 THE ORIGIN, PROGRESS, AND TERMINATION OF DISEASES OF 
 THE HEART. 
 
 The stomach is an organ which, from its intimate connection 
 with the other parts of the economy, cannot be long or seriously- 
 disturbed in its functions, or thrown into states of disease, without 
 in some measure, affecting other organs, with which it is so closely 
 connected. The reverse of this proposition is also true, that as the 
 stomach affects the integrity of other organs in states of disorder or 
 disease, so do they react upon and disturb it when they are thrown 
 into morbid conditions. These remarks apply more particularly to 
 the connection of the heart with the stomach, than, perhaps, to those 
 of any other organ, for we find the mutual reaction of these two 
 upon each other, in states of disease, to constitute a circle of morbid 
 phenomena, which are not merely confined to the organs in ques- 
 tion, but become the exciting causes of other diseases in remote 
 parts, the starting point of which we shall trace, in most instances, 
 to its commencement in the stomach alone. 
 
 In the first series of observations I shall trace the effect of the 
 stomach upon the heart. All inflammatory irritations of the sto- 
 mach do not influence the heart's action ; they generally affect this 
 organ more as they are more intense, as they occur in patients of 
 greater susceptibility, or as they occupy more immediately the car- 
 diac portion of the stomach. 
 
 CASE 1. Palpitations after meals for some months; the meals also suc- 
 ceeded by flatulence and nausea Subsequently acute gastritis, with 
 inordinate action of the heart. 
 
 A gentleman, aged forty-five, had suffered, for three or four 
 months, from palpitations, which came on after eating. Accompa- 
 nying these palpitations he had flatulence, fulness and weight in 
 the epigastrium, with occasional nausea. To these succeeded throb- 
 bings in the neck, a degree of stupor, and total inability to exercise 
 any intellectual faculty as long as the period of digestion continued. 
 After the continuance of these symptoms, in the manner I have re- 
 lated, for about four months, they assumed an acute type ; vomit- 
 ing, pain, and excessive tenderness of the epigastrium set in, with 
 thirst, a loaded tongue, vividly red at the point and edges, and in- 
 ordinate action of the heart. The pulsations of this organ were 
 unusually strong and frequent ; the pulse rose to one hundred and 
 twenty after taking even the smallest quantity of nutriment,* the 
 eyes were suffused, and the face slightly swollen. Examined by 
 auscultation the heart appeared to possess an unusual degree of 
 force in its action, but did not afford any evidence of hypertrophy nor 
 
112 PARKER ON THE STOMACH. 
 
 of valvular disease. Two relays of leeches were applied over the 
 epigastrium, by which all the symptoms were so far mitigated as to 
 render the patient nearly convalescent. Still there continued a 
 great disposition to excitement about the heart, which even small 
 quantities of farinaceous food brought on ; at the same time the 
 gastric symptoms were also aggravated. The prussic acid was now 
 given freely with great benefit, allaying the irritability of the sto- 
 mach, and at the same time quieting the heart's action. 
 
 Remarks. This case may be taken as the type of a class in 
 which symptoms of great irritability exist naturally, both in the 
 stomach and in the heart one keeping up the state of excitement 
 in the other. The previous history of the case shows that this 
 irritability of both organs was constitutional ; for if, after exertion 
 which had accelerated the heart's action, this patient had at any 
 time taken a hearty meal of solid food, symptoms of gastritis 
 immediately set in. The violent action of the heart preventing the 
 free return of blood from the vena-cava in such cases, this fluid is 
 retained in the portal system, and the mucous surfaces of the duo- 
 denum and stomach become mechanically congested with more 
 blood than is necessary to the fulfilment of their functions. The 
 impression of stimulating food upon a membrane in this state only 
 increases the mischief by determining into it a still greater quantity 
 of blood, and hence true gastritis is easily brought on. Where the 
 heart's action is habitually energetic, the mucous membrane of the 
 stomach is constantly thrown into this state, and digestion, in -con- 
 sequence, rendered laborious. " Those persons in whom the action 
 of the heart is habitually energetic have generally the tongue red 
 and pointed, the sensibility of trie epigastrium exalted, and the region 
 of the liver and duodenum full and more or less painful. This 
 results from the sympathies which connect the heart and the sto- 
 mach ; but in many cases it appears that the gastro-duodenal irri- 
 tation is kept up by congestion of blood in the liver, caused by the 
 difficulty experienced by the vena cava in discharging its blood 
 into the heart, in consequence of its hurried action. Treatment 
 confirms this view, since we find leeches applied over the right 
 hypochoridrium and the hepatic and duodenal regions relieve the 
 symptoms more than general bleeding or leeches applied o\ r er the 
 heart." 1 With regard to the case in question, we observe the 
 exemplification of the truth of these remarks. Naturally energetic 
 action of the heart, with constant symptoms of irritability of the 
 stomach, terminating in acute gastritis; accompanying this we have 
 an unusual disturbance of the heart's action, consequent upon its 
 constitutional excitability. The results of treatment, too, correspond 
 with the remarks of Broussais: the leeches to the epigastrium 
 mitigate to convalescence all the symptoms. Attendant upon the 
 vascular irritation, which forms the chief features of this case, we 
 find a great degree of nervous irritability, evidenced in the unusually 
 
 1 Broussais, Comrnentaires des Propositions de Pathologie 3 t. ii. p. 606. 
 
INFLUENCE OF ITS MORBID STATES ON THE HEART. 113 
 
 irritable state of the heart. In such a state, after bleeding, the 
 hydrocyanic acid is a most invaluable remedy ; and, in fact, I know 
 of no other article in the inateria rnedica which could be employed 
 in such a state, as its substitute. We have another class of morbid 
 phenomena in this case, which are referable to the head the loss 
 of memory and thought after meals ; these are, doubtless, owing- to 
 a temporary cerebral congestion ; we observe them disappear as the 
 process of digestion is completed. Apoplexy is common in such 
 states. We shall allude to this more particularly in speaking of the 
 influence of the stomach upon the brain. 
 
 The heart is not only influenced in the force and frequency of its 
 pulsations by inflammatory irritation of the stomach, but the regu- 
 larity or rhythm of its action is interrupted ; its beats become irre- 
 gular, tumultuous, and intermittent, and put on all the characters 
 of organic disease ; the breathing is hurried, and occasionally the 
 lower limbs become oedematous, from interruption to the free return 
 of blood through the heart. I have met. with one very remarkable 
 case of this kind, and a second is recorded by Cruveilhier, in which 
 even the physical as well as rational signs of diseased heart were 
 present ; yet on examination after death no disease of the heart is 
 apparent, all the pathological changes being found in the stomach 
 alone. 
 
 CASE 2. Irregular action of the heart Intermittent pulse (Edema of the 
 legs Gastritis No disease of the heart to account for its irregular 
 action. 
 
 A middle-aged female, addicted for some time to the free use of 
 spirituous liquors, came under my care for what was supposed to 
 be an organic affection of the heart. The pulse at the wrist was 
 a mere unsteady trembling of the artery, in which nothing like dis- 
 tinct pulsation could be discovered. On examination of the heart 
 itself a similar state of things was observed. Auscultation indicated 
 little: There was merely a tumultuous undulating motion of the 
 heart; no distinct action could be made out. Accompanying this 
 state she had much flatulence, distension after food, nausea, arid 
 vomiting, with considerable pain arid weight in the epigastrium, 
 much increased by pressure. The weak and emaciated state of 
 this patient precluded the use of active remedies of all kinds. After 
 the continuance of this state for some weeks, she gradually sank 
 and died. 
 
 On examination after death the heart was found perfectly healthy ; 
 it presented no evidence of disease, either in its muscular structure, 
 in the valves, or in its investing or lining membranes. The sto- 
 mach presented, in its cardiac portion, one universal mass of deep 
 pink injection. The liver was hypertrophied, its substance con- 
 siderably more dense and pale than in the healthy state. 
 
 Remarks. We have here an evample of gastritis exerting a 
 most marked influence over the action of the heart, in fact, pro- 
 11 g parkS 
 
114 
 
 PARKER ON THE STOMACH. 
 
 ducing symptoms of disease in this organ, which appear of so unequi- 
 vocal a character that we are led to regard the affection of the heart 
 as the leading feature in the disease. If we dwell upon the symp- 
 toms furnished by the heart the intermittent pulse, the tumultuous 
 motion of the heart when examined by auscultation, in which 
 nothing distinct in the action of the ventricles could be discovered, 
 there seerns no reason to doubt but that the patient was labouring 
 under an organic disease of this viscus, and that the stomach dis- 
 ease was dependent upon it. The post-mortem examination, how- 
 ever, shows the reverse to be the fact. We find after death a 
 diseased stomach, and a healthy heart, at least as far as our senses 
 are capable of appreciating a normal state of organisation. Cru- 
 veilhier records a similar case, in which both the physical arid 
 rational signs of disease in the heart, were present. After death, 
 however, the heart was found perfectly healthy; cancerous disease 
 of the stomach, with a similar morbid condition of the liver, were 
 the only organic changes met with. 
 
 I record the leading features of the case recorded by Cruveilhier. 
 " The patient was thirty-eight years of age, and had been indis- 
 posed for five weeks. He at first complained of loss of appetite, 
 slight uneasiness after food, with distressing flatulence, relaxed 
 bowels, dry cough, palpitations, felt principally in the epigastrium, 
 coming on from the least exertion, and ceasing after a few minutes' 
 repose. No tenderness in the epigastrium on strong pressure. 
 These symptoms were noted on the 15th of October; on the 1st of 
 December there was no amendment: the patient then complained 
 of weight at the stomach, nausea, eructations, arid acidity, with some 
 fever. 
 
 "April 10th. The symptoms, at this date, remained much the 
 same ; there was no sensibility in the regions of the stomach or 
 liver. Distressing palpitations in the epigastrium, as well as in the 
 region of the heart, so strong as to be felt all over the head. Food 
 sits heavy upon the stomach for eight or ten hours after eating; 
 warm drinks occasion distress, cold ones were agreeable and 
 refreshing. The stethoscope, applied over the heart, discovered a 
 strong and extended pulsation diffused over the whole of the left 
 side of the thorax ; accompanying it was a whistling sound (bruit 
 de sifflement), synchronous with the pulsations of the heart and the 
 pulse. It was concluded, from this examination, that the patient 
 was affected with hypertrophy of the heart and disease of its valves ; 
 and a treatment calculated to retard the progress of such a disease 
 was consequently adopted. In May constant vomiting set in. but 
 the state of the epigastric region remained the same; there was no 
 tenderness, fulness, or tumefaction. 
 
 " In August physical signs of disease of the liver were added to 
 the symptoms previously existing. Milk and fruits were the only 
 aliment his stomach could then retain. 
 
 "On examination after death the liver was found filled with 
 deposits of encephaloid mailer; the stomach near the pylorus, pre- 
 
INFLUENCE OP ITS MORBID STATES ON THE HEART. 115 
 
 sented an indurated mass with considerable thickening, hollowed 
 in the centre by a deep circular ulcer. The heart, the lungs, and 
 the remaining organs were perfectly healthy." 1 
 
 Andral and Broussais both attribute the occurrence of irregular 
 and increased action of the heart, consequent upon gastric disturb- 
 ance to predisposition to disease on the part of the heart, character- 
 ised by a preternatural thickness in its walls, or an over-excitable 
 state of the nerves distributed to it. Thus the gastric irritation 
 becomes the occasional cause of the more rapid development of 
 disease of the heart, the rudiments of which these persons carry 
 about them. I am often consulted by patients who complain loudly 
 of stomach derangement and the palpitations which accompany it, 
 which only come on after meals, to which they have been subject 
 for years. Although the stomach is the organ principally attract- 
 ing attention, yet when we come to examine minutely into the state 
 of the heart, we find in it the physical signs of disease. I have two 
 gentlemen now under my care in this state. It is impossible to say, 
 in such cases, whether the stomach may not have been the primary 
 seat of disease ; but it is certain that the removal or mitigation of 
 the symptoms indicating an inflamed state of the mucous membrane 
 of the stomach renders stationary the evils which exist in the heart. 2 
 How common is it to see persons, who carry about them all the 
 signs of diseased heart, tormented with periodical attacks of gastri- 
 tis, which are termed bilious seizures, during the continuance of 
 which the affection of the heart becomes more urgent and alarming. 
 To this point we shall return, however, on examining the influence 
 of the heart upon the stomach. The two cases I have mentioned 
 are examples of the most acute and marked forms, under which 
 sympathetic affections of the heart are manifested, consequent upon 
 disease in the stomach ; these sympathies may. however, assume 
 much milder forms, from the mere increase in the force and fre- 
 quency of the heart's action to irregularities of various kinds, with 
 an intermittent pulse. These derangements taking place only 
 during the continuance of disease in the stomach, they cease with 
 it, and reappear when these morbid states again set in. 
 
 I have now to record several examples of peculiar states of the 
 pulse dependent upon gastritis or gastric hyperemia. 3 
 
 CASE 3. A young lady, aged eight, after the disappearance 
 of the eruption of scarlatina, was seized with sickness and constant 
 vomiting of food, with pain arid tenderness in the epigastrium: the 
 bowels were constipated, the papillae of the tongue enlarged and 
 intensely red. The pulse was frequent, and had a double beat to 
 
 1 Anatomie Pathologique, &c. 12me. livraison. 
 
 2 " Cure the gastritis and you will often see the affection of the heart 
 become stationary." Andral. 
 
 3 These forms of irritation in the stomach are evidently combined with 
 some peculiar conditions of the nervous system; the stupor in some cases, 
 and the convulsions in others, are evidences of this. Those cases also illus- 
 trate some of the sympathies existing between the stomach and the brain. 
 
116 PARKER ON THE STOMACH. 
 
 each systole of the heart, two pulsations of the artery at the wrist 
 to each single contraction of the left ventricle of the heart. 
 
 CASE 4. A boy, aged ten, was seized, after the disappearance of 
 the eruption of scarlatina, with constant sickness, vomiting, and 
 pain and tenderness in the epigastrium. The bowels were obsti- 
 nately constipated, and the stomach would not retain either food or 
 medicine. The pupils were dilated to the utmost extent. After 
 the continuance of this state for two days violent convulsions came 
 on. which recurred after bleeding from the arm, but did not again 
 come on after the application of leeches to the head and stomach 
 at the same time. The double pulsation at the wrist continued 
 during the whole of the period that the symptoms of gastric irrita- 
 tion lasted: they disappeared with the sickness. I could, in this 
 case, predict the effect which would follow the administration of 
 food or medicine ; they invariably produced sickness as long as the 
 double pulsation continued. 
 
 CASE 5. A young gentleman aged ten, after scarlatina had con- 
 stant sickness, pain, sometimes of a violent character, with tender- 
 ness in the epigastrium, and confined bowels. The stomach was 
 so irritable that it would retain nothing in the shape of medicine, 
 excepting a pill of calomel and opium. The pupils were largely 
 dilated, and he had occasional fits of stupor. The symptoms con- 
 tinued many days; but the patient ultimately recovered from the 
 application of leeches to the epigastrium and the occasional use of 
 injections. This patient had a double pulsation at the wrist during 
 the whole continuance of the gastric symptoms. I noticed it some 
 hours before the vomiting commenced, and predicted the occurrence 
 of the sickness from the state of the pulse. 
 
 CASE 6. A middle-aged man had diarrhoea, with occasional 
 sickness, and vomiting, distension, flatulence, and uneasiness after 
 taking food. With these symptoms of gastro-enteric irritation, he 
 had a double pulsation of the radial artery. 
 
 CASE 7. An athletic man, after hard labour in the heat of the 
 sun for many hours, was seized with the symptoms of acute gas- 
 tric irritation ; great heat of skin, constant vomiting, pain and ten- 
 derness in the epigastrium, thirst, dry red tongue, and tendency to 
 delirium, with a tremulous double pulsation of the artery at the 
 wrist. All the symptoms yielded at once to the application of 
 twenty leeches over the epigastrium. The pulse then resumed its 
 customary single beat. 
 
 Remarks. These cases I have selected from many others to 
 illustrate the influence of the stomach upon the arterial system. 
 These peculiar states of pulse sometimes a distinct double pulsa- 
 tion, at others a mere tremulous motion of the artery seem alto- 
 gether independent of any action of the heart itself. I have fre- 
 quently had my ear upon the stethoscope, placed over the heart, 
 and my finger upon the pulse at the same moment, but in the cases 
 which I have detailed, the action of the heart has invariably been 
 steady, whilst the pulse presented a mere tremulous motion or a 
 
INFLUENCE OF ITS MORBID STATES ON THE HEART. 117 
 
 distinct double, or even triple, pulsation to each contraction of the 
 ventricle. When these states of pulse coincided with the symp- 
 toms of gastric hyperemia, the head always appeared to be more or 
 less affected: in some cases, certainly, there were no symptoms in- 
 dicating any affection of the brain ; but in others these symptoms 
 were very marked. The convulsions in the third case, and the ex- 
 tremely dilated state of the pupil in the third and fourth cases, are 
 examples of these secondary states of disease in the head subse- 
 quently to gastritis, accompanied by this peculiar condition of the 
 pulse. Most of the examples which I have collected of these forms 
 of disease have been after the disappearance of the eruption in scar- 
 latina; but it will be observed that, in the fifth case, no feverish 
 affection had previously been in existence; and, in the sixth case, 
 the peculiarity of pulse coincided with symptoms of acute gastritis, 
 and disappeared with the disease, which was treated with active 
 local depletion. In this case we observe the pulse to resume its 
 single pulsations as the blood flows from the region of the stomach. 
 The nature of the symptoms on the part of the stomach, and the 
 effect of local depletion from the epigastrium, leave us no room to 
 doubt of the nature of the stomach affection ; they also convince 
 us that the state of the pulse was entirely dependent upon it, since 
 we see the action of the artery become natural as the symptoms of 
 inflammatory irritation are removed. 
 
 The pulse is modified in a thousand ways in inflammatory irri- 
 tation of the stomach; but, in most of these instances, it is influ- 
 enced through the medium of the heart. Thus it is, in many 
 cases, languid and creeping, not exceeding forty beats in a minute 
 in certain forms of chronic gastritis. These states of languid cir- 
 culation exist with symptoms of chronic gastritis. I have now a 
 gentleman and lady under my care who have this state of circula- 
 tion with chronic gastritis; one of them has an aphthous state of the 
 mucous membrane of the mouth and fauces, obstinate constipation, 
 occasional nausea, with vomiting, flatulence, and acidity; pain and 
 tenderness in the epigastrium are almost altogether wanting; he 
 may be pressed rudely without occasioning more than a mere un- 
 easiness, yet I consider this patient's as one of the most confirmed 
 cases of chronic gastritis. In the case of the lady, the symptoms 
 are still more obscure ; uneasiness after food, with acidity, lan- 
 guor, rapid wasting, and a pulse not exceeding forty beats in a 
 minute, are the prominent features of her disease. Both patients 
 have been materially benefited by small local depletions from tha 
 epigastrium. 
 
 Broussais would say these states of disease were not sufficiently 
 acute to irritate the heart. It is true they are not; but they are 
 sufficiently formidable to disorganise the mucous membrane, and to 
 perforate the stomach, which is a common termination of those latent 
 forms of disease, the patients hardly fancying themselves, during 
 the whole progress of the affection, which will last for years, more 
 than slightly indisposed. I have traced the histories of some of 
 
I 
 
 I 
 
 118 PARKER ON THE STOMACH. 
 
 these cases ending by softening of the mucous coat and perforation 
 of the stomach. 
 
 A languid state of circulation does not preclude the existence of 
 chronic inflammation of the mucous coat of the stomach; in fact, 
 it accompanies some of its most insidious, uncontrollable, and fatal 
 forms. At other times the pulse is slightly accelerated; its fre- 
 quency increasing towards the evening, at which time some slight 
 accession of fever is present, sometimes attended with cough and 
 flushings of the cheek, resembling perfectly the character of hectic 
 fever depending upon disease of the lung. 
 
 In a third form of disease the pulse is intermittent. This may 
 be present during the whole period of the continuance of the affec- 
 tion of the stomach, or it may only be observed when the inflamed 
 condition of the mucous coat assumes a greater degree of severity, 
 or becomes for a time more acute. I have carefully noted the cases 
 of several patients, who are subject to attacks of severe inflamma- 
 tory indigestion, at the time when they were in perfect health, and 
 also during their attacks of disease. When well, nothing could be 
 more natural than the state of the heart; when suffering from sto- 
 mach disease the disturbance of the heart and circulating system 
 has been so great that it has been difficult, even knowing the pre- 
 vious condition of these organs, not to suppose that their functional 
 disturbance was the result of disease in the organs themselves. 
 Where this disturbance of the circulating system is so easily occa- 
 sioned, it shows a predisposition on the part of the heart to become 
 diseased; and the continuance of stomach disease, either in a 
 marked or latent form, would, in such instances, ultimately induce 
 disease on the part of the heart itself. I shall relate the histories 
 of three cases in which the patients died from diseases of the heart 
 where no physical sign of such disease was, at the commencement 
 of the complaint, in existence, and in which the primary symptoms 
 were referable to the stomach alone. 
 
 I. Of the association of Disease of the Stomach with that of 
 the Heart) and of the influence which the former exercises 
 upon the progress of the latter. 
 
 CASE 8. Disease of the heart. Fungoid ulcerations of the mitral valve, 
 with inflammation of the mucous coat of the stomach. Great relief af- 
 forded to the symptoms of the disease of the heart by mitigating that of 
 the stomach. 
 
 A lady, aged thirty-four, was placed under my care in the month 
 of September, 1835. She had before this period complained occa- 
 sionally of palpitations, but nothing more had been remarked in 
 the previous history of her disease. 
 
 September 8th. On the first examination of the patient on this 
 day I noticed the pulsations of the heart to be tumultuous, strong, 
 irregular, and diffused over a great portion of the left side of the 
 
 
INFLUENCE OF ITS MORBID STATES ON THE HEART. 119 
 
 chest. When -examined by auscultation the impulse of the heart 
 was very strong; a loud "bruit de soufflet" was present, which was 
 distinctly heard all over the thorax. The pulse unsteady, flutter- 
 ing, and indistinct, intermitting every third or fourth beat, and 
 bearing no relation to the systole of the left ventricle. Orthopnoaa, 
 cough, frothy expectoration ; legs anasarcous to some extent. Pain 
 and tenderness in the epigastrium, with constant nausea and vomit- 
 ing of food; tongue dry and coated, vividly red at its point and 
 edges. These symptoms are of comparatively recent date, during 
 which time she has been much worse; they commenced with fla- 
 tulence, pain, and distension after food, then the palpitations became 
 more distressing, the breathing bad, and the legs anasarcous. 
 
 September 14th. Leeches have been twice applied to the epi- 
 gastrium, and alkalies with morphia have been administered. The 
 patient describes the palpitations to be much less distressing, hardly 
 feeling them all. The tongue is clean, the sickness gone. The 
 contraction of the ventricle and the pulse at the wrist now coincide, 
 the one regularly following and corresponding with the other. 
 The heart's action, examined by auscultation, is still remarkably 
 strong, still diffused over a lar^e surface, and still accompanied by 
 a "bruit de soufflet," though of a much less intense character. It 
 is evident that the mitigation of the symptoms of gastric disease 
 has materially allayed the irregularity and force of the heart's 
 action. 
 
 September 20th. At the present date no gastric symptoms were 
 present; the legs, however, were very dropsical, the breathing 
 much oppressed, and the abdomen large and full. Small doses of 
 elaterium were now administered, which relieved all these symp- 
 toms materially, but distressed the stomach very much, and brought 
 on a return of the irregular action of the heart. To relieve the 
 symptoms of gastritis, leeches were again applied, and the action of 
 the heart again became steady; still there was a disposition to the 
 return of the anasarca, with an oppressed state of the breathing. 
 The elaterium always agreed with the patient, and relieved the 
 dropsical symptoms without aggravating the state of the heart, 
 when the gastric symptoms were kept under by the application of 
 leeches to the epigastrium, which unloaded the congested vessels of 
 the mucous membrane of the stomach, and brought it into a state 
 to bear the impression of the elaterium. In this manner the pa- 
 tient's state was rendered comfortable till the 3d of October, on the 
 morning of which day she died suddenly. 
 
 Post-mortem examination, thirty hours after death. About ten 
 ounces of serum were effused into the bag of the pericardium; large 
 fibrinous clots in all the cavities of the heart. Heart hypertrophied 
 to some extent; membrane of the left ventricle thickened to the 
 consistence of thick writing-paper, easily stripped from the muscular 
 structure of the heart; the edges of the mitral valve were covered 
 with two large, dark-red, fungoid ulcerations. The stomach was 
 immensely large, extending some distance below the umbilicus, 
 
120 PARKER ON THE STOMACH. 
 
 nearly filling the whole abdomen; the cardiac portion extremely 
 thin, the mucous membrane had here almost disappeared; the 
 pyloric portion of a uniform bright-red injection; the veins of the 
 submucous coat much distended; here and there black patches, 
 and arborescence on the mucous coat of the cardiac extremity. 
 
 Remarks. This is a very instructive case, and illustrates many 
 points of importance in the co-existence of diseases of the stomach 
 with those of the heart. The nature of the disease of the heart, 
 to which this patient fell a victim, was inflammation of the lining 
 membrane of the left ventricle, and its terminations. I shall adduce 
 some facts in the history of the next case which lead me to suppose 
 that this inflammation, however frequently it may derive its origin 
 from other causes, is commonly developed from continued gastric 
 irritation. The present case principally illustrates two points in 
 diseases of the heart the state of the stomach during the progress 
 of such diseases, the influence this exercises upon the heart's action, 
 and the effects of remedies administered to relieve any particular 
 state which may depend upon the disease of the heart, or to which 
 it may give rise during its continuance, such as the anasarca, &c., 
 in the present instance. If we enquire into the pathologic condi- 
 tion of the stomach, in the first place, we find it to be one of pure 
 inflammation, varying in the effects which this has upon the sto- 
 mach according to the irritability of the patient in whom the dis- 
 ease occurs. It is true that many of the changes which we find in 
 the stomach, during diseases of the heart, are the consequences of 
 mere congestion, owing to the mechanical impediment offered by 
 the embarassed state of the heart to the free return of blood from 
 the venous system of the abdomen ; but, at the same time that we 
 find congestion in one part of the stomach, we find a pure inflam- 
 matory state existing in others. The mere appearances of redness 
 observed in the stomach after death in diseases of the heart are not 
 enough, perhaps, to enable us to determine of which exact character 
 these changes may be, "since," says Andral, "we are convinced 
 that this congestion may assume most of the shades of inflamma- 
 tory redness." Broussais distinguishes congestion from inflamma- 
 tion in these states. If the affection be of an inflammatory kind 
 the redness is not uniform, but irregular, vivid in points or arborU 
 sations, &c., and commonly combined with some of the conse- 
 quences of inflammation, with induration, softening, or nlceration. 1 
 If we find during life vomiting, flatulence, uneasiness, weight, and 
 tenderness in the epigastrium, we maybe sure that gastritis is asso- 
 ciated with the disease of the heart, and the continuance of the 
 former, will only hasten the termination of the latter, and give rise 
 to many symptoms which would otherwise be absent, caused by the 
 additional embarrassment the disease of the stomach produces in 
 the heart's action. We have a remarkable instance, in the case 
 just detailed, of the effect which the mitigation or increase of the 
 
 1 Cours de Pathologie, &c., tome iii., p. 125, 126. 
 
INFLUENCE OF ITS MORBID STATES ON THE HEART. 121 
 
 gastric symptoms has upon' the heart's action. We find the pulse 
 at the wrist become steady and lose its intermission when the gas- 
 tritis subsides, and return with the disturbance of the stomach. In 
 many cases we shall find also anasarca and great dispnoea coming 
 on during diseases of the heart, associated with gastritis, which 
 symptoms are commonly attributed to the disease of the heart, to 
 which they cartainly belong, but the state of the heart which gives 
 rise to these symptoms is caused by the irritation to which it is 
 subjected from the disease in the stomach. Mitigate or cure this, 
 and we shall find the aggravated symptoms attendant upon disease 
 of the heart disappear, and persons sometimes cease to feel they 
 bear such disease about them. 1 A point of great importance, in the 
 history of the last case, refers to the effects of remedies given to 
 relieve the symptoms accompanying, or produced by, the heart-dis- 
 ease, such as anasarca, or the threatenings of effusion into the 
 peritoneum, pleura, or pericardium. Thus, we see the use of the 
 elaterium in the preceding case aggravate the symptoms, by in- 
 creasing the irregularity of the heart's action; this arises from the 
 effects this medicine produces in the stomach, adding to the irritation 
 already existing in this organ. We observe this medicine to pro- 
 duce the good effects generally attributed to it. in dropsy, whilst the 
 gastric irritation is subdued by the local depletion from the epigas- 
 trium. It is a common circumstance, that stimulating diuretic and 
 purgative medicines, given to excite the kidneys or bowels, during 
 various dropsical states, which accompany diseased heart, produce 
 a totally opposite effect to that which they are intended. We ob- 
 serve sickness produced, and the urine, already scanty, actually 
 becomes more so, under the use of these remedies, whilst at the 
 same time the dropsical symptoms increase. On the other hand, 
 leeches to the epigastrium (if the symptoms are urgent), and reme- 
 dies calculated to allay the gastric irritation, at once reduce the 
 dropsical symptoms and increase the urinary secretion. The evils 
 which are frequently attributed to the disease of the heart, very 
 
 'In a considerable number of cases, irritation of the stomach or of the 
 intestines is announced only by local'symptoms rather obscure; but this 
 irritation reacts sympathetically on the heart, and the symptoms arising from 
 the affection of the latter are very much aggravated. Thus its beats acquire 
 unusual frequency, they become irregular and tumultuous; the difficulty of 
 breathing increases: these symptoms, again, acquire for a time a higher 
 degree of intensity every time that food is taken into the stomach. Among 
 other instances, we saw an individual in whom the indigestion ef simple 
 drinks was immediately followed by difficulty of breathing, so that lying 
 down was impossible; and for about two hours the patient was, as it were, 
 threatened with asphyxia. At the same time that, under the influence of 
 the gastro-intestinal inflammation, the local symptoms of heart-disease are 
 increased in severity, we also see dropsy either manifest itself, for the 
 first time, consecutively to the increase in the disturbance of the venous 
 circulation, or become increased if it did exist before, or, finally, if, after 
 having already existed, it had disappeared. These different symptoms 
 become aggravated as long as the affection of the digestive tube exists, and 
 they amend along with il.Andral. 
 
122 PARKER OF THE STOMACH. 
 
 commonly arise from inflammatory irritation of the stomach, when 
 affections of the former organ produce, as in most instances they 
 do, disease of the inflammatory kind in the latter. I may observe, 
 in concluding these remarks, that in diseases of the heart, whether 
 acute or chronic, the state of the stomach should never he overlooked, 
 since irritation, secondarily set up in it, most materially adds to the 
 severity of the primary disease. Even during acute affections of 
 the heart or its membranes, we sometimes observe this state of the 
 stomach present, and the patients chiefly complaining of epigastric 
 pain and tenderness, accompanied by vomiting. 
 
 A youth, aged twenty, subsequent to rheumatism, was seized 
 with an acute attack of pericarditis. He was relieved by general 
 bleeding, and leeches applied freely over the cardiac region ; still, 
 however, the symptoms did not entirely give way. During the 
 progress of his disease, he had complained of a constant pain in the 
 epigastric region, which was highly sensible to pressure ; the sto- 
 mach would retain nothing. Leeches were now applied over this 
 region ; the vomiting ceased, the action of the heart became steady 
 and a perfect convalescence was speedily established. 
 
 Attacks of acute gastritis sometimes supervene in persons who 
 carry about them organic affections of the heart. A lady, aged 
 fifty-four, had suffered from palpitations for about ten years, ac- 
 companied by great dyspnoea and occasional faintness. The pulse 
 at the wrist was merely an unsteady tremulous motion of the 
 artery in which nothing like distinct pulsation could be detected 
 The action of the heart was diffused over a great extent of surface, 
 the hand laid over it detected no impulse, a mere tremor was all that 
 was perceptible ; the stethoscope indicated an indistinct undu- 
 lation, in which all the regular rhythm of the heart was lost. Occa- 
 sionally this patient was seized with acute pain in the epigastrium 
 which was increased to agony by pressure. The stomach rejected 
 in a sour and bitter state, every thing taken into it. These symp- 
 toms recurred, without any marked cause, at intervals of some 
 months, and were subdued by local depletion from the region of the 
 stomach. 
 
 CASE 9. A second lady, aged thirty-five, had presented all the 
 symptoms of an organic affection of the heart for five years 
 These consisted in an unusually strong impulse of the organ, ex- 
 tended over a great surface, occasional irregularity of its rhythm 
 accompanied by a strong " bruit de soufflet," the pulse intermitting 
 always at intervals of five or six beats. Every six weeks or two 
 months, distressing attacks of vomiting set in, accompanied by great 
 pain and tenderness in the epigastrium. During the continuance 
 of the gastric symptoms, the pulse at the wrist was indistinct 
 merely an unsteady fluttering, whilst the action of the heart was 
 strong and tumultuous ; auscultation detected nothing but a pow 
 erful fluttering motion, in which all traces of the heart's natura 
 action were lost. The patient, during the continuance of the gas 
 trie symptoms, could never rise from the bed, the faintness occa 
 
INFLUENCE OP ITS MORBID STATES ON THE HEART. 
 
 123 
 
 sioned by the violent disturbance of the heart's action was so great. 
 When free from the stomach affection she was comparatively well. 
 After this state had continued for four or five years, with little vari- 
 ation, symptoms of a regular tertian intermittent fever set in, accom- 
 panied by constant gastric derangement, pain and tenderness in the 
 epigastrium, with occasional vomiting; anasarca succeeded, and the 
 patient suddenly died, apparently from effusion into the pericardium, 
 for d ul ness on percussion to great extent in the region of the heart 
 was detected after death, which had not previously existed. Per- 
 mission to examine the body was refused. 
 
 This case is another example of the influence which disease of 
 the stomach exercises over that of the heart, in aggravating the 
 symptoms of the latter and accelerating their termination. These 
 coincident affections of the heart and stomach afe a circle of mor- 
 bid actions, in which it is difficult to fix a point of commencement ; 
 the disease of the stomach irritating the heart, and the affection of 
 the latter causing congestions of the former, and predisposing it to 
 inflammatory action. I have often found the veins of the sub- 
 mucous coat of the stomach, in diseases of the heart, as full of 
 coagulated blood as though they had been filled with injection. In 
 the case just related, as in that which precedes it, we notice the 
 increased severity of the affection of the heart taking place when- 
 ever the symptoms of gastritis occurred ; though, doubtless, the 
 predisposition to disease in the stomach is occasioned by that of the 
 heart, retaining in the coats of this organ, as I have previously 
 stated, a greater quantity of blood than is necessary to the fulfilment 
 of its functions. 
 
 CASS 10. Gastritis Softening of the heart. 
 
 An elderly female, aged sixty, came under my care, who had for 
 many months had great difficulty of breathing, with daily vomiting 
 of food. 
 
 When I first saw her on the 8th of December, 1836, she pre- 
 sented the following state : pallid countenance with livid lips, 
 legs anasarcous to a considerable extent ; the breathing very diffi- 
 cult. She could not take any kind of food without its producing 
 pain and vomiting; the epigastrium was painful, and very sensible 
 to slight pressure ; the pulse at the wrist a mere tremulous motion 
 of the artery, hardly to be called pulsation ; the heart, examined 
 by auscultation, presented merely a tremulous undulation, but no 
 distinct sounds. She died suddenly, a few days after my first visit 
 to her. 
 
 Post-mortem examination^ twenty-four hours after death. 
 The stomach was one uniform mass of vividly red injection in its 
 pyloric half; the cardiac portion black, with blood conjested in 
 numerous patches ; the veins of the submucous coat distended with 
 blood. The spleen, four times its natural size, full of black blood ; 
 the vasa brevia as much distended with this fluid as though they 
 
124 PARKER ON THE STOMACH. 
 
 had been filled with injection. The liver greatly elarged, pale, and 
 hard. Heart so soft as almost to drop to pieces in the fingers ; its 
 muscular structure very pale; it might be rubbed away to a pulp 
 between the thumb and finger. 
 
 Remarks.-^This is a third example of that form of irregular 
 action of the heart which stimulates valvular disease of that organ, 
 and which appears to have been produced and kept up by continued 
 gastric irritation. In chronic gastric diseases, which have con- 
 tinued for a number of years, it is common to find a softened slate 
 of the pareriehymatous organs, generally similar to that which, in 
 this instance, affected the substance of the heart. This softening is 
 very commonly found in the liver, to such an extent that it may be 
 rubbed away easily between the fingers. I have remarked this 
 condition of structure in the spleen, the kidneys, the heart and the 
 liver to be a common attendant on that cachetic state into which 
 patients with long-continued chronic gastritis sometimes fall. 
 
 In the present instance, we notice it affecting the heart, the irre- 
 gularity in the actions of which was evidently dependent on the 
 softene .1 state of its walls, they not being sufficiently powerful to 
 cause a proper contraction of the ventricle ; hence the peculiar 
 condition of the pulse. 
 
 II. General history of the influence of the Stomach upon the 
 Heart) and of the state of the Stomach in diseases of the Heart. 
 
 The first effects we shall notice of the influence of the stomach 
 upon the heart are certain irregularities in the action of the latter 
 organ, which are independent of any appreciable alteration in its 
 structure, either as regards the consistence of its walls, the state of 
 its valves, or its investing or lining membranes. These irregularities 
 consist in an unusual frequency of its pulsations, or alterations of 
 their character, in which the regular and natural rhythm of the heart 
 is lost, the contractions of its cavities do not follow each other in 
 their customary and due succession, and the pulse consequently in- 
 termits. We find many persons in whom both these states of the 
 heart's action occur, without there being any organic affection of 
 the heart itself, or even an approach to it. 
 
 The states of stomach which produce these irregularities of the 
 heart's action are various, but may generally be referred to three 
 classes ; 1. A state of mere hyperemia, or congestion of the mucous 
 coat ; 2. A confirmed inflammatory condition ; or, 3. A morbid 
 state of its sensibility. In some instances, as in case 1, we find an 
 unusual degree of frequency in the heart's action after taking a 
 moderate meal, which continues as long as the period of digestion 
 lasts. I have occasionally been consulted by a gentleman, in whom, 
 the pulsations rise to as many as a hundred and ten or twenty beats 
 in a minute. No fever accompanies this state: as long as the 
 symptoms of stomach derangement are urgent, the action of the 
 heart keeps up. This is relieved as the stomach becomes healthy ; 
 but after its return to an apparently healthy state, the action of the 
 
INFLUENCE OF ITS MOU13ID STATES ON THE HEART. 125 
 
 heart is again excited by food to almost its primitive frequency, 
 which continues for some time after all the symptoms connected 
 with the stomach have disappeared, excepting, perhaps, a slight 
 decree of flatulence. This state of the heart is frequently accom- 
 panied by considerable tenderness, heat and beating in the epigas- 
 trium, and in such cases local depletion from this region is produc- 
 tive of great benefit. Occasionally, however, it happens, that the 
 irritability of the heart continues, after eating, for some time, when 
 the inflammatory or hyperemic conditions of the stomach, which 
 accompany or produce it, have subsided: in such instances I have 
 found the various preparations of iron of great service, combining 
 them with anti-spasmodic, aperient, or sedative remedies, according 
 to the circumstances of the case. The remedies should be suited 
 to the- nature of the stomach affection, upon which the excited 
 action of the heart appears to depend. If the inflammatory symp- 
 toms are well marked, we must have recourse to a moderate deple- 
 tion from the epigastrium; if constipation, with flatulence and pain 
 after food, a combination of the pil. aloes comp. with the pil. hyd., 
 or pil. rhaei comp. with the galbani comp., and minute doses of the 
 muriate of morphia, will be of service, taking at the same time the 
 hydrocyanic acid; the latter remedy is of great use, given in the 
 mist, cretse, if diarrhoBa be present instead of constipation, or when 
 great irritability of the stomach, accompanied by acidity, are the 
 prominent symptoms. 
 
 In a second form of sympathetic irritation of the heart, we find 
 irregularities in its actions, which are of various kinds. These 
 irregularities display themselves in intermissions of the pulse, and 
 tumultuous, hurried, and confused beating. We find that, in 
 some persons, the pulse intermits every four or five beats, during 
 the accession of an attack of stomach derangement, whilst, during 
 the freedom from such attacks, the action of the heart is perfectly 
 natural. In the cases of two ladies, who occasionally consult me, 
 the heart presents these forms of intermission. In one of these 
 cases, the pain after food, with beating, heat, and tenderness in the 
 epigastrium, is always accompanied by an intermittent pulse: when 
 well, the heart does not present the slightest irregularity in its 
 beats, or any increase of force, in the second instance, the sto- 
 mach affection is not so well marked ; but the intermittent pulse is 
 a certain symptom that the stomach is affected, and, consequently, 
 by attention to the latter organ, the heart resumes its natural and 
 accustomed action. Not the slightest physical sign of disease can 
 be detected in the heart in either of these cases. I have before 
 said, that the symptoms of disease in the stomach are sometimes 
 to be found in the heart: the last case to which I have alluded is 
 a remarkable instance of this. 
 
 The two forms of intermittent pulsation, which I have noticed, 
 are common, and doubtless depend upon a morbid condition of the 
 sensibility of the epigastric nervous centre, sympathetically affect- 
 ing the heart, and in such instances there is no reason to suspect 
 
126 PARKER ON THE STOMACH. 
 
 that any affection of this viscus is in existence, more than a mere 
 derangement of the nervous system supplying it. "In a crowd of 
 diseases, 1 ' observes Andral, "in those particularly where the action 
 of the nervous centres is more or less modified, the heart presents 
 irregularities and well-marked intermissions." I have shown some 
 varieties of these variations, as they affect the arterial circulation, 
 at the commencement, and during the progress of fevers, which 
 depend altogether on a modification of the sensibility of the nerves 
 of the stomach and epigastrium. There are, however, sometimes 
 cases occurring, in which all the tissues entering into the composi- 
 tion of the heart remaining healthy, the irregularities of its action 
 heard under the stethoscope, and the character of the pulse at the 
 wrist, precisely resemble those of organic disease. The second 
 case of the preceding chapter, and that recorded by Cruveilhier 
 and quoted in the notes to my own case, are examples of this form 
 of disease. In both these instances, no disease was detected in the 
 heart; even the state of its nutrition, the consistence of its walls, 
 presented no appreciable morbid state. 
 
 In other instances, as in case 10, these tumultuous and irregu- 
 lar actions, and intermitttent pulsations, coincide with an alteration 
 in the structure of the walls of the heart, evidently produced by 
 long-continued gastric disease. In acute and chronic gastric and 
 gastro-enteric diseases there is, as I have before said, a peculiar 
 tendency to the softening of some organs, particularly of the liver 
 and heart: if we turn to the chapter on the Diseases of the Liver 
 we shall remark many instances of this softened state of the or- 
 gan. "In the conditions of which we are speaking," observes 
 Broussais, 1 "the heart is sometimes so friable that the finger pene- 
 trates its walls with ease." In the subject of the tenth case, we 
 noted that the substance of the heart was so soft, that we might 
 rub it to a fleshy pulp between the fingers. It is most likely, that 
 this state of softening is the result of a protracted irritation in the 
 heart, marked, in the first instance, by the irregularities observed 
 in case 2, which, after the continuance of such irritation for a cer- 
 tain period, terminates in the softening of the organ, as exhibited in 
 case 10. In this manner do continued irritations ultimately pro- 
 duce alterations of the structure of organs, in which such irri- 
 tations are set up ; and, in the cases before us, these irregularities 
 in the pulsations and action of the heart, are the result of com- 
 plaint first seated in the mucous surfaces of the stomach. 
 
 When actual disease of the heart is in existence, manifested 
 by the most unequivocal physical signs, we commonly find the 
 state of the heart's action increasingly embarrassed, under the ad- 
 ditional irritation produced by the occurrence of any morbid con- 
 dition of the mucous membrane of the stomach, set up during the 
 progress of the disease of the heart: the seventh case is a remark- 
 
 l(< Etat du OoB-ur, &c., dans les Gastro ententes aigues." Cours de 
 Pathologie, Le9on 27me. 
 
INFLUENCE OF ITS MORBID STATES ON THE HEART. 127 
 
 able example of this fact. The knowledge of this is of extreme 
 importance in the treatment of all diseases of this character. The 
 detail of the seventh case and the notes appended to it are well 
 worthy of attention. We sometimes ohserve the symptoms of 
 distress produced by the action of a diseased heart, under the in- 
 fluence of stomach irritation, mitigated or entirely removed by the 
 relief or cure of such irritation. A gentleman, of middle age, 
 who had suffered severely from attacks of acute rheumatism, com- 
 plained to me of distressing palpitation, which incapacitated him 
 for exertion, and produced hurried breathing and a sense of suffo- 
 cation. On examining the heart its impulse was found much 
 stronger than in the natural state, at the same time a loud "bruit de 
 souffiet" was present. With these physical signs of disease of the 
 heart the digestive powers were seriously disturbed; he had pain 
 and tenderness in the epigastrium, nausea, distressing flatulence, 
 and distension after food, with a full, hard pulse, a tongue dry and 
 red, on which the papillas were unusually red and developed. By 
 removing the gastric irritation under which he labored, the palpi- 
 tations and oppressed breathing disappeared; and although the 
 state of the heart remained the same, as far as the physical signs 
 of disease it exhibited were concerned, still all irregular action 
 subsided, and the patient felt himself perfectly well. 
 
 When any impediment is offered to the free passage of blood 
 through the heart, either from frequent irregularities in the action 
 of this organ without any apparent disease, or from disease either 
 of the acute or chronic kind, the mucous membrane of the stomach 
 becomes the seat of certain morbid changes, which are dependent 
 upon the mechanical obstacle to the circulation, presented by the 
 disease of the heart. These may consist in mere redness, the re- 
 sult of congestion, or pure inflammatory affections, in which there 
 are marked changes in the colour and consistence of the gastric 
 mucous membrane 1 . 
 
 1 The same views are supported by Andral and Broussais. " From the 
 mere stagnation of blood in the mucous membrane of the stomach, which 
 is merely mechanical, there results not only a red colouring of their tissue, 
 appreciable after death, but, consecutively to this accumulation, there are 
 also seen to arise real alterations of texture and remarkable symptoms. 
 * * * Rut from the circumstance of the intestinal redness in aneuris- 
 matic patients being most frequently the mere mechanical results of em- 
 barrassment in the venous circulation, it would be a serious error to con- 
 clude that, every time this redness is observed, it recognises a similar 
 cause. Often enough it seems to depend on a real inflammatory process, 
 to which, in some cases, the venous congestion probably predisposes." 
 Clinique Medicale, by Spillan, p. 253, 254. " This redness is not the same in 
 the two cases of mere passive congestion and inflammation. If the patient 
 has died free from inflammation in the organs of digestion, the redness is 
 uniform, and accompanied by a fulness of the veins, resembling an injected 
 state o tL"m. If, on the contrary, a true inflammation has succeeded to the 
 congf iij:-, which commonly happens when a due regard has not been paid 
 to the sensibilities of the stomach and the state of the tongue, and strong 
 diuretics have been exhibited, the redness is not uniform; but irregular, 
 
128 PARKER ON THE STOMACH. 
 
 The congestion or stagnation of blood alone, in the veins and 
 membranes of the stomach, is sufficient, without any other cause, 
 to disturb its functions, to render the process of digestion laborious. 
 and to produce sympathetic affections in other organs of the body; 
 but the disturbance of the digestive process, and the sympathetic 
 affections which accompany it, are commonly more severe when 
 other changes, resulting from inflammation, have been produced. 
 It is most probable that the first morbid condition, produced in the 
 coats of the stomach by diseases of the heart, is an accumulation of 
 blood in its veins and mucous membrane, the result of a mechani- 
 cal obstacle to the passage of this fluid through the heart ; the con- 
 stant presence of food and stimulating medicines, upon a mem- 
 brane already irritated, convert what was at first a mere congestion 
 into inflammation. The effects of elaterium, upon the subject of 
 the seventh case, strikingly corroborate this view. In that case, 
 when the vessels and coats of the stomach were unloaded by 
 leeches applied to the epigastrium, before the administration of the 
 elaterium, this remedy did not distress the stomach, but produced 
 the happiest effects in relieving the dropsy. If the remedy were 
 given, without previously leeching the stomach, it irritated this 
 organ, produced vomiting, and added to the patient's distress, 
 instead of relieving her. 1 
 
 Andral has remarked the frequent inutility and hurtfulness of 
 digitalis, in diseases of the heart, that it frequently excites arterial 
 action arid produces sickness, instead of controlling and depressing 
 the pulse. This arises from its being exhibited upon a mem- 
 brane, already irritated by congestion or inflammation. 
 
 CHAPTER XL 
 
 ON THE INFLUENCE OF MORBID STATES OF THE STOMACH, 
 UPON THE ORIGIN, PROGRESS, AND TERMINATION OF DIS- 
 EASES OF THE LUNGS. 
 
 PARTICULAR CASES. 
 
 CASE 1. Incessant cough, depending on inflammation of the stomach, cured 
 with the latter affection. 
 
 A healthy little boy, aged seven, was seized with shivering and 
 the ordinary symptoms of fever, during the first few days of which 
 
 vivid, deep-coloured, pointed, arborescent, dispersed over the surface of the 
 mucous membrane, and combined with other lesions, proper to inflamma- 
 tion, as induration, softening, or ulceration." Broussais, Cours de Patholo- 
 gic et Therapeutique generales, Je9on 67, t. Hi., p. 135, 136. Paris, 1834. 
 
 '"The unseasonable exhibition of different stimulating medicines, given 
 for the purpose of exciting perspiration, urine, or stools." Andral. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 129 
 
 no particular symptoms or complications were remarked. At the 
 end of this period a short dry cough made its appearance, which 
 increased to such an extent, that the young patient was never ten 
 minutes free, night or day, from its constant irritation, for many 
 days. It was in its character short and dry, unaccompanied by 
 expectoration. Dunns: its progress he was reduced to an extreme 
 degree of emaciation. The most careful and repeated examination 
 of the chest detected no lesion in the lungs, their investing or lining 
 membranes. Once or twice in the day there was slight sickness ; 
 the tongue was intensely red, its papillse shining, elevated, and 
 much developed ; the bowels alternately confined and relaxed ; the 
 stools green as grass and scanty. The skin was hot and dry. the 
 pulse one hundred and thirty : some slight uneasiness was experi- 
 enced in the epigastric region, when examined by pressure, and the 
 patient referred us to this point as the seat of his pain. On reflect- 
 ing upon this case, I was disposed to consider the affection of the 
 chest as a purely functional disease, depending upon an acute form 
 of inflammation of the mucous membrane of the stomach, and pro- 
 bably of the duodenum. Eight leeches were applied over the epi- 
 gastrium, and the patient took four grains of the hyd. c. creta every 
 six hours, and in the intervals a drop of hydrocyanic acid in some 
 almond emulsion. The plan was pursued for two days without 
 much benefit, the patient still complaining of the stomach, the sick- 
 ness and green stools continuing. Convinced that I was accurate 
 in my diagnosis, the plan was still continued; leeches were applied 
 daily in smaller quantities, and the same medicines were persevered 
 in. At the end of the fifth day the patient was perfectly convales- 
 cent, although the disease had continued three weeks, and the child 
 was reduced to an extreme degree of marasmus. 
 
 Remarks. This is an example of a functional affection of the 
 lungs, under the form of cough, produced and kept up by gastric 
 inflammation. The features of the affection of the lungs, however, 
 were so prominent, that the stomach disease was, in some measure, 
 masked by it. The cough was incessant, and allowed the sufferer 
 no rest ; he was actually exhausted by its constant irritation, yet 
 no physical sign of disease of the lung could be detected. Here 
 we experience the value of auscultation, for, doubtless, had the 
 remedies been directed to the relief of the pulmonary affection, the 
 patient would have been lost. If we take into review the group of 
 other symptoms, we shall find that they point to the digestive organs 
 as the seat of disease. The state of the tongue, the sickness, the 
 alternate constipation and diarrhoea, the character of the evacuations 
 when passed, with the epigastric pain and tenderness, leave us no 
 doubt as to the seat of complaint ; the absence, also, of physical 
 signs of disease in the lung, lead us to look upon that affection as 
 purely sympathetic. The success of the plan of treatment adopted 
 confirms the diagnosis ; we have the satisfaction to observe the 
 patient recover under its persevering use. 
 
 12 a park 9 
 
130 PARKER ON THE STOMACH. 
 
 Case 2. Cough dependent upon chronic Inflammation of the Stomach. 
 Cure with the Stomach Disease. 1 
 
 A young man, twenty-six years of age, had been troubled for 
 four months with a dry, irritating cough, which had been in vain 
 treated by the usual pectoral remedies: these had, in fact, rather 
 increased, than mitigated, the disease. Suddenly he was seized 
 with general fever, accompanied by lassitude, headach, nausea, 
 and vomiting; at the same time the cough became much more 
 frequent and distressing. The respiration was only slightly acce- 
 lerated in the intervals of the fits of coughing ; but whenever the 
 cough came on, even if the fit was slight, the respiration became 
 hurried and irregular. The cough, also, produced pain in the 
 region of the stomach, which the patient was obliged to press with 
 his hands, during the paroxysms, to give himself ease. Slight 
 pressure upon the epigastric region brought, on the cough, and pro- 
 duced considerable pain: a deep inspiration had the same effect. 
 The chest was sonorous in all parts ; the patient could lie in any 
 position without producing any influence upon the cough, even 
 since the fever had become violent, and the former so much in- 
 creased in intensity. Such were the symptoms observed in the 
 chest. On examining the state of the digestive organs and their 
 dependencies, we found the epigastrium hot, tender, and painful on 
 pressure; the tongue vividly red at its point and edges, its upper 
 surface covered with a whitish pellicle; the throat and fauces were 
 hot. Food of any kind when taken, even before the commence- 
 ment of the fever, produced pain in the stomach and a paroxysm 
 of coughing. The bowels had been constipated for some time; 
 he had profuse perspiration occasionally, which, instead of procur- 
 ing relief, accelerated the progress of emaciation ; the mental con- 
 stitution of the patient became much depressed, and the counte- 
 nance hollow and anxious. 
 
 The aggregate of these symptoms resemble, very much, an 
 organic affection of the lungs ; but the absence of physical signs of 
 disease in these organs, with the positive indications afforded of 
 the inflamed condition of the stomach, pointed to this as the primi- 
 tive and chief seat of disease. 
 
 Two relays of leeches, of fifteen at each application, were 
 applied over the region of the stomach, domestic enemas were 
 employed, and the patient was limited to a strict dietetic regimen. 
 On the twentieth day of treatment he ate with impunity of a mixed 
 diet; not the least symptom of any pectoral affection remained. 
 
 Remarks. On examining this case carefully, we shall find that 
 here, as in the last instance, there exist a class of symptoms indi- 
 cating pulmonary irritation, combined with a second class referable 
 to the condition of the stomach. For four months, we have a dry 
 
 1 J. B. de Lairoque, De quelques Maladies Abdominales, qui simulent 
 Maladies de Poitrine, 2me. Qhs. p. 12. 
 
INFLUENCE OP ITS MORBID STATES ON THE LUNGS. 131 
 
 cough in existence, which is invariably produced by eating; at the 
 same time, the food occasions pain and uneasiness in the stomach. 
 Suddenly the symptoms become acute ; we have fever, vomiting, 
 pain in the stomach, epigastric tenderness, a red tongue, approach- 
 ing to an aphthous condition ; whilst, accompanying this condition 
 of irritation in the digestive organs, the cough becomes more active 
 and tearing. Pectoral remedies in the first instance, before the 
 onset of fever, do not allay the cough, they increase it doubtless by 
 adding to the irritation already existing in the stomach. The 
 absence of physical signs of disease in the lung are here, again, 
 worthy of notice. The patient could lie in any position without 
 increasing the cough, and the chest was every where resonant. 
 The treatment, when the affection has become acute, is applied to 
 the relief of the inflammatory affection of the stomach, and as this 
 subsides we observe the symptoms of pulmonary irritation become 
 less, and at length altogether disappear. The origin, progress, and 
 termination, of disease in the chest, as well as the result of treat- 
 ment prove beyond question that the chest affection was called into 
 existence by the inflamed condition of the stomach, upon which it 
 was strictly dependent. 
 
 The nature of the affection of the chest demands our attention : 
 mere irritation of the lungs, under the form of cough, without ex- 
 pectoration. No symptom of any inflammatory affection, as bron- 
 chitis, pneumonia, or pleurisy. We shall observe, however, in 
 pursuing our investigations, that these forms of pulmonary irrita- 
 tion, if continued, soon degenerate into one of the forms of inflam- 
 mation I have alluded to, and are, in some instances, followed by 
 phthisis, of which Andral, De Larroque, and myself, have reported 
 examples. 
 
 Those forms of gastritis, which are accompanied by cough, 
 become complicated the more easily with pleurisy or pneumonia, 
 as the chest of the subjects is more irritable, and the paroxysms of 
 cough more violent and frequent. 1 
 
 CASE 3. Long-continued chronic gastritis, with cough. Subsequently 
 expectoration of a quantity of muco-purulent matter, to the extent of 
 three half-pints daily. Cure 
 
 A gentleman, aged forty-five, indulging freely in the pleasures of 
 the table, -had been subject to indigestion of the inflammatory kind 
 for twenty-live years, during the whole of which time he had 
 almost daily vomited some portion of his food; in fact, this was 
 the symptom 1 for which he first consulted me. At the time of my 
 first attendance upon him he presented the following state: 
 Sallow countenance, smooth red tongue, nausea, succeeding to 
 
 1 De Larroque, Op. cit. See, also, the opinions of Dr. Stokes on this point 
 Cyclopaedia of Practical Medicine, art. Gastritis; Lectures in the Medical 
 and Surgical Journal, &c. 
 
132 PARKER ON THE STOMACH. 
 
 each meal, and terminated by vomiting ; tenderness in the epigas- 
 tric region, which was hard and resisting. The pulse exceeded a 
 hundred, and there was a short, dry cough, without any expectora- 
 tion. The patient, during the last few months, had become much 
 emaciated. The respirations were generally free, but occasionally 
 hurried and irregular. In all points the chest was perfectly reso- 
 nant, the most careful and repeated examination by the stethoscope 
 detected no disease. The symptoms continued much in this state 
 for many weeks ; sometimes the derangements connected with the 
 stomach were relieved, at other times they were worse. The fits 
 of coughing now terminated by the expectoration of a little slimy 
 mucous ; this went on increasing till upwards of a pint and a half 
 of muco-purulent fluid was spat up in the course of a day and 
 night. With this there was occasional vomiting; but. since the 
 establishment of the free expectoration, the symptoms connected 
 with the stomach had been decidedly ameliorated. After the con- 
 tinuance of the catarrh for many weeks, there did not appear to 
 remain any stomach affection. Small doses of the dilute nitric 
 acid were administered, and a combination of hyoscyamus and 
 ipecacuanha given.' Under this plan the patient gradually reco- 
 vered from the affection of the chest, and with it disappeared all 
 complaint in the stomach, from which this gentleman had never 
 been free a day for twenty-five years. 
 
 Remarks. In this case, several particulars are worthy of notice. 
 All the symptoms, with which this patient had been troubled, 
 through a long period, were evidently dependent on a chronic state 
 of inflammation of the mucous coat of the stomach. The symp- 
 toms which denoted this condition of the stomach were unusually 
 rebellious. They were palliated, and relieved sometimes for a 
 week together, but again recurred with their primitive severity. 
 At this period, the catarrh, with expectoration, set in : when the 
 latter was fully established, the disease in the stomach began to 
 subside, and ultimately disappeared. The catarrhal affection ap- 
 pears to have acted as a revulsive upon the disease of the stomach, 
 and thus to have cured it. Occasionally affections of the chest and 
 stomach alternate in this manner; we observe one subsiding as 
 the other is aggravated. Andral, with his usual correct and pene- 
 trating observation, has observed cases of this character in con- 
 sumptive patients, on which he remarks, that one organ acts, by 
 way of revulsion, upon the other. 1 In many instances, however, 
 the increase of disease in the stomach is attended by a correspond- 
 ing aggravation of it in the lungs, as in the two first cases detailed. 
 
 CASE 4. Sub -acute inflammation of the stomach, producing the symptoms 
 of acute catarrh. Cure of the pectoral, by the removal of the stomach 
 disease. 
 
 J. E., thirty-two years of age, ill, for two years, with pain in the 
 epigastrium, sickness, and occasional vomiting. 
 
 1 Clinique Medicale, p. 529. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 133 
 
 June 8, 1834. Constant pain in the stomach, aggravated to a 
 great degree by taking food, which is commonly rejected by vomit- 
 ing^ great tenderness in the epigastrium, the slightest pressure 
 occasions most violent pain, which is confined to a small surface ; 
 the epigastrium hard and tense, feeling as though some resisting 
 body lay under the muscles. There is no uneasiness whatever in 
 any other part of the abdomen. The tongue is coated with a yel- 
 lowish brown fur, red at its point and edges, the papillae enlarged 
 and florid. Countenance anxious and pale ; extremities cold ; 
 pulse small and frequent ; great irregularity of breathing, with 
 constant cough and bloody expectoration ; the stools occasionally 
 streaked with blood. The patient was limited to a strict farinace- 
 ous diet; bottles of hot water applied to the feet; twelve leeches 
 to the epigastrium. The leeches were repeated on the 9th, 10th, 
 1 1th, and 12th, to the same part, in less number, proportionate to 
 the degree of complaint; on the 12th they were succeeded by a 
 blister. On the 20th. the food, which then consisted of thin ani- 
 mal broth, occasioned no pain ; no tenderness in the epigastrium 
 on pressure; the difficulty of breathing had subsided, arid there 
 was neither cough nor expectoration. The patient, during the 
 whole course of his disease, took no other medicine than a few 
 grains of the ponderous carbonate of magnesia with morphia, when 
 the acidity accompanying the vomiting was very intense. 
 
 Remarks. This is another example of inflammatory disease in 
 the mucous membrane of the lungs, succeeding to a similar condi- 
 tion of the mucous membrane of the stomach. In this case, we 
 observe the stomach affection to have been in existence two years 
 before the respiratory organs became affected. Complaint in both 
 organs disappears, from remedies directed solely to the removal of 
 the gastric disease. 
 
 CASE 5. Inflammation of the stomach, simulating inflammation of the 
 mucous membrane of the lungs. Healthy state of the lungs ascer- 
 tained after death. Disease confined to the mucous membrane of the 
 stomach. 1 
 
 A surgeon, aged twenty-four, who had occasionally been subject 
 to severe colds and spitting of blood, became indisposed after break- 
 fasting for a fortnight on bread soaked in wine. On the eighth 
 day of his illness he presented the following symptoms: General 
 fever, loss of appetite, internal heat in the stomach, thirst, pulse 
 full, hard, and irregular; he complained of pain in the chest and 
 a sense of tightness across the epigastric region. He was restless, 
 and continually drawing deep sighs. At the commencement of 
 the complaint, he had spat a little blood ; but, subsequently, he had 
 been unable to cough fully, notwithstanding the irritation which 
 continually prompted him to do so, on account of the excruciating 
 pain which the force of the cough occasioned. 
 
 On the following day, the violence of the cough allowed him no 
 
 1 Broussais, Histoire des Phlegmasies Chroniques, t. ii., p. 448. 
 
134 PARKER ON THE STOMACH. 
 
 rest. He then informed his medical attendant that, on the first 
 days of complaint, the food taken had been rejected by vomiting. 
 Leeches were now applied to the epigastrium ; they had the effect 
 of relieving the pain in the chest and stomach, and almost entirely 
 removing the cough. Some aromatic antispasmodic remedies were 
 administered; they were rejected by vomiting. Some acidulated 
 gummy preparations were retained. During" the remaining days 
 of his existence, the chief circumstances remarked, were vomiting 
 of the stimulating and cordial remedies, or an increase in the rest- 
 lessness, anxiety, and distress of the patient when they were not 
 vomited. Whilst these were rejected, the mucilaginous and acidu- 
 lated medicines remained upon the stomach and appeared to afford 
 relief. He died on the eighteenth day of disease. 
 
 Post-mortem examination.- The lungs and viscera of the 
 chest, perfectly healthy. The stomach contracted to the size of 
 the small intestines ; its consistence hard ; its mucous membrane 
 thickened, of a deep dark red colour, approaching in many places 
 to black. All the intestines were contracted, their mucous sur- 
 faces dry and of a bright red colour. The capillary vessels of the 
 mesentery, also, much injected. 
 
 Remarks. This is the first case detailed in which we have an 
 opportunity of examining the state of the lungs and stomach after 
 death, in diseases of the character of which we are speaking. 
 The dissection shows us the lung and its membranes perfectly 
 healthy, whilst the stomach and intestines bear the evidences of 
 the most acute form of inflammation. Many of the symptoms of 
 gastritis, in this case, were obscure, and masked by the pulmonary 
 affection, which consisted in constant cough with occasional expec- 
 toration of blood. The bloody sputa may be explained by the state 
 of congestion into which the lungs was thrown, consequent upon 
 the violent irritation which produced and accompanied the cough : 
 thus, blood might be exhaled upon the mucous membrane of the 
 bronchiae during the violence of a paroxysm. The effects of reme- 
 dies should here be carefully noted ; the leeches to the epigastrium 
 mitigated the cou^h most materially. The stimulant remedies 
 (juleps aromatises et antispasmodiques) added to the pulmonary 
 irritation, as well as to the generel distress of the patient; mucila- 
 ginous and acidulated drinks were taken with pleasure, and pro- 
 cured relief. When pulmonary irritation arises in the stomach, 
 we may easily conceive of the increase of complaint in the lungs, 
 occasioned by the impression of stimulating medicines upon a 
 membrane rendered, by inflammation, "as sensible as an erysipe- 
 latous skin. 
 
 CASE 6. 1 Catarrhal and pneumonic symptoms during life, dependent upon 
 acute inflammation of the stomach. Healthy condition of the lungs. 
 
 A man, previously healthy, entered the hospital Udine, suffering 
 1 Broussais7 Histoire des Phlegmasies Chroniques, tome ii., p. 459. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 135 
 
 from rheumatism. After remaining there for some time, he was 
 seized with cough and general fever. He at that time presented 
 the following symptoms : Frequent, sharp pulse, hot skin, patched 
 cheeks, loss of appetite, dry coated tongue, with distaste for all kinds 
 of drinks. He had, at the same time, constant fits of coughing, 
 with copious expectoration and hurried breathing; no fixed pain 
 existed in any point of the chest, but the patient indicated the right 
 side, under the sternal ribs, as the point of deep-seated pain. He 
 was supposed, by his medical attendants, to be suffering from acute 
 bronchitis, and treated, accordingly, with leeches and blisters to the 
 chest, to which were added some expectorant remedies. The pa- 
 tient died on the tenth day of the disease. 
 
 Post-mortem examination. The lungs were free from disease, 
 merely presenting a slight degree of congestion. The stomach was 
 contracted, as in the Ias4 case, to the size of the small intestine ; 
 its mucous coat was thickened, and of a deep-red colour, deepening 
 to violet towards the pyloric portion of the organ. The small in- 
 testines were contracted also, arid red ; the large intestines presented 
 similar appearances. 
 
 Remarks. The detail of symptoms during life are so loosely 
 given by Broussais, in his account of this case, that without the 
 account of the impression upon his own mind, that the patient was 
 labouring under a bronchitis, approaching to a condition of general 
 inflammation of the lung, we should be at a loss to determine on 
 the nature of the disease. The dissection, however, clears all 
 doubtful points. We find, on examination, the lungs healthy, ex- 
 cepting a slight degree of congestion; whilst the stomach and 
 intestines exhibit marks of most intense inflammatory action. 
 Here, as in the last case, the nature of the disease was miscon- 
 ceived; both were supposed to exist in the chest, but dissection 
 shows that they were seated in the stomach and intestines. 
 
 Case 7. 1 Catarrhal symptoms, dependent on acute inflammation of the 
 
 stomach. 
 
 .A stout man, aged twenty-seven, entered the hospital Udine with 
 cough and symptoms of indigestion. On the sixth day of dis- 
 ease he presented the following symptoms: Considerable dyspnoea, 
 patched and flushed cheeks, great heat of skin, a full, frequent, and 
 hard pulse, constant fits of coughing, which followed each inspira- 
 tion; the cough caused severe pain, and was accompanied by a 
 frothy expectoration, tinged with blood. The patient complained 
 of no fixed uneasiness, although the whole surface of the fore part 
 of the chest was painful. The anxiety and distress were extreme; 
 there existed a disgust for all kinds of fluids, whilst the mouth was 
 very foul. The patient was bled in the arm twice, and two blisters 
 were applied to the chest. On the eighth day of disease the 
 anxiety, agitation, and the convulsive cough, continued; the little 
 
 Broussais, Des Phlegmasies Chroniques, tome ii., p. 466, Case 3. 
 
136 PARKER ON THE STOMACH. 
 
 expectoration which existed at the commencement of disease had 
 now ceased, and the cough was perfectly dry. To these symptoms 
 were now added diarrhoea and tenesmus. 
 
 The patient sunk into a state of stupor on the sixteenth day of 
 disease, the looseness of the bowels, and the general distress and 
 agitation, continuing. 
 
 Post-mortem examination. The lungs were adherent, but the 
 adhesions were of old standing. Their substance was healthy, but 
 congested. The stomach, in all parts, inflamed, of a deep violet 
 colour, approaching to blackness towards the cardiac portion. 
 Spots, resembling ecchyrnoses in the greater curvature, with thin- 
 ning of its coats in this situation. Redness, at intervals, of the 
 mucous membrane of the intestines. 
 
 Remarks. In these three cases, which are detailed at great 
 length by Broussais, he confesses himself ignorant as to the true 
 nature of the disease, till the autopsy revealed it to him. He had a 
 suspicion of the nature of the last case, and, acting upon this, 
 abstained from the use of stimulating expectorant remedies, which 
 had aggravated the condition of the two first patients. These cases, 
 in a practical point of view, are highly important: we observe in 
 them the general characters of gastritis wanting, the more prominent 
 symptoms being observed in derangements of the organs of respira- 
 tion. In the first case only, have we vomiting present ; in the last, 
 some diarrhoea. The pains were chiefly felt in the chest : in the 
 second case, they existed in the right hypochondriac region. I 
 refer the reader to the first part of this work, for details upon the 
 uncertainty of the symptoms of gastritis ; remarking here, that, the 
 pains which are symptomatic of this disease, are very commonly 
 felt on some part of the surface of the chest. Broussais lays great 
 stress upon the extreme anxiety, and restlessness of these patients, as 
 features of gastric, rather than of pulmonary disease. No account 
 is given of the condition of the bronchial mucous membrane in these 
 cases ; but we must not omit his remarks upon this omission : " I 
 am now convinced," says he, " that redness existed in the bronchial 
 mucous membrane of these three patients, but it was not verified. 
 The cough, although sympathetic, could not fail to produce conges- 
 tion of these membranes, when frequently repeated. In this manner 
 phthisis is produced by diseases of the stomach." 1 In this way, 
 also, the bloody expectoration may be explained, as we shall see 
 subsequently, in the details of some cases of incipient phthisis. 
 
 Having noticed the influence of inflammatory diseases of the 
 stomach upon the lining membrane of the lungs, we proceed to 
 notice some facts connected with their influence in the production 
 of diseases resembling pleurisy. 
 
 1 Op. cit., t. ii., p. 469. Note. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 137 
 
 CASE 8. Inflammation of the stomach accompanied by cough, assuming 
 subsequently the rational symptoms of pleurisy. 1 
 
 A young man, aged 25, contracted a venereal affection, for which 
 he was ordered to take the solution of the oxymuriate of mercury, 
 commonly known by the name of " Yari Swieten's Liquor." Per- 
 ceiving no amelioration in his symptoms after a fortnight's use of 
 the medicine, he increased the dose till he had taken, in the course 
 of one day, three large spoonfuls of the solution. This produced 
 violent pains in the stomach, incessant vomiting, giddiness, and 
 general uneasiness ; he abandoned the use of his remedy, and drank 
 freely of diluents, the vomiting ceased, but the pain in the stomach 
 continued. On the next day, an acute pain under the left breast 
 came on, which appeared to be connected with that already existing 
 in the stomach. This pain was accompanied by frequent and dry- 
 cough, a red tongue, and distressing thirst. The pulse frequent 
 and hard ; the surface of the body cold. The pain in the side was 
 increased whenever the gastric symptoms were aggravated ; pres- 
 sure on the epigastrium, by adding to the uneasiness in this region, 
 likewise added to that in the side. 
 
 Leeches were applied over the epigastrium, and the patient was 
 placed in a warm bath. On the next day all the symptoms had 
 disappeared. 
 
 It is evident that, in this case, the patient was suffering from acute 
 gastritis, the result of an over-dose of the oxymuriate of mercury ; 
 the pain in the side, resembling pleurisy, being purely sympathetic. 
 In the next case, we shall observe this kind of pain occurring after 
 long-continued gastric irritation, and accompanied by irregular 
 action of the heart, so that the disease resembled, in some measure, 
 pericarditis, or a complication of pleurisy with some affection of the 
 heart. 
 
 CASE 9. Long-continued gastric irritation, becoming acute, accompanied by 
 pains resembling pleurisy, and by irregularity in the action of the heart. 
 
 A gentleman had, for some time, suffered from nausea, loss of 
 appetite, flatulence, and almost daily vomiting of food. He had, at 
 the same time, cough, difficulty of breathing, and a sense of oppres- 
 sion seated over the centre of the sternum. There was considerable 
 tenderness in the epigastrium, increased to acute pain by slight 
 pressure. The stools were very dark. The action of the heart was 
 also laboured and irregular, the pulse intermitting every five or six 
 beats. Suddenly, these symptoms, which had been varying in their 
 degree of intensity for three or four months, became acute ; the 
 oppression over the sternum increased, and was accompanied by 
 sudden and acute pain in the right side, over the heart, the action 
 
 1 De Larroque, Op. cit., c. i., case 5. 
 
138 PARKER ON THE STOMACH. 
 
 of which organ was much more embarrassed. With this, the ten- 
 derness and pain in the region of the stomach also increased in 
 violence. The most careful examination of the lungs and heart, by 
 auscultation, detected no disease : all the organs of the chest appeared 
 healthy. The long continued symptoms of inflammatory indiges- 
 tion, led me to conclude that the pain in the side and chest, with the 
 condition in the heart's action, were dependent upon acute inflam- 
 mation of the mucous coat of the stomach, suddenly supervening 
 upon a chronic state of disease. The epigastrium was freely 
 leeched, the hydrocyanic acid was given, at the same time, inter- 
 nally, with a combination of the carbonate of magnesia and Dover's 
 powder. The oppression, the acute pain, the cough, and irregular 
 and laboured action of the heart, ceased as the epigastric tenderness 
 and pain were removed. After all the acute symptoms had subsided 
 there remained occasionally a little irregularity in the heart's action ; 
 this ceased from the administration of a few minims of the tincture 
 of ammoniated iron, twice or three times in the day. 
 
 Remarks. We observe, in this case, symptoms of chronic gas- 
 tritis existing for several months, accompanied by cough, and irre- 
 gular action of the heart. Suddenly, constricting pain in the chest 
 comes on, 1 with oppression over the centre of the sternum, and with 
 this, acute pain in the side, laboured action of the heart, and inter- 
 mittent pulse. The stethoscope indicates no disease, either in the 
 heart or lungs. The symptoms all disappear from a treatment 
 framed for the removal of the stomach disease. 
 
 It is certain that Andral supposed in the following passage, that 
 inflammation of the lungs might succeed to, and be dependent upon, 
 inflammatory disease of the stomach. " In the acute state, in the 
 diseases called continued fevers, the inflammation, congestion, or 
 irritation, which exists in the gastro-intestinal mucous membrane, 
 usually extends to the air-passages, whether, limiting itself to the 
 great bronchial ramifications, it constitutes a simple catarrh, or, 
 attacking the pulmonary vesicles, it is changed into a pneumo- 
 nia. In the chronic state we may, again, observe the same simul- 
 taneous existence of disease." 2 Stoll has recognised the same 
 morbid conditions of both organs under the title of " bilious pneu- 
 monia." 
 
 CASE 10. Inflammation of the lungs complicated with and apparently suc- 
 ceeding to, that of the stomach Cure of the pulmonary by the chief 
 attention to the stomach disease. 
 
 J. G., an athletic man, states that he had been ill a fortnight at 
 
 1 This constricting pain in the chest, with oppression over the centre of 
 the sternum, is one of the most frequent incipient symptoms of gastritis, as 
 well as of some forms of pneumonia. When the physical symptoms of dis- 
 ease of the lung are absent, these pains are generally symptomatic ot some 
 inflammatory affection of the stomach. 
 
 Op. cit., by Spillan, p. 513. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 139 
 
 the time of his first application for medical assistance. He then 
 complained of acute pain in the epigastrium, with a sense of con- 
 striction ; the pain was aggravated to a great degree by slight 
 pressure. Food, and drink of all kinds, added to his distress, and 
 were constantly rejected by vomiting. There was no pain or 
 uneasiness in any other part of the abdomen. The countenance 
 was anxious, the tongue red at its point and edges, and the pulse 
 small, frequent, and fluttering. There was considerable difficulty 
 of breathing on slight exertion. 
 
 On carefully examining the chest by auscultation, there was a 
 strong " rale crepitant" occupying the whole of the superior lobe 
 of the left lung, most distinctly marked, both in the infra-clavicular, 
 the axillary, and scapular regions. I disregarded the pain in the 
 epigastrium and the constant sickness, and ordered the patient to be 
 freely bled from the arm. The blood presented the usual charac- 
 teristics : the clot was firmly contracted, and covered with a layer 
 of lymph half an inch thick. On the succeeding day the patient's 
 state was not at all amended; the " rale" continued as intense, and 
 the symptoms of gastric derangement were, if possible more urgent. 
 Leeches were now applied to the epigastrium, and the patient took 
 the smallest quantities of cold gruel. On the following day he was 
 much relieved; the difficulty of breathing and "rale crepitarit," 
 were much less, and had abated in direct proportion to the mitiga- 
 tion of the stomach disease. The local depletion was continued 
 for a few days, and the patient continued the plan of abstinence, 
 except from thin, cold gruel. On the tenth day of disease there 
 was no sickness or epigastric tenderness ; he could take food with- 
 out pain or distension : no difficulty of breathing, and no trace of 
 any morbid "rale" in the lung. I believe I am correct in stating 
 that this patient took no medicines during the continuance of his 
 disease. 
 
 Remarks. Whether the gastritis or the pneumonia were, in 
 this instance, the primary affection, I cannot pretend to say, and it 
 is of little moment ; it is plain there was inflammation of the two 
 organs in an acute form. It is to be remarked, that the bleeding on 
 the first day of the patient's application did not, apparently, benefit 
 the inflammation of the lungyatid certainly did not at all relieve 
 the symptoms of gastritis. The first application of leeches to the 
 epigastrium benefited both ; and this was the sole remedy that was 
 afterwards employed. I should be inclined to believe, from the 
 effects of the remedies employed, that the pneumonia was subse- 
 quent to, and dependent upon, the gastritis ; though, if the disease 
 had been permitted to go on unchecked, it would riot have been 
 relieved, as it evidently was, by leeching the epigastrium alone. 
 However this may be, the case shows that, in certain states, there 
 exist sympathies between the lungs and the stomach, which render 
 disease in one a cause of disease in the other. I think, on careful 
 examination of the results of the treatment, there can be little 
 doubt of the pneumonia having succeeded to the gastritis, which 
 
140 PARKER ON THE STOMACH. 
 
 became its exciting cause. The similarity of the next case renders 
 this almost a matter of certainty. 
 
 CASE 11. Pneumonia, with symptoms of gastritis. 
 
 J. H ., an athletic labourer, about forty years of age, 
 
 became unwell on the 29th of December, with pain in the stomach 
 and vomiting of food. At the time of his application he had 
 constant sickness ; the stomach rejected every thing that was 
 taken; acute pain in the epigastrium, increased to agony by pres- 
 sure. The breathing was hurried, accompanied by constant cough, 
 and expectoration of frothy, brown-coloured mucus ; the pulse 
 small, frequent, and unsteady. On examining the chest by per- 
 cussion and auscultation, it was observed that there existed a 
 slight dulness over the middle lobe of the right lung. The respira- 
 tion here was only distinct in places, and where it was evident, 
 accompanied by a strong "rale crepitant." In the whole of the 
 superior lobe of the same lung the "rale" was strongly marked. 
 On the 30th his state was worse. The tenderness in the epigas- 
 trium was very great, although the sickness had, in some measure, 
 abated. The right side of the chest duller on percussion than 
 yesterday; the "rale crepitant" was strongly marked in places, but 
 in many points the respiration was absent. Leeches were applied 
 over the chest yesterday, and to-day the patient was bled from 
 the arm. 
 
 December 31st. The respiration more distinct in the upper 
 and lower portion of the lung. The "rale" accompanying it in 
 these points approaching more the character of the "rale mu- 
 queux." In the centre of the lung there is still absence of respira- 
 tion in points, with a "rale crepitant" where the respiration is per- 
 ceptible. Still excessive tenderness in the epigastrium, with occa- 
 sional vomiting. Twelve leeches to the region. 
 
 January 1st. The cough and difficulty of breathing much 
 relieved. Pulse steadier and fuller, at seventy. The patient states 
 that the relief afforded by the last leeches was greater than all the 
 previous treatment. 
 
 On the 4th the epigastric tenderness and vomiting had disap- 
 peared; there was no hurried breathing, the pulse was steady and 
 soft, there was little cough, the respiration was distinct in the supe- 
 rior lobe of the lung, absent in places in the middle and inferior, 
 accompanied, where present, with a strong "rale muqueux." In 
 certain places the respiration was distinct and natural without this 
 complication. 
 
 Remarks. This case affords another example of the compli- 
 cation of gastritis and pneumonia similar to the last, although the 
 diseases, in this instance, appear in both to have been of a more 
 acute character. We find the symptoms of pneumonia and gas- 
 tritis both strongly marked, in this patient's case, on the first appli- 
 cation for relief, on December 29th. On that day, and on the 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 141 
 
 30th, local depletion from the surface of the chest and general 
 bleeding were resorted to, certainly with some effect upon the 
 inflammation of the lung, but without much influence upon the 
 cough and hurried breathing. On the 31st the epigastrium was 
 covered with leeches, and at this period, although the disease was 
 mitigated, which is evident from the physical signs afforded by the 
 stethoscope, the sense of oppression and constriction which the 
 patient experienced, with the hurried breathing and cough, did not 
 abate till the application of leeches to the stomach. The patient 
 stated that to himself he appeared no better till the application of 
 leeches to this part, after which he expressed himself greatly bene- 
 fited. I do not pretend to offer any opinion on the primary seat of 
 disease in this case ; whether one organ became diseased consecu- 
 tively, and in consequence of morbid action in the other, or 
 whether the affections were merely coincident. This is difficult to 
 decide ; but the effects of the treatment prove that the most mark- 
 ed benefit resulted to the disease in the lung from the remedies 
 applied to the stomach, whilst the reverse does not appear to have 
 been the case. 
 
 CASE 12. Pleuro-pneumonia co-existing with acute inflammation of the 
 intestines. Injurious effects of the tartar-emetic. 1 
 
 A young man, aged twenty, of delicate constitution, was admit- 
 ted into the Hotel Dieu on November 29th, suffering from pain 
 on the left side of the chest, cough, difficulty of breathing, fever, 
 and bloody expectoration. On the 30th he was bled in the arm. 
 On December 2d the dyspnoaa, the fever, and the pain in the side 
 continued, as well as the bloody expectoration. The pulsations 
 were one hundred ; the respirations thirty-six in a minute. The 
 signs furnished by auscultation and percussion were almost insig- 
 nificant. The chest was a little duller on the left side than on the 
 right. The ear detected neither crepitation, "souffle bronchique," 
 or bronchophony. Twenty leeches were applied to the painful 
 point on the side. On the 3d no amendment: the pulse and 
 respiration were as frequent as on the 2d ; the expectoration was 
 not now bloody. In the axilla of the left side a slight "rale crepi- 
 tant" was perceptible. The patient was again bled in the arm. 
 
 On the succeeding days of disease the difficulty of breathing 
 became still greater, and the pulse kept up in frequency. The 
 stethoscope furnished nothing more decisive than on the previous 
 days of examination. The tartar-emetic was now ordered to be 
 given in large doses, notwithstanding pain which existed in the 
 abdomen^ and a relaxed state of the bowels. The difficulty of 
 breathing continued to increase, and the patient died on the 9th. 
 
 Post-mortem examination. The superior lobe of the left lung- 
 was hepatised throughout, as well as a portion of the inferior lobe. 
 
 *La Lancette Fran9aise, p. 10, "Clinique de M. Chomel, Hotel Dieu." 
 
142 PARKER ON THE STOMACH. 
 
 The tissue of the lung was hard and resisting, and did not present 
 the least signs of softening. The pleura contained five or six 
 ounces of sero-purulent fluid, and its surface was covered with a 
 coating of lymph, recently effused. A few tubercles were found 
 in the apices of each lung. The intestinal mucous membrane 
 presented traces of acute inflammation. 
 
 Remarks. I have shown, in the two former cases, that where 
 pneumonic symptoms co-exist with inflammatory affections of the 
 stomach and bowels, the effects of general bleeding, as well as 
 local bleeding from the surface of the chest, are not attended with 
 the usual well-marked beneficial results. In these cases no evi- 
 dent impression was made upon the difficulty of breathing, till the 
 epigastrium was leeched. In this case of Chomel's the same effects 
 are observed ; the fatal issue of the disease was. doubtless, hasten- 
 ed by the exhibition of the tartar-emetic. This remedy is contra- 
 indicated in all cases where any gastric or gastro-intestinal irrita- 
 tion co-exists with inflammation of the lungs. "It ought also," 
 says the editor of this case, "to be proscribed in pneumonia where 
 there is reason to suspect the existence of tubercles ; since, in a 
 great majority of instances of this nature, a complication of 
 disease, in some form, is generally found in the digestive mucous 
 surfaces. 
 
 CASE 13. A gentleman, aged forty, first became indisposed, 
 some years before the present date (September 20th, 1835), with 
 the following symptoms: Pain and distension after eating, with 
 nausea, and daily vomiting of food. These symptoms had con- 
 tinued, in a greater or less degree, for some months, when dry 
 cough came on. On questioning this patient closely on the his- 
 tory of his disease, he informed me that he had been perfectly 
 healthy till, about two or three years ago, his stomach began to 
 swell after he had eaten his food, which was generally vomited. 
 After the cough had continued for some time, it was followed by 
 expectoration of frothy mucus. I had attended this gentleman at 
 intervals for a long period; he had found most relief from a com- 
 bination of the ponderous carbonate of magnesia with Dover's 
 powder, and the occasional application of a small number of leeches 
 to the epigastrium. On the last attendance, which terminated in 
 his death, he presented the following state: Earthy and sallow 
 complexion ; tongue vividly red, no coating, except a little towards 
 the base; constant vomiting of every thing taken, whether solid 
 or fluid, in an intensely acid state; the breathing was laboured and 
 difficult, accompanied by constant cough and hoarseness ; the epi- 
 gastrium was painful, constricted, and exceedingly sensible to 
 pressure. Six leeches were ordered to the epigastrium, and a 
 twelfth of a grain of morphia administered every four hours, with 
 ten of the carbonate of soda. 
 
 22d. Infinitely better. Can lie down in bed, which he has 
 not done for a week; less cough; less difficulty of breathing; 
 sickness gone. Slight epigastric tenderness still remaining, with 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 143 
 
 considerable fulness after food. Repeat the leeches. To take a 
 combination of the ponderous carbonate of magnesia and the com- 
 pound powder of ipecacuanha. 
 
 On the 28th, the symptoms became much worse. Constant 
 cough, with occasional sickness, an intensely red tongue, with 
 feeble, fluttering, unsteady pulse. During the remaining fourteen 
 days of life, the stomach did not retain any solid food, "and fluids 
 were mostly rejected. For the last four days, the pain, sickness, 
 and oppression, were so great on taking even fluids, that the patient 
 merely wet his lips to ease the thirst, but dared not swallow them. 
 He died on October 10th. 
 
 Post-mortem examination, twenty-two hours after death. The 
 lungs were filled with tubercles in all stages; the back part of the 
 superior lobe of each lung contained several small caverns. Small 
 drops of pus exuded from the cut bronchial ramifications, when the 
 lung was compressed. Pericardium every where adherent to the 
 heart. Liver pale and greatly hypertrophied, adherent to the spleen, 
 its tissue breaking down every where under the slightest pressure 
 of the finger. The stomach contracted to the size of the small 
 intestines, quite empty, covered with a black viscid secretion ; its 
 coats thickened and hard, its mucous surface covered with dark- 
 coloured patches, redness of the pyloric portion. 
 
 Remarks. In this case, the patient was a perfectly healthy man 
 till the occurrence of the first attack of inflammatory indigestion. 
 We perceive this disease to have continued, and at length to have 
 assumed the character of confirmed chronic gastritis. After the 
 symptoms of stomach disease had lasted for some months, we 
 observe dry cough added to the symptoms, and, subsequently, 
 muco-purulent expectoration. In the advanced stages of disease, 
 the chief complaint made by the patient was of his stomach, of the 
 agonising pain which he endured till the food he had eaten was 
 vomited, and the distress it produced in adding to the sense of 
 oppression. The difficulty of breathing and the cough, with the 
 beneficial effect produced on the organs of respiration by the local 
 depletions from the epigastrium, and from the remedies employed 
 to mitigate the stomach disease, leave little room to doubt that the 
 disease of the lungs was produced by the prolonged and severe 
 irritation existing in the stomach. I consider this a well-marked 
 case of what has been termed dyspeptic phthisis. Louis, in his 
 work On Pulmonary Consumption, has recorded two similar 
 instances of disease in the lung succeeding to. and evidently pro- 
 duced by, prolonged gastric irritation. Andral's Clinique contains 
 another well-marked case of this nature. 
 
 "A young girl had retained, after a profuse spitting of blood, a 
 dry cough, and some oppression. She gradually lost flesh ; she 
 had no fever, had still some appetite, and attended to her usual 
 occupations. There was reason for dreading, in her case, the 
 existence of pulmonary tubercles, but nothing afforded any cer- 
 tainty of them. One day the patient felt a pain in the stomach ; 
 
144 PARKER ON THE STOMACH. 
 
 she was attacked with vomiting, the tongue became red, fever was 
 lighted up. The second day of the attack of the inflammation of 
 the stomach the cough became more intense, and the patient, very 
 much oppressed, spat a considerable quantity of blood. Under the 
 influence of proper treatment the symptoms of inflammation of the 
 stomach disappeared, and at the same time that they improved, the 
 haemoptysis ceased, the cough became lighter, and the patient re- 
 turned to the same state in which she was before the attack of 
 gastritis. Two months after, the stomach disease again set in, 
 accompanied by the same symptoms; in a little time after, 
 spitting of blood also manifested itself. The gastritis again 
 minated favourably, and with it the spitting of blood was obse 1 
 to disappear. The pulmonary tubercles again seemed to rem 
 stationary. Lastly, at the end of some months, new symptoms . 
 inflammation of the stomach developed themselves, and, as before 
 the spitting of blood re-appeared with marked increase of all th> 
 symptoms of disease in the chest. The stomach disease quick' 
 again disappeared ; but this time the symptoms of disease in t 
 chest, far from improving, became more and more severe, 
 patient was soon brought to the last stage of pulmonary consun 
 tion, and died." 1 
 
 In this case, although it is probable that tubercles existed in 
 latent state in the lung, (for nothing indicated their existence,) we 
 observe them to remain stationary till the attack of acute inflamma- 
 tion of the stomach. Even the two first attacks of this disease 
 left the patient much as she was before their commencement: on 
 the occurrence of the third, the symptoms of phthisis were rapidly 
 developed, and ran to a speedy termination. " From these facts we 
 conclude," says the reporter of this case, "that acute inflammation 
 of the stomach which supervenes, as a complication, in the first 
 period of pulmonary consumption, may exercise a most mischievous 
 influence on the progress of the latter disease." 
 
 CASE 14. 2 Inflammation of the stomach producing cough, succeeded by 
 tubercular consumption. 
 
 A lady, twenty-two years of age, born of healthy parents, had 
 complained, for about two years, of a dull pain in the region of the 
 stomach, when, after a series of untoward circumstances, her di- 
 gestive powers became more seriously disturbed. The pain which 
 she suifered from taking food was so great, that she was reduced 
 to the necessity of living upon milk and farinaceous food, ripe 
 fruits, and some kinds of vegetables. If she took more substantial 
 food, the gastric irritation became extreme, and was only relieved 
 by three or four days of rigid abstinence, and the use of demulcent 
 drinks. Two years from this date, owing to great mental uneasi- 
 
 1 Clinique Medicale. by Spillan, p. 519. 
 *De Larroque, Op. cit., p. 58, case 10. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 145 
 
 ness, the symptoms became acute. Severe vomiting of green fluids 
 set in, with violent and increased pain in the region of the stomach, 
 spasms, and cold perspiration. This fresh attack yielded to the 
 same treatment; but now it left behind it a dry cough, which oc- 
 casioned so much pain in the stomach that the patient, during the 
 paroxysm, was obliged to press the region with a napkin. The 
 cough, which was at first dry and by fits, was soon accompanied 
 by mucous expectoration and slight pains in different parts of the 
 chest. After these symptoms had continued three months, the 
 expectoration assumed a purulent character; the cough was not 
 more frequent, but it produced still increasing pain in the stomach, 
 over which region the slightest pressure caused pain so severe that 
 the patient could not forbear crying out. The point of the tongue 
 was red, the respiration hurried, the percussion of the chest obscure, 
 whilst there was an inability to recline on either side. The 
 patient now became hectic, had night perspirations and slight diar- 
 rhoaa, and died at the end of a month from the date of the account 
 of the last symptoms. 
 
 Post-mortem examination. The right lung contained several 
 small caverns, and a number of tubercles not yet softened; the left 
 lung hepatised, red, and adherent to the parietes of the chest ; the 
 mucous membrane of the bronchiae slightly injected. The mucous 
 coat of the stomach was covered by a false membrane, similar to 
 that observed occasionally in the mouth; under this membrane, it 
 was of a deep violet colour, which deepened towards the pyloric 
 portion. The duodenum and small intestines presented traces of 
 inflammation. 
 
 Remarks. On reviewing the history of this case, we find the 
 symptoms of gastric derangement, arising from a series of moral 
 impressions, preceding the symptoms of pulmonary irritation for 
 two years. It was not till the attack of acute inflammation that 
 the disease of the stomach became complicated with cough and 
 pain in the chest. The cough, by its violence, added to the distress 
 of the patient and the uneasiness already existing in the stomach. 
 We note again, that the cough was at first dry, resembling that 
 which, in a great number of instances, accompanies various forms 
 of stomach derangement, whether of the inflammatory or saburral 
 kind ; soon afterwards, it is followed by mucous, and subsequently 
 with purulent expectoration, whilst other symptoms, indicating the 
 extension of disease from mere nervous irritation to organic change, 
 make their appearance. The commencement and progress of this 
 case, lead us to place the origin of the pulmonary disease in the 
 stomach. 
 
 12 b park 10 
 
146 
 
 PARKER ON THE STOMACH. 
 
 CASE 15.' Chronic inflammation of the stomach, with diarrhoea, preceding 
 the symptoms of disease in the chest for eleven months. Termination 
 in pulmonary phthisis. 
 
 A man, aged thirty-four years, entered the hospital of La Charite, 
 complaining of having been indisposed for a year and a half. He 
 had not ben able to follow his usual occupation for five months: 
 and attributed the origin of his complaint to severe mental distress, 
 occasioned by some pecuniary losses. The disease had commenced 
 with total loss of appetite and looseness of the bowels. He had 
 neither had nausea, vomiting, or fever, but, with the symptoms 
 before complained of, some pains in the region of the stomach. 
 Suddenly, and without any evident cause, he was seized in the 
 night with spitting of blood, to the amount of half a pint; this 
 came on again two days afterwards: it yielded to the exhibition of 
 acidulated drinks. Cough, with expectoration, difficulty of breath- 
 ing, and vomiting, succeeded; the diarrhoea ceased. From this 
 period the patient continued weak, and the pulse small, feeble, and 
 slightly accelerated; exacerbation of fever in the evening, night 
 perspirations. The respiration approached the cavernous character 
 at the summit, and round the whole of the chest on the left side. 
 Slight expectoration, with considerable emaciation. A month after- 
 wards the nausea and vomiting ceased, and the digestion was im- 
 proved; the difficulty of breathing was also much amended: the 
 patient, however, continued very weak. The cough and vomiting 
 again re-appeared, and the appetite again became bad. During the 
 remaining period of his existence the appetite continued variable; 
 diarrhoea set in once, but was speedily checked. The patient con- 
 tinued to sink, and died with the physical symptoms of the soften- 
 ing of tubercles six weeks after the last relapse. 
 
 Post-mortem examination. The superior lobe of the left lung 
 contained two large caverns at its summit, whilst in other parts of 
 the substance of this lobe smaller caverns, partially emptied of 
 tuberculous matter, existed. The inferior lobe contained also some 
 crude tubercles. On the right side the same kinds of lesion were 
 found, but to a less extent. The mucous membrane of the trachea 
 and bronchias was inflamed, and had small ulcerations in parts. 
 The mucous membrane of the stomach was of a yellow colour in 
 its cardiac portion, more or less gray over the remaining part of its 
 surface; the gray colour was interrupted, in certain points, by small 
 white patches, where the mucous membrane was considerably 
 thinner than in the natural state. A small ulcer existed midway 
 between the cardia and pylorus. Ulcerations in the small and 
 large intestines. 
 
 Remarks. In analysing the progress of the symptoms in this 
 case, we observe it to have commenced in mere indisposition, the 
 
 1 Louis, Recherches sur la Phthisic, p. 326, Case 21. 
 
INFLUENCE OP ITS MORBID STATES ON THE LUNGS. 147 
 
 result of grief from pecuniary loss; this indisposition is marked by 
 loss of appetite, pain in the stomach, and diarrhoea, the ordinary 
 symptoms and concomitants of various forms of what is called 
 indigestion. "At this period," remarks Louis, the affection of the 
 lung did not appear to be in existence." Suddenly spitting of 
 blood occurs, the breathing becomes bad, and cough, with expecto- 
 ration, appears ; at the same time the stomach symptoms become 
 more serious, vomiting, which had not previously been present, is 
 added to the pain in the stomach and the loss of appetite. We 
 observe the patient to amend after this, although he still continued 
 weak; suddenly the vomiting again set in, with the cough, and the 
 symptoms of disease in the chest became aggravated. From this 
 period the patient continued to sink, with all the physical and 
 rational signs of disease in the lungs. We note the most remark- 
 able features in this case: that the dyspeptic symptoms (the result 
 of mental uneasiness, which so commonly produces such symptoms) 
 were in existence eleven months before the least appearance of dis- 
 ease in the chest was evident, or before even it was suspected; and, 
 again we remark both the first attack of spitting of blood, and his 
 relapse after partial recovery, to have been accompanied with an 
 increase in the symptoms of the disease in the stomach, marked by 
 the vomiting which accompanied both these occurrences. The 
 state of the stomach after death, sufficiently accounts for the phe- 
 nomena observed during life. In this case it certainly appears that 
 the disease in the chest was, in the first instance, produced by the 
 gastric irritation, which terminated in ulceration of the coats of the 
 stomach. The relapse, which ultimately proved fatal, also appears 
 to have been owing to an increase in the severity of the stomach 
 disease. 
 
 RECAPITULATION AND GENERAL HISTORY OF DISEASES OF THE 
 STOMACH, IN THEIR INFLUENCE UPON THE ORIGIN, PROGRESS, 
 AND TERMINATION OF DISEASES IN THE LUNGS. 
 
 In the detail of the preceding cases, we have seen that an in- 
 flamed or irritable condition of the mucous membrane of the stomach 
 and bowels exercises a marked influence upon the condition of 
 the lungs and their appendages, whether in reference to mere func- 
 tional derangements in the organs of respiration, or in the produc- 
 tion of various forms of hyperemia and inflammation, which, in 
 many instances, terminate in incurable organic disease. 
 
 We shall first enquire into the nature of the symptoms which 
 indicate the commencement of pulmonary irritations, which depend 
 on an inflamed condition of the lining membrane of the stomach. 
 Two of the most common symptoms which denote the commence- 
 ment of affections of the lung arising from this cause are, a pain 
 
148 PARKER ON THE STOMACH. 
 
 in the centre ot the sternum, with a sense of constriction and 
 oppression across the chest, and cough coming on after eating. 
 
 We sometimes find persons who have no appetite, a foul tongue, 
 a disposition to a relaxed, and at other times to a constipated, condi- 
 tion of the bowels, complaining of pain and oppression in the centre 
 of the sternum and fore part of the chest, with a dry, irritating 
 cough, which becomes invariably aggravated by a meal. 
 
 The epigastrium, in many cases of this kind, is not at all sen- 
 sible to pressure: it may be handled and pressed without any un- 
 easiness being produced. In other instances, however, epigastric 
 tenderness co-exists, but it is not essential to the existence of chro- 
 nic gastritis or hyperernia that it should do so. I met with a 
 remarkable case of this kind in a gentleman who had occasionally 
 been seized with violent sicknesses" and diarrhoea, at long intervals, 
 during a period of three or four years. These were soon removed, 
 but the tongue remained constantly foul ; and though the patient 
 took food he had never any appetite for it. He was neither well 
 nor ill, had a sallow cast of countenance, and always a disposition 
 to relaxed bowels, with a dry cough, becoming worse after dinner. 
 His food never disagreed with him, never caused him pain, was 
 never vomited, except at the periods mentioned, and he never felt 
 sick; yet I was convinced this patient was suffering from chronic 
 gastritis, and felt assured that, sooner or later, it would manifest 
 itself in some marked form, as he lived freely. I met him by ac- 
 cident one day, and he complained of pain in the chest, with 
 oppression, and increased cough ; in all other points he remained 
 much the same. In the evening of that day acute inflammation of 
 the stomach came on ; the epigastrium, before indolent, was now so 
 sensible that he could not bear a finger upon it, the tongue was 
 become vividly red, whilst the pain in the chest and oppression 
 were so great that he could not breathe without difficulty; at the 
 same time, the bowels, which were before relaxed, became obsti- 
 nately costive. From freely leeching the epigastrium for four or 
 five days, the tongue became clean, which it had not been for 
 twelve months, and all the symptoms of thoracic disease, cough 
 and pain, were removed. 
 
 In other forms of disease, the acute form of inflammation of the 
 stomach is never assumed. Thus we see, in delicate females, the 
 cough after food, with pains in the chest, masking all the symptoms 
 of gastric disturbance, which are often obscure, continue month 
 after month, with progressive emaciation. If auscultation be not 
 understood by the practitioner in attendance, it is difficult, nay, im- 
 possible, to determine whether the disease be pulmonary or not. 
 It is concluded that it is so, since the symptoms of such disease are 
 well marked, stimulant expectorants, or tonics, are resorted to, 
 which only aggravate the symptoms, and the patient sinks from a 
 suspected chest affection, which, on examination after death, is 
 found not to exist, and the seat of the disease is found to be the 
 stomach. Broussais' cases are examples of errors of this kind: he 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 149 
 
 was deceived in all three cases, merely suspecting that the disease 
 which appeared bronchial, in the last case, might possibly be 
 gastric. The first case of the fifteen given in this part of the work 
 is a well-marked example of the irritation which arises in the lungs, 
 the consequence of inflammation of the stomach, whilst the proper 
 and customary symptoms of the gastric disease are masked or alto- 
 gether absent. Many of the cases of gastritis recorded by M. de 
 Larroque, in his work on Diseases of the Abdomen which simulate, 
 produce, or keep up Diseases of the Chest, were marked by this 
 peculiar symptom of dry cough, increased by taking food. 
 
 Accelerated respiration is another symptom observed in the func- 
 tions of the lungs, which is dependent on disease in the stomach. 
 In many cases, even where cough, pain, and tightness exist in the 
 chest, the number of respirations are not at all quickened : the 
 patient can inspire deeply without pain, or without increasing the 
 cough. But in other instances the breathing is quickened : there 
 is a peculiar catching at the breath, a deep inspiration occasions 
 pain, and brings on cough. These symptoms, still more than those 
 we have been considering, appear to indicate pulmonary disease ; 
 yet still these are found to depend on gastric inflammation, and no 
 physical sign of disease in the lung can be observed to account for 
 the production of these symptoms. We have commonly observed 
 children to be suddenly seized with fever and short breathing, pre- 
 cisely resembling the rational signs of pneumonia ; yet, in analysing 
 the state of the organs in the chest and belly, I have been convinced 
 that this hurried breathing, with catching, when the diaphragm 
 was depressed by an inspiration, depended upon inflammation of the 
 mucous coat of the stomach, and not upon any lesion of the organs 
 of respiration. Sometimes, in these cases, children will complain 
 of pain in the belly ; at others there may be vomiting present ; or 
 diarrhoea, with green, frothy, offensive, or parti-coloured evacuations. 
 Again, all these signs may he absent, the difficulty of breathing pre- 
 sent, yet no physical sign indicating an affection of the lung! In 
 such instances I agree with De Larroque that the vivid redness of 
 the point and edges of the tongue, with the general fever, are the 
 chief indications of gastric inflammation. I have noted numbers of 
 these cases occurring in children, continuing fora shorter or greater 
 length of time, and exasperated or not amended by medical treat- 
 ment, cease promptly on the application of one or two relays of 
 leeches to the epigastrium. 
 
 The chief symptoms, then, of the commencement of pulmonary 
 irritation, as a consequence of gastric disease, are dry cough, in- ' 
 creased by food during digestion, and by stimuli ; pain on some 
 point of the thoracic parietes, oppression, constriction of the chest, 
 with accelerated or irregular respiration. These may exist with 
 gastric irritation, and without any evident affection of the lung to 
 account for them; or they may be found with both pulmonary and 
 stomach disease. We will enquire for a moment into the mode of 
 their production. 
 
150 PARKER ON THE STOMACH. 
 
 When inflammation of the mucous coat of the stomach becomes 
 a source of irritation to the lungs, it may be propagated in several 
 ways; 1. The existence of dry cough with irregular states of the 
 respiration appears to depend on irritation of the gastric extremities 
 of the pneumo-gastric nerve. In some instances of this kind 
 Lobstein has found the branches of this nerve inflamed. 1 In other 
 forms the trunk of these nerves was enlarged and hypertrophied to 
 a great extent, as in the fourth and fifth cases of cancer of the sto- 
 mach related by Dr. Lombard of Geneva. 2 In most instances of 
 this kind the disease appears limited to mere irritation of the pul- 
 monary branches of this nerve, 2. Irritation may be propagated 
 from the stomach to the lungs, in accordance with that law which 
 disposes diseases to spread by similarity of tissue ; and thus we find, 
 after death from gastric inflammation, accompanied by cough or 
 other symptoms of derangement in the organs of respiration a 
 pinky, congested, or inflamed state of the bronchial mucous mem- 
 branes. This explains also the bloody expectoration observed 
 during acute forms of gastritis, and the profuse hemoptysis to 
 which they sometimes give origin, which in many instances, marks 
 the first invasion of phthisis. This bloody expectoration was well 
 marked in the fourth case; and an example of hemoptysis thus pro- 
 duced, and terminating ultimately in phthisis, is exemplified in a 
 case quoted from Andral in the notes to the thirteenth case, one of 
 phthisis succeeding to inflammation of the stomach. 3. The affec- 
 tion of the chest may depend upon an inflamed condition of the 
 peritoneum lining the inferior surface of the diaphragm. De 
 Larroque has reported a case, in which such a condition of the 
 diaphragm, coincided with severe gastric inflammation. 
 
 Where the affection of the lung commences as it most commonly 
 does, in mere nervous irritation, it does not long continue in this 
 form, since the violent fits of coughing and the continuance of irri- 
 tation ultimately induce a congested, and subsequently an inflamed, 
 condition of the mucous membrane of the bronchiae, of the substance 
 of the lungs, or the pleura. We have examples of most of these 
 states coinciding with, or succeeding to, gastric diseases, in the 
 detail of the preceding cases. Thus, in some were observed a true 
 bronchitis; in others, a congested state of the lung, without inflam- 
 mation ; whilst, again, the signs of pneumonia were present. These 
 facts teach us to note well the progress of the symptoms, both 
 physical and rational, which accompany cough and disordered res- 
 piration evidently of gastric origin, since, in many forms, the dis- 
 ease in the lung is not limited to mere nervous irritation, but quickly 
 and insidiously progresses into various inflammatory affections, 
 
 1 De Nervi Sympathetici Fabrica, Usu, et Morbis, Commentatio, &c., p. 
 152, 153, 154. 
 
 2 "Clinique Medicale de l'H6pital Civil et Militaire de Geneve," par H. 
 C. Lombard. Gazette Medicale de Paris, Janvier, 1837. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 151 
 
 which, if there he a tubercular tendency, may ultimately degenerate 
 into phthisis. 
 
 It happens, in many instances, that cough, disordered respiration, 
 and progressive wasting-, the result of chronic inflammatory disease 
 of the stomach, exist without any physical sign of disease in the 
 lung being present, upon which these symptoms can be said to 
 depend ; and although the affection may very much resemble 
 organic disease of the lung, yet the stethoscopic signs afforded by 
 examination of these organs at once convince us that they are free 
 from complaint (Cases 1, 2). In these cases it is easy to ascertain, 
 that this affection of the chest is dependent upon the condition of 
 the stomach, by the symptoms of disease which the latter organ 
 presents, in the state of the tongue, of the digestive powers, and that 
 of the epigastrium. In circumstances, however, where we are not 
 called to ihe patient till late in the disease, where the primitive 
 state of irritation in the lung has proceeded to one of inflammation 
 or its consequences, and these coincide with a marked diseased con- 
 dition of the stomach and other organs concerned in the digestive 
 process, it becomes a matter of great difficulty to ascertain in which 
 organ disease has at first commenced. 
 
 Inflammatory diseases of the" stomach, which complicate those of 
 the lungs, may originate simultaneously with the affection of the 
 chest, and from the same cause. The disease of the stomach may 
 be primitive, and that of the lungs secondary; or the disease of the 
 stomach may succeed to that of the lungs. But, at whatever period 
 the affection of the digestive organs may have appeared,* it is not 
 less influential in its effects upon the organs contained in the chest. 
 This remark derives support from the history of the preceding 
 cases, but more particularly from the 1st. 2d, 10th, llth, and 13th 
 cases. 
 
 I was requested to see a lady, aged 22, who laboured under the 
 following symptoms: great difficulty of breathing, constant pain 
 in the epigastrium, aggravated by pressure, uneasiness after food 
 terminating in vomiting, universal "rale sonore"in all points of the 
 chest, alternating in places with the sibilant and mucous rales. 
 This was evidently subacute inflammation of the stomach, occurring 
 at the same time with a similar condition of the mucous membrane 
 of the lungs. Leeches were ordered to the epigastrium, and a 
 combination of the ponderous carbonate of magnesia administered 
 with Dover's powder, in the proportions of half a dram of the 
 former to five grains of the latter, three times a day. No other 
 treatment was employed, and under this she speedily recovered. 
 Dr. Copland has alluded to the frequent simultaneous occurrence 
 of disease in the mucous membrane of the lungs and that of the sto- 
 mach. 1 These complications, also frequently pass from the subacute 
 to the chronic slate together; thus we often see. more particularly 
 in children, diarrhcea, with vomiting, accompanying cough, quick- 
 
 1 Dictionary of Practical Medicine, p. 253. and note. 
 
152 PARKER ON THE STOMACH. 
 
 ened breathing, and the physical signs of bronchial disease. In 
 such instances, all remedies calculated to excite the digestive mucous 
 surfaces should be avoided, particularly all forms of antimonial 
 remedies with squills, and the usual syrups or balsams, since they, 
 by adding to the irritation already existing in the stomach, are more 
 likely to increase than diminish the co-existing affections of the 
 chest. I have generally found in such states the mist, cretse, with 
 the opiate confection and hydrocyanic acid, or a combination of 
 hyd. c. creta with pulv. ipecac, co., succeed better than any other 
 remedies, at the same time leeching the epigastrium, if the gastric 
 symptoms are urgent, or using counter-irritants to the chest with 
 local depletion, if the pectoral symptoms become predominant. The 
 digestive mucous surfaces must not be irritated. I cannot too fre- 
 quently press upon the reader the importance of this, since their 
 sympathies with the lungs in so many forms of chest disease are so 
 marked, as we shall still further see in their complication with 
 various forms of pneumonia. 
 
 In some forms of inflammation of the mucous coat of the stomach, 
 which produce disease in the lungs, we observe, as in case 3, the 
 affection of the stomach to cease after the establishment of disease in 
 the chest, terminating in profuse expectoration. Andral has noticed 
 the alternation of disease between the lungs and intestinal tube, in 
 certain forms of inflammation. He, as I have done in the remarks 
 on that case, considers the secondary disease to act by way of re- 
 vulsion upon the first. 1 Thus as in the third case, the affection 
 of the stomach, which had not yielded to remedies, diminished 
 when the disease in the chest was fully established, and ceased 
 altogether when free expectoration set in. Inflammatory affections 
 of the stomach in this way occasionally relieve similar forms of dis- 
 ease in the lungs. We must not. however, attempt to imitate, by 
 artificial means, these inflammations of the digestive surfaces, which 
 occasionally seem to relieve the disease in the chest when they 
 occur subsequently to the affections of the lungs, since, in a great 
 majority of instances, the cough and expectoration are increased by 
 the inflammation of the stomach and bowels, and the difficulty 
 of breathing, more particularly, becomes aggravated, as we may 
 observe by perusing the details of the tenth, eleventh, and twelfth 
 cases. 
 
 Occasionally the symptoms of chronic inflammation of the sto- 
 mach are accompanied by dull pains in either of the sides, under 
 the mammae, or in the cardiac region. At times, these pains become 
 suddenly acute, and when accompanied by cough and inability to 
 dilate the chest for free inspiration, they have the character of 
 pleurisy. I have never seen these pains, when occurring with 
 marked symptons of stomach derangement, exhibit, on examination, 
 any of the physical signs of pleurisy, although they have con- 
 tinued for weeks, or even months, and in some instances are never 
 
 1 Clinique Medicale, by Spillan, p. 529. 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 153 
 
 absent during the continuance of the stomach disease. Sometimes 
 irregular action of the heart, with intermittent pulse, is attendant on 
 these thoracic pains. I have seen leeches and blisters applied over 
 the seat of pain fail in giving relief, when the stomach has not been 
 attended to; whilst, again, local depletion from (he epigastrium, 
 with the exhibition of the hydrocyanic acid, or other remedies 
 suited to the particular features of the stomach affection, have seldom 
 failed in relieving these sympathetic pains. Cases 8 and 9 are 
 examples of these forms of disease. I have seen similar acute 
 pains seated on the scalp, resisting every mode of local treatment, 
 yield only to remedies calculated to remove the gastric disturbance 
 upon which they depended. 
 
 I have shown, in the details of the tenth, eleventh, and twelfth 
 cases, that pneumonia is frequently complicated with inflammation 
 of the mucous coat of the stomach. This complication was first 
 described by Stoll, under the term " bilious pneumonia:" it is a 
 complication of a saburral, irritative, or inflammatory state of the 
 stomach, with inflammation in the substance of the lungs, the affec- 
 tion of the stomach being characterised by nausea, vomiting, a loaded 
 tongue, red at its point and edges, yellow tinge of the countenance 
 and conjunctive, with pain and tenderness in the epigastrium; 
 whilst in the lungs the physical symptoms of pneumonia are present. 
 The disease in the lung may be subsequent to, and dependent upon, 
 the gastritis, or the two may be ushered in together. I remember 
 being called to attend a person who, in a state of intoxication, had 
 laid down upon the grass and fallen asleep. Previous to this occur- 
 rence he had been in the most robust health; he did not remember 
 ever to have been sick, and had never had a cough or shortness of 
 breath. On the next morning he was seized with acute pain in the 
 stomach, with constant vomiting of every thing he swallowed. This 
 continued to increase for ten days ; at the end of that time I first saw 
 him. He had then acute pain in the epigastrium, increased to 
 agony by pressure ; incessant vomiting, cough, short breathing, con- 
 striction and pain across the chest. On examining the chest, the 
 respiration was absent in the middle and inferior parts of the right 
 lung, except that here and there the slightest murmur was detected; 
 in the apex of the same lung it was more distinct. He was bled in 
 the arm : the blood presented the usual characters of inflammation. 
 Leeches were applied, also, to the stomach, and he took an occa- 
 sional dose of calomel and opium. By a perseverance in the local 
 depletion from the epigastrium, and opiates from time to time, the 
 gastric disturbance was so far subdued as to enable him to retain 
 the milder kinds of food upon his stomach ; but the short breathing, 
 with cough and frequency of pulse, (one hundred and twenty,) con- 
 tinued. I saw the patient at intervals, for twelve months; during 
 this time his state continued much the same ; the cough, the diffi- 
 culty of breathing, the absence of respiration in the greater part of 
 the right lung (to which was now added dulness on percussion) 
 continued, with attacks of severe vomiting whenever any errors in 
 
154 PARKER ON THE STOMACH. 
 
 diet were committed. I noted his state particularly, thirteen months 
 after the commencement of the acute disease, it was as follows: 
 September 28th, 1S35. In the superior lobe of the right lung the 
 respiratory murmur was audible, absent in the middle and inferior; 
 dulness on percussion, hoarseness, occasional loss of voice, constant 
 acidity, nausea, with vomiting almost daily. The pulse intermits, 
 but there is no evident affection of the heart. He has derived 
 great benefit lately from the application of four or six leeches to 
 the epigastrium, and taking internally the ponderous carbonate of 
 magnesia with the compound powder of ipecacuanha. All the 
 complaint is of the stomach ; and in proportion to the relief afforded 
 to the gastric symptoms is there amendment in the short breathing 
 and hoarseness. 
 
 In some instances, the pneumonia may succeed to the gastritis ; 
 but in all instances where there is a complication of these diseases, 
 the contra-stimulant treatment of inflammation of the lungs by the 
 antirnonium tartarizatum is inadmissible. A medical friend, in my 
 absence, observing the marked symptoms of chest disease of the 
 inflammatory character in the last case, administered the sixth of 
 a strain of this remedy, three times a day, to the subject of it ; the 
 aggravated state of the gastric symptoms, consequently developed, 
 was so great that there was some difficulty in subduing them, 
 while the respiration became, under its use, still more embarrassed. 
 We observe the ill effects of its exhibition in the history of the 
 twelfth case, where the fatal issue was, doubtless, hastened by its 
 use. The general and local abstraction of blood, with subsequent 
 counter-irritation on the surface of the chest, are the only means 
 left to us to combat inflammatory affections of the lungs, thus com- 
 bined with similar conditions of the gastric mucous membranes. 
 The tenth and eleventh cases cannot be too attentively studied. 
 In both these instances the general bleeding, as well as that locally 
 employed from the surface of the chest, appeared to have some 
 effect upon the inflammation of the lung; but still the disordered 
 respiration was not relieved. This might depend as much upon 
 the gastritis as the pneumonia; for we observe it yield, in a marked 
 manner, to local bleeding from the epigastrium. It is, again, ex- 
 tremely probable, from what we have seen of the influence of the 
 stomach upon the lungs, that the gastritis itself would, by the irri- 
 tation it occasioned in the chest, act as a stimulus in keeping up 
 the pneumonia; certainly the inflammatory symptoms in the lungs 
 yielded much more quickly after the gastric symptoms had been 
 subdued. 
 
 Cases 13 and 14 are examples of tubercular phthisis, developed 
 after continued gastric irritation. The work of Louis contains two 
 cases of this kind ; that of De Larroque two. Andral also men- 
 tions the history of one or two cases of tubercular disease of the 
 lung, succeeding to a continued inflammatory condition of the 
 stomach. I have myself seen four examples of inflammation of the 
 stomach, commencing in the symptoms of inflammatory indiges- 
 
INFLUENCE OF ITS MORBID STATES ON THE LUNGS. 155 
 
 tion, and thence progressing into confirmed chronic gastritis, ter- 
 minate, at periods of an earlier or later date, in true tubercular 
 phthisis. I have given, in Case 13, a detail of one of these cases. 
 In that case, the treatment directed to the stomach alone exercised 
 a marked influence over the more distressing symptoms connected 
 with the pectoral disease. The occurrence of repeated attacks of 
 inflammatory indigestion or of diarrhoea in persons exhibiting any 
 predisposition to affections of the chest, or where there is any 
 hereditary tendency to phthisis, should excite our most watchful 
 attention. If we analyse the symptoms of every case of indiges- 
 tion not amounting to a chronic gastritis, even in its faintest shade, 
 which comes before us, we shall find a great majority complicated, 
 in a greater or less degree, with cough. Fulness of blood in the 
 coats of the stomach, or an exalted state of the sensibility of its 
 nerves, has a particular tendency to the production of this symp- 
 tom. In some it follows a meal, and continues during the period 
 of digestion; in others, pressing the epigastrium will produce it; 
 in a third series, dry, short cough is constantly present. 
 
 I know not whether a morbid sensibility to impression in the 
 mucous surfaces of the stomach is accompanied by a similar con- 
 dition of the same parts in the lung; but I am certainly inclined 
 to such a view of the subject. " We are convinced by observa- 
 tion," says Andral, "that persons affected with chronic enteritis, 
 have a fatal tendency to pulmonary phthisis. We think we should 
 never neglect, by active means, to combat the colds with which 
 they are affected, however slight they may appear. Too often, in 
 this case, temporising has been fatal ; in consequence of it, a slight 
 bronchitis has rapidly given rise to numerous tubercles. It is cer- 
 tainly a matter of every-day occurrence to witness persons who 
 have a stomach habitually sick, or bowels constantly loose, at the 
 same time troubled with constant, colds, and a dry, short cough. 
 
 The cough, which is the result of gastric irritation, is sometimes 
 succeeded by hemoptysis, after which tubercles are quickly deve- 
 loped, as in the remarkable case quoted in the note to Case 13; we 
 there see the spitting of blood produced by, and subsiding with, the 
 symptoms of gastritis. Sometimes a true bronchitis, with bloody 
 expectoration, is the consequence; at others, a congested state of 
 the lung. Stoll has observed a great number of these bernoptyses. 
 the result of inflammatory irritation of the stomach. We must be 
 at once aware of the evil tendency of such conditions of the lung, 
 where there exists a predisposition to phthisis, or where tubercles 
 exist in the latent state. Even this continued irritation in the lung 
 would, as it has done in some cases, produce a disposition to 
 phthisis, which is quickly developed from a repetition of irritations 
 in the stomach of the same kind. 
 
 The symptoms of gastric irritation sometimes continue, in the 
 chronic form, for months, and even years, before they become com- 
 plicated with any signs which would lead us to suspect any affec- 
 tion of the chest. I have notes of cases continued for a series of 
 
155 PARKER ON THE STOMACH. 
 
 years, in which chronic disturbances of the organs of digestion 
 were alone observed, with a short, dry cough. Auscultation has 
 indicated nothing for a long period, and the progressive emaciation 
 has been attributed to some organic change in the stomach; in 
 time, however, the physical signs of tubercular disease in the lung 
 have been set up, and the patient has soon sunk from this fatal 
 complication of disease. I have noted one case of this kind for 
 three, arid a second for seven, years. 
 
 In another form, the disease is more quickly developed. I 
 attended a lady, previously in the most perfect health, who had 
 been suddenly seized with pain in the stomach, vomiting of food, 
 and other symptoms characterising an acute gastritis. The more 
 acute symptoms were subdued, but the affection passed into the 
 chronic state; and at the end of twelve months she died, phthisical, 
 with large caverns in both lungs. 
 
 We deduce from these facts two important considerations: 
 1. Inflammatory irritations of the digestive organs are readily, 
 under certain circumstances, transmitted to the lungs, where they 
 may become the source of various diseases, as cough and dis- 
 ordered respiration, bronchitis, pneumonia, hgemoptysis, and even 
 tubercular phthisis. 2. Diseases of the lungs are frequently com- 
 plicated with an inflamed condition of the stomach; and in framing 
 a treatment for the relief of the former, we should be careful to 
 avoid the use of remedies which would exasperate the latter. 
 
 CHAPTER XII. 
 
 ON THE INFLUENCE OP MORBID STATES OP THE STOMACH UPON 
 THE ORIGIN, PROGRESS, AND TERMINATION OP DISEASE IN 
 THE BRAIN. 
 
 The brain isjiot less influenced in the integrity of its functions, 
 by disease of the mucous surfaces of the stomach, than are the 
 liver, lungs, and heart; and in many instances the sympathetic 
 affections of the former organ are of as much, if not of more, 
 importance than those we have already considered. 
 
 In many instances these are manifested, during life, by infinite 
 varieties of condition of the reasoning and intellectual powers, 
 from mere irritability of temper, to confirmed lunacy or mania. 
 Sometimes stupor is present ; at others, pain in the head, with 
 excitement. The functions of the senses are impaired or exalted, 
 whilst, in more aggravated forms, the disease of the head progresses 
 into profound coma, or terminates in convulsions or varied partial 
 paralyses, and changes in the sensibilities of different parts of the 
 skin. 
 
 It is hardly possible to determine upon what exact pathologic 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 157 
 
 condition of the stomach these varied forms of irritation in the 
 brain depend. Sometimes a mere hyperemic condition is detected 
 after death in the former organ ; again, confirmed inflammatory 
 conditions are present, with various changes of colour or consist- 
 ence. As in the stomach, so in the brain ; varied pathologic 
 changes are detected after death, upon which the symptoms 
 observed during life are dependent. 
 
 These changes, however, are not sufficient to account for all we 
 observe. The organic lesions are, doubtless, combined, in both 
 organs, with certain conditions of excitement in the nervous 
 system, which produce many of the symptoms observed during 
 life, but which anatomy does not enable us to appreciate in the 
 dead body. 
 
 I have, in a previous part of this work, shown that the process 
 of digestion is accompanied by a flow of blood into the mucous 
 coat of the stomach, which places this organ, during the continu- 
 ance of this function, in a state of active congestion. This active 
 congestion is the first form of inflammation; and hence it is that 
 we find the process of digestion, in many persons, influencing the 
 condition of the brain in the same way that active congestion of 
 the stomach, or inflammatory affections of this organ, do at other 
 periods. 
 
 The affections of the head that accompany the progress of diges- 
 tion are most commonly those of vascular turgescence (cerebral 
 congestion), and are evidenced by a great variety of symptoms. 
 Thus, many persons become so drowsy after a meal that they are 
 unable to keep awake; others are tormented with an intense frontal 
 headach ; a third series experience a total inability to the perform- 
 ance of any intellectual act, and are completely stupid. If we 
 examine the condition of the circulation at these periods, we shall 
 find the action of the carotids much increased, both in frequency 
 and force, and the head much hotter than at other times. " There 
 can be no doubt," says Andral, "that, in those who are predis- 
 posed, the process of digestion favours the return of congestion of 
 the brain ; to a slight degree of these congestions may be attri- 
 buted the drowsiness exhibited by some persons after meals. With 
 respect to diseases of the stomach, they possess, in certain cases, a 
 manifest influence on the development of cerebral congestions. 
 Thus, at all ages, and particularly in infancy, acute gastro-intes- 
 tinal affections may be accompanied by symptoms announcing the 
 presence of an undue quantity of blood in the brain. The same 
 happens, though less frequently, in chronic cases." 1 
 
 I shall give some examples of the milder, as well as of the more 
 severe forms of cerebral affections, consequent upon gastric dis- 
 turbance. 
 
 CASE 1. A gentleman, aged thirty-two, was suddenly seized 
 with nausea and vomiting of food, which had continued for some 
 
 1 Clinique Medicale, by Spillan, p. St. 
 
153 PARKER ON THE STOMACH. 
 
 days. He had at the same time great heat and tenderness in the 
 epigastrium ; he was giddy, the vision was cloudy and indistinct, 
 and he had a constant ringing in the ears. All the symptoms, 
 both those connected with the head and those connected with the 
 stomach, disappeared from two applications of leeches over the 
 epigastric region. 
 
 This is an example of a slight cerebral congestion, succeeding 
 to a sub-acute affection of the stomach, of an inflammatory kind. 
 In this instance, we observe the conditions of the brain to be 
 relieved by removing the gastric irritation which produced it. In 
 many instances, particularly if any disease have previously existed 
 in the brain, this apparently trivial derangement of the stomach 
 might have produced a fatal termination in the brain, as I shall 
 show by some of the following cases. 
 
 CASE 2. A gentleman, of middle age, consulted me for what 
 appeared to be an attack of sub-acute gastritis, or active hyperemia. 
 He had daily vomiting of food, some fever, with great heat and 
 tenderness in the epigastric region. For some time before the 
 occurrence of the symptoms in an acute form, he had been trou- 
 bled with flatulence, and great distension of the stomach after eat- 
 ing, accompanied by palpitations, throbbing of the carotids, stupor, 
 and a total inability to exercise any mental or intellectual process. 
 As the symptoms connected with the stomach became more acute, 
 the faculty of memory was totally lost ; yet, during a state of 
 health, this gentleman was remarkable for the strength and clear- 
 ness of his intellect. No remedies afforded any marked relief 
 except the application of leeches to the epigastrium; the mind 
 became clearer, and the stupor abated as the blood flowed from 
 the region of the stomach. 
 
 This case, as well as the last, exhibits a form of vascular fulness 
 in the brain, removed by curing the inflammatory irritation of the 
 stomach which produced it. In many instances, however, the state 
 of the brain will become the special object of our attention, since 
 the symptoms connected with it, although called forth by the 
 stomach affection, are more alarming than the primitive disease to 
 which their origin is due. 
 
 We have seen the influence of the process of digestion upon the 
 brain, and those states of active congestion, at other periods, which 
 resemble it. In persons who consume large quantities of animal 
 food, and malt, vinous, or spirituous liquors, the state of active con- 
 gestion, or hyperemia of the stomach, becomes constant ; this, how- 
 ever, may occur from other causes, and from none more frequently 
 than from strong mental impressions. These, first received by the 
 brain, and then transmitted to the nervous centres of the epigas- 
 trium, first exalt the sensibility, arid then, by the exercise of a 
 natural law, determine to the stomach an increased quantity of 
 blood. Here is now produced a permanent centre of irritation, 
 which, as long as it continues, reacts upon the brain, and disposes 
 that organ likewise to irritation. 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 159 
 
 Let ns examine the influence of both these classes of causes 
 existing in the stomach, and sympathetically affecting the brain. 
 
 I have shown the influence of the former, that is, of active con- 
 gestion, or hyperemia of the stomach, the result of the stimulus of 
 food, upon the brain, in the two cases detailed at the commence- 
 ment of the chapter. The second class now demands our attention. 
 
 CASE 3. Influence of a diseased condition of the stomach, the result of 
 moral impression, upon the brain. 
 
 A lady, aged 25, suffered from a series of domestic afflictions for 
 some time, having lost one or two relatives, to whom she was 
 tenderly attached, from phthisis. Her health now began to decline, 
 she had some hysteric seizures, to these succeeded nausea, vomit- 
 ing, a disordered condition of the bowels, accompanied by wander- 
 ing pains, and an occasional diarrhoea ; settled uneasiness in the 
 epigastrium and the two hypochondria, with heat, tenderness, and 
 continual beatings. After the continuance of these symptoms for 
 some time, she became affected with weight, pain, and throbbing 
 in the head, fits of mental irritation, flushings of the face ; suddenly 
 she lost the use of the right side. These symptoms were continued 
 in a variety of forms, through a series of five or six years. She 
 was placed under my care, and at that period presented the follow- 
 ing state. The hemiphlegia had nearly disappeared, she could 
 walk well, but the pain and throbbing in the head, the thirst, flush- 
 ing of the face and occasional numbness of the limbs, made her 
 fearful of a return. The head was continually hot, the seat of 
 severe pain on the vertex, with occasionally violent and sudden 
 darting pains through it, which made the patient scream out ; the 
 carotids and temporal arteries throbbed violently, and the pulsations 
 were seldom less than a hundred. 
 
 On examining the epigastric region, the first thing that attracted 
 attention was a violent pulsation ; of this beating she continually 
 complained, as the source of her chief uneasiness. This part was 
 full, hot, exceedingly tender on pressure, and the seat of internal 
 pains shooting into the hypochondria, where she had also fixed 
 uneasiness. 
 
 The stomach and intestines were become so morbidly sensible 
 to impression, that every thing she took produced pain, sickness, 
 and very frequently vomitings, there was constantly an intensely 
 acid taste in the mouth. The bowels were scantily evacuated daily, 
 but the stools were dark, and very offensive, and the patient enter- 
 tained so great a dread of aperient medicines, that, for the first week 
 she remained under my care, I was afraid to administer them. As 
 there appeared no disposition to amendment, and as each meal was 
 followed by an aggravation of the symptoms both in the head and 
 stomach, I determined to give a mild cathartic. Four leeches were 
 placed over the region of the stomach, and five grains of the hyd. 
 c. creta, with five of rhubarb, were given in a pill at bed-time. 
 
160 PARKER ON THE STOMACH. 
 
 The medicines produced severe griping, and were followed by 
 seven or eight evacuations, as black as pitch, and much resembling 
 it. The succeeding evening, they were again given, discharges of 
 a better character were obtained, and much less pain was produced 
 by their operation. The remedies were repeated every night for a 
 week, whilst the patient adhered to a mild, unstimulating diet of 
 farinaceous food. At the end of this period she had no nausea, 
 sickness, or pains in the stomach or bowels, the epigastric pulsation 
 had disappeared with the tenderness and heat ; the mind was calm, 
 the throbbings and pain in the head were gone, it was become cool, 
 and the arterial pulsations did not exceed seventy. The patient 
 was in fact well. 
 
 Remarks. This case may serve as a type of a certain class of 
 diseases in which we observe the mutual reaction of the brain and 
 stomach upon each other, and the patient suffering from a class of 
 symptoms which are dependent upon irritation in both organs. 
 
 We observe the disease of this lady to have commenced in 
 mental disturbance, to this succeeded attacks of hysteria, which, 
 during the paroxysms, were treated by the free exhibition of stimuli 
 of various kinds, aether, brandy, various antispasmodics, and in the 
 interval a generous diet was followed to give the patient strength; 
 we observe, in the first instance, that the brain, excited by the 
 mental distress of the patient, produces by sympathy a correspond- 
 ing degree of exalted sensibility in the nervous centres of the 
 epigastrium, and in the stomach. 1 The free exhibition of stimu- 
 lating medicines, and a rich diet, in such a state, tend to change 
 what was at first a mere exalted condition of the sensibility into an 
 active congestion of blood. At this period we find nausea, vomit- 
 ing, pains after food, fulness and heat in the epigastrium, tender- 
 ness on pressure over the region of the stomach and liver, and 
 other symptoms, indicating increased determination of blood to the 
 organs concerned in the function of digestion. This, kept up by 
 rich diet and stimulants, now reacts upon the brain, and in conjunc- 
 tion with mental emotion, produces an active congestion in this 
 organ, under the influence of which we have pain, weight, and 
 fulness of the head, ringing in the ears, dim vision, &c. which 
 terminates in the loss of power over the right side, the patient 
 becomes hemiplegic. From the irritation existing in the stomach, 
 
 1 Bichat (JRecherchessurlavie et la mort) has placed the seat of the pas- 
 sions in the organic life, i. e. in the nervous system supplying the stomach 
 and its dependencies. Georget, (Physiologie du Systeme Nerveux. Mala- 
 dies Nerveuses,} on the contrary, has seated them in the brain. It is plain, 
 however, that the mental emotions here alluded to are the result of impres- 
 sions fiist made upon the brain, and thence immediately transmitted to the 
 nervous system supplying the stomach and abdominal viscera. Thus we 
 find that impressions received first by the brain, become permanently seated 
 in the stomach, the condition of which is every hour modifying that of the 
 brain: La correspondance entre la membrane muqueuse de 1'estpmac et le 
 cerveau est telle que les modifications de cette membrane paraissent etre 
 celle du cerveau lui me'me. Broussais, Commentaires, $c. t. i., p. 152. 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 161 
 
 the bowels become costive, and their secretions scanty and impaired. 
 In this state the patient continues, with some variation, for nearly 
 six years, presenting, at the end of this period a permanent condi- 
 tion of irritation in both the brain and the stomach, the former, as 
 the results of the treatment prove, being now dependent almost 
 altogether upon the condition of the latter. An unstimulating diet, 
 mild aperients, and the application of a few leeches to the epigas- 
 trium, speedily relieve the patient, and we find a disease, which 
 had been kept up by gastric irritation for years, give way immedi- 
 ately that irritation is removed. It is in this manner that the 
 stomach becomes the centre or receiver of irritations from other 
 organs, and by its own irritations, thus produced, keeps up disease 
 in other parts, when the causes producing the first affection have 
 long ceased to act, A permanent state of active congestion of the 
 mucous membrane of the stomach tends to keep up a permanent 
 and an undue fulness of blood in the vessels of the brain. 
 
 We may here enquire, whether this permanent state of cerebral 
 congestion in cases of hyperemia of the stomach or of gastritis, is 
 kept up through the medium of increased force and frequency in 
 the actions of the heart, or whether it is dependent on a direct 
 transmission of irritation from one organ to the other. It may 
 occur in both ways. There are certain forms of disease, com- 
 mencing in hyperernia, or inflammatory conditions of the stomach, 
 in which the brain is thrown into a state of congestion under the 
 influence of the heart, acting with increased force, and driving the 
 blood to the brain with an impetus which is inconsistent with the 
 integrity of the structure and functions of the latter organ. In 
 these instances the heart may be perfectly healthy, acting with in- 
 creased force under the irritation kept up in it by confirmed affec- 
 tions of the stomach ; or, on the other hand, it may be itself 
 diseased, its walls thickened, and the unusual force with which it 
 would thus act upon the brain, may be still farther increased by 
 gastric irritation. 
 
 CASE 4. A gentleman, aged fifty-three, consulted me in 1836, 
 for unpleasant symptoms connected with his stomach, stating him- 
 self to have been subject to indigestion for twenty years. He had 
 pain, weicrht, and uneasiness in the region of the stomach after 
 eating, with acid eructations ; the stools dark coloured, and scanty; 
 the epigastric region and the right hypochondrium full, hot, and 
 tender on manual examination. 
 
 After eating, he was subject to considerable stupor, with pain, 
 throbbing, arid weight over the back part of his head ; at these 
 periods he was totally unable to attend to business from the stupor 
 that came over him. He was also tormented occasionally with an 
 almost uncontrollable venereal appetite when the head was thus 
 affertfid. On examining the heart, I found the impulse unusually 
 strong and diffused over a great extent of surface, a strong "bruit 
 de soufflHt" was also detected. 
 
 This patient was placed upon a mild farinaceous diet; the food 
 12 c park 11 
 
162 PARKER ON THE STOMACH. 
 
 was given in small quantities at short intervals, so as never to dis- 
 tend the stomach or interfere with the action of the heart; eight 
 leeches were placed over the epigastrium, and combinations of the 
 pil. hyd. with rhubarb, followed by a solution of the sulphate and 
 carbonate of magnesia in mint water, were exhibited. By this 
 treatment the stomach soon became tolerably comfortable; the un- 
 pleasant symptoms connected with the head were materially lessen- 
 ed, and altogether disappeared from cupping the back of the neck. 
 The state of the heart remained the same ; I merely remarked that 
 its impulse was less. 
 
 Remarks. In this case we must note the state of the stomach, 
 that of the brain, and that of the heart. There can be no question 
 but that the disordered state of the former organ was dependent on, 
 or connected with, a degree of permanent fulness of blood in it. In 
 the brain we note, also, the symptoms of a permanent congestion, 
 verging almost to the apoplectic condition after eating. In fact, 
 the face used to assume a purple cast after meals. The hyper- 
 trophy of the heart must have influenced the congestion of the 
 brain materially in this case ; and, independent of the direct rela- 
 tion between the brain and the stomach, the heart, in such instances 
 as the present, powerfully modifies the state of the brain. The 
 stomach, however, is the organ through which the chief influences 
 are impressed upon both heart and brain. Thus the process of 
 digesting a full meal, in a stomach already morbid, first irritates 
 the heart by increasing the force and frequency of its pulsations, 
 and then modifies the circulation in the brain through the medium 
 of the heart. The stomach, also, acts directly upon the brain 
 through the media of the sympathies which connect them, inde- 
 pendently of the influence which is exercised over the latter organ 
 through the medium of the heart. 
 
 I have shown, in the preceding cases, the influence of the stomach 
 upon the brain in certain circumstances. These circumstances 
 were a healthy condition of the brain, and a diseased one on the 
 part of the stomach. I shall now illustrate the influence of the 
 stomach upon the brain, where disease exists in both organs. 
 It must be borne in mind, during the whole of these remarks, that 
 the process of digestion is, as I have before frequently stated, one of 
 hyperemia, or of active congestion of the mucous membrane of the 
 stomach ; this hyperemia varying in degree and extent, in direct 
 relation to the quantity of food taken, and to its stimulating proper- 
 ties. This active congestion is repeated or reproduced in the brain 
 as long as it continues in the stomach, in two ways ; by the direct 
 action of one organ upon the other, or through the intervention of 
 the heart. We need only analyse the condition of the organs, after 
 a full meal, to be convinced of this. The arterial excitement, the 
 stupor or drowsiness, the variations in the condition of the intel- 
 lectual powers after a full meal, are dependent upon this cause. 
 
 As I have before said, this state of the stomach produces, during 
 its continuance, a corresponding congestion in the brain, which 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 163 
 
 subsides when its exciting cause no longer ceases to act, in other 
 words when digestion is completed. This daily repetition of eva- 
 nescent congestion in a healthy brain, perhaps does no more mischief 
 than predisposing to permanent states of affection of the head, on 
 the occurrence of slight exciting causes ; but, where disease exists 
 already in the brain, the return of every meal threatens a fatal form 
 of congestion. 
 
 CASI-: 5. August 14, 1835. A man aged forty, of intemperate 
 habits, had some years previous to the present date, a fall upon the 
 head during a state of intoxication, and a year since, a second. 
 These falls were succeeded by occasional headachs. Four days 
 prior to the present date, he was seized with vomiting, diarrhoea, 
 and severe pain in the region of the stomach after eating some in- 
 digestible food. During^ the continuance of these symptoms he 
 complained of giddiness. On the third day from the commence- 
 ment of sickness and diarrhosa, he ate freely of cucumber, and a 
 mixture of other aliments. After the meal he felt drowsy and 
 stupid ; this increased, and, during the night, he fell into a state of 
 profound coma. He remained totally insensible to impressions of 
 all kinds : one thing only appeared to affect him, this was pressure 
 upon the epigastric region. When it was done, he experienced 
 slight convulsive motions of the limbs, which could be brought on 
 as often as the hand was laid with moderate force upon the stomach. 
 He was bled from the arm; twenty-five leeches were applied behind 
 the ears, and upon the temples; and some croton oil was given. 
 The remedies afforded no relief; he died about thirty-six hours 
 from the commencement of the stupor. 
 
 Post-mortem examination eight hours after death. Great 
 thickening of the dura mater covering the posterior third of the 
 cerebral hemispheres. The membranes were here all so completely 
 amalgamated that they could not be separated from the substance 
 of the brain without bringing portions of it away with them. The 
 central white portions of the brain studded every where with red 
 points, from which oozed great quantities of thick black blood. The 
 orifices of some of these vessels would easily have admitted the 
 point of a small crow-quill. The lateral ventricles contained about 
 an ounce and a half of turbid serum. On the inferior surface of 
 the left middle lobe was found a softened portion of brain about 
 the size of a walnut, of the consistence and appearance of curd, 
 which fell out on raising the encephalic mass. The other parts of 
 the brain were remarkably firm and healthy. 
 
 The mucous membrane of the stomach was vividly injected, 
 covered in its pyloric half, more particularly, with intensely red 
 dotting and arborescence. 
 
 Remarks. We have seen in the preceding cases, that a tempo- 
 rary state of congestion is induced in the brain after a full meal, 
 during the whole time the digestive process continues. In these 
 instances the fulness of blood in the brain is merely a repetition in 
 in that organ of what exists in the stomach. The affection of the 
 
164 PARKER ON THE STOMACH. 
 
 head, whilst the brain and its membranes are healthy, strictly de- 
 pending upon the state of the stomach, soon reassumes the natural 
 condition when digestion is finished, or when the fulness of blood in 
 the mucous coat of the stomach has disappeared. Not so, however, 
 is the state of things when disease exists in the brain or its mem- 
 branes, independent of any influence impressed upon them by 
 gastric irritation. These old standing diseases of the brain, as in 
 the present case, are, as Andral has well observed, so many thorns, 
 which are continually irritating the brain and deter mining conges- 
 tions, variable in degree and intensity. We observe, however, in 
 the present instance, which may be taken as the type of a class, 
 that the cerebral congestion, determined by the disease of the brain, 
 never affected the patient, as long as the stomach was healthy, 
 more than by occasioning severe headachs. Under the influence 
 of irritation existing in the stomach, we see the congestion in the 
 brain augmented to a fatal degree, and the patient die comatose 
 during a state of cerebral congestion. The subject of this case 
 never complained of giddiness even, till the vomiting and diarrhoea 
 came on ; he then suffered from giddiness and stupor, which in- 
 creased to profound coma as the gastric irritation progressed, and 
 became aggravated. 
 
 This case shows that a full meal, which determines, whilst the 
 brain is in a healthy state, merely so much blood to it, as inclines 
 to a degree of drowsiness and stupor, may, when disease exists in 
 the brain, cause a congestion of a character sufficiently intense to 
 occasion death. 
 
 Richond 1 has detailed three cases of this form of gastric apoplexy, 
 if I may so express myself; cases in which the patients after having 
 suffered from chronic affections of the stomach and liver for a 
 longer or shorter period, suddenly fell victims to apoplexy, when 
 the disease of the stomach assumed a more acute form. I have, in 
 the preceding cases, sufficiently explained the manner in which 
 attacks of apoplexy or fatal cerebral congestion take place after pro- 
 longed irritation of the stomach of the inflammatory kind. 
 
 I must again call the reader's attention to the fact, that the pro- 
 cess of digestion is one which determines into the coats of the 
 stomach a flow of blood proportionate to the quantity of aliment 
 taken and to its quality ; that which offers most resistance to the 
 action of the gastric fluids promotes the greatest flow of blood, and 
 causes the greatest irritation. Thus it will be perceived that the 
 process of digestion of large quantities of food differs but little from 
 that primitive morbid state of the stomach I have described in this 
 work under the title Hyperemia (excess of blood, not combined 
 with the tissue of the organ in which it takes place, and conse- 
 quently not strictly of an inflammatory character.) 
 
 1 De 1'Influence de PEstomac sur la Production de 1'Apoplexie. Paris, 
 1824. Similar forms of apoplexy or fatal cerebral congestion have also been 
 observed by Schroeter, De apoplexizt ex prsecordiis vitiis, &c. and Koch, De 
 apoplexia bilios&. 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 165 
 
 CASE 6. A little boy, aged ten, had been indisposed for some 
 weeks, he suffered from occasional fits of stupor, and once in every 
 two or three days had a slight convulsion. The convulsions in- 
 creased and at length occurred daily after dinner. At this meal he 
 ate voraciously, and consumed large quantities of animal food; fell 
 asleep immediately he had dined, and awoke convulsed. He was 
 directed to take daily a grain and a half of calomel, with four of 
 rhubarb, and his food was given to him in very small quantities at 
 stated periods. He had no return of his convulsions after this plan 
 of treatment was established. 
 
 Remarks. This case, not of unfrequent occurrence, is adduced 
 as an example of hyperemia of the stomach, consequent upon the 
 digestion of large quantities of stimulating food, producing a similar 
 condition of the brain under the influence of which convulsions are 
 excited. The hot and sensible stomach, the stupid and heavy head 
 at once prove this to be the pathologic state of both organs. Here 
 we observe no disease except what the state of the stomach during 
 digestion produces. By reducing the quantity of food, so as to 
 lessen the degree of excitement in the stomach during digestion, 
 all the evils give way. If, on the contrary, the same manner of 
 living had been continued, it is highly probable that the complaint, 
 already excited in the head, might have terminated in serous effu- 
 sion, or a fatal form of congestion of blood. 
 
 There are other forms of cerebral disease consequent upon 
 gastric irritation, which do not consist purely in fulness of blood. 
 In the forms of disease I have passed in review, the morbid actions 
 observed are confined chiefly, if not altogether, to the vascular 
 system. In the present series of cases, irritation is seated princi- 
 pally in the nervous system of the parts affected, and the forms of 
 vascular excitement which accompany them are secondary, though 
 demanding great attention, since, in the brain, such affections 
 much more commonly terminate in fatal effusion, than in the 
 instances already adduced. 
 
 The irritations of the stomach, which produce the affections of 
 the brain I am about to notice, exhibit symptoms of a character 
 different from those just mentioned ; whilst the sympathetic affec- 
 tions observed in the brain are likewise indicated by distinct symp- 
 toms. The following cases will afford examples of the nature, 
 progress, and terminations of such affections, and the mode of 
 treatment best calculated to afford relief. 
 
 CASE 7. An elderly lady consulted me in the spring of last 
 year, for painful sensations connected with the digestion of her food, 
 which had harassed her for some time, and which lately had been 
 attended by symptoms which had occasioned her some alarm. 
 After eating a moderate quantity of the ordinary kinds of food, she 
 was tormented by a pain in the stomach, which sometimes became 
 extremely violent : the pain was accompanied by great swelling of 
 the stomach, nausea, and occasional vomiting. The bowels were 
 confined, although a mild aperient acted freely upon them; the 
 
166 
 
 PARKER ON THE STOMACH. 
 
 tongue dry, smooth, and red ; (he epigastric region hot, and sensible 
 to pressure. The pulse was remarkably slow, full, and unsteady, 
 occasionally intermitting. After the pain, nausea, .and distension of 
 the stomach had continued for a few days, the patient began to 
 complain of giddiness, ringing in the ears, and pain in the head, with 
 great stupor and imperfect or distorted vision. The state of the head 
 bore a strict relation to the affection of the stomach, and was miti- 
 gated or aggravated with it. If the pain and uneasy sensations in 
 the stomach were worse, the stupor aud indistinct vision were worse 
 also; whatever increased the affection of the stomach added to the 
 complaint in the head. Local depletions from the epigastrium, 
 with anodyne fomentations over that region, for an hour or two in 
 the course of every day, afforded great relief. Still, stupor and pain 
 in the head, with affections of the sight and hearing, continued, and 
 demanded special attention. These were materially benefited by 
 blisters. 
 
 The effects of aperient medicines in this case demand particular 
 attention, for although the head and stomach were both made 
 worse by constipation, active aperients did more harm than the 
 confined bowels. The state of the stomach, and that of the head, 
 were never relieved by active aperients, such as combinations of 
 aloes and rhubarb, or solutions of the neutral salts in bitter infu- 
 sions. They ahoays added to the irritation already existing. 
 I recommended four grains of rhubarb to be exhibited three times 
 a day, with an eighth of a grain of the muriate of morphia. This 
 lady likewise took the hydrocyanic acid in the mistura cretse with 
 great relief. The rhubarb generally kept the bowels sufficiently 
 open : its operation was occasionally assisted by an injection of 
 warm salt and water. 
 
 Remarks. We have to remark, in this case, the nature of the 
 disease, and the effects of remedies. The affection of the sensibility 
 observed in the stomach, evidenced by pain, distension, nausea, 
 vomiting, &c., was unquestionably combined with inflammatory 
 action, and was one of those forms of disease described in the earlier 
 parts of this work, in which lesions of the sensibility of the stomach 
 are combined with a certain form and degree of inflammation. We 
 observe a repetition of the disease in the stomach to arise sympa- 
 thetically in the brain ; and here the same pathologic state is recog- 
 nised. At the time that we notice an excited state of the circulation 
 in the brain, marked by the heat of the head, and increased force 
 of the pulsation of the carotid arteries, we observe a degree of irri- 
 tation which is proper to this organ as a mass of nervous matter ; 
 this irritation, being marked by the giddiness, ringing in the ears, 
 and the imperfect and distorted vision. That these latter symptoms 
 are not altogether dependent upon vascular excitement is evident, 
 since they yield more readily to blisters than to the local abstraction 
 of blood. Hence it is that these forms of irritation in the brain ter- 
 minate, not in cerebral congestion, not in undue fulness of blood, 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 167 
 
 but in effusion of serum ; and these terminations occur when pre- 
 vious local vascular excitement in the brain has not existed, or has 
 been so trivial that it is impossible to attribute to it the results 
 which we witness. 
 
 We notice in this case a point of great importance the effect of 
 active aperients on the condition of the stomach and brain. Brous- 
 sais has said that, in gastric or gastro-enteric inflammations, aperient 
 remedies are decidedly injurious, adding to the irritation and tend- 
 ing to the production of fatal organic changes in the mucous mem- 
 brane of the stomach. Others have treated these opinions as 
 chimerical, and have continued to harass a membrane already irri- 
 tated by a succession of remedies calculated to do, in such states, 
 incalculable mischief. From my own experience, drawn from close 
 attention to this class of diseases for many years, I am convinced 
 that, although in many forms of gastric disease aperient remedies, 
 of a certain kind, are borne well and are productive of material 
 benefit, still there is another class of cases in which they are as 
 positively hurtful, and this class is well exemplified by the case just 
 related. Not only are aperients injurious to the particular stomach 
 irritation in question, but they are also prejudicial to the sympathetic 
 affections which it excites, since the irritation in the stomach which 
 produced the sympathetic disease, and upon which it depends, is 
 aggravated by the remedies employed. I believe that a constant 
 repetition of irritating aperients, in a case like the present, would, in 
 all probability, have terminated in serous apoplexy. 1 The mode in 
 which constipation may be most effectually removed, in cases of 
 great irritability of the stomach where constipation appears to add 
 to the complaint, is exemplified, among others in the treatment of 
 the last case. 
 
 The forms of gastric irritation I have just described, occasionally 
 terminate in fatal forms of disease in the brain, as the following case 
 will show. 
 
 CASE 8. In October 1835, a young lady, aged seven, was 
 brought to me, slightly indisposed. The parents supposed the sto- 
 mach to be disordered from some indigestible food which had been 
 eaten. The child complained of griping pain in the belly occa- 
 
 oiicilly; she had constant uneasiness and soreness about the epi- 
 astrium, with a red contracted tongue, and some slight frequency 
 of pulse. There was no complaint whatever of the head, nor did 
 the patient exhibit the slightest degree of stupor. The next day 
 the pulse was slow, creeping and occasionally unsteady. I now 
 looked upon the case with suspicion, arid stated my fears of the 
 result. On the evening of that day, the stupor increased, and on 
 the following morning she was profoundly comatose. In this state 
 
 1 " Purging medicines sometimes relieve unpleasant sensations ; but they 
 do not in general produce even this effect ; and all active purges seem to me 
 to increase disorder. It is natural to suppose that strong stimuli will aggra- 
 vate the unhealthy condition of weak and irritable parts." Abernethy, p. 53. 
 
168 PARKER ON THE STOMACH. 
 
 she lingered for some days, perfectly insensible to every thing, 
 except pressure upon the epigastrium. If this were done she 
 writhed, and appeared to suffer great pain, uttering a mournful cry. 
 some dark green evacuations were passed involuntarily during the 
 continuance of the coma. She died on the fifth day from its com- 
 mencement. 
 
 Permission could not be obtained to examine the body. 
 
 Remarks. The brain and spinal chord, in children, appear to 
 sympathise more readily with gastro-intestinal irritation than in 
 adults. Hence is it that we see the slightest forms of gastritis, or 
 even gastric irritation, speedily produce in them convulsive motions 
 by the rapidity with which such irritations radiate to the great 
 nervous centres. The case just adduced is an example of this. 
 Although convulsions, the result of gastric irritation, are more 
 common in children and young persons, still they are occasionally, 
 under certain conditions of the nervous system, observed in adults. 
 
 A middle aged man was seized, without any known cause, with 
 profuse bilious vomiting, pain in the epigastrium, and fever. About 
 twenty hours after the appearance of these symptoms, he began to 
 feel some difficulty in depressing the jaw; violent trismus soon set 
 in, and continued for the two following days. The spasm extended 
 to the muscles of the trunk, and the patient died. 
 
 On examining the body, the brain and spinal chord were found 
 perfectly healthy, as far as anatomy was capable of appreciating 
 their condition. The stomach throughout its whole extent was of 
 an intensely red colour; this resulted from "the injection of an 
 immense number of small vessels." This inflamed condition could 
 not be perceived till a thick layer of mucus, which lined the surface 
 of the stomach, was removed.' 
 
 One point in the history of this case is deserving of particular 
 attention. Although the disease was ushered in by symptoms 
 exclusively referable to the stomach, still, after the sympathetic 
 disease which the gastric irritation had called forth was fully esta- 
 blished, the vomiting and pain in the stomach ceased: yet, after 
 death, we find the most vivid inflammation ; although this affection 
 of the stomach had ceased to be indicated by the symptoms which 
 primarily accompanied it, the disease is still observed to remain. 
 In this, as in many other examples detailed in this work, we observe 
 the symptoms of the primitive disease of the stomach to be masked 
 by the more formidable ones which accompany the sympathetic 
 affection. 
 
 It is thus that we find the symptoms of gastric irritation some 
 times exhibited in the heart, at other times in the lungs, and again 
 in the brain or muscular system, whilst the symptoms directly indi- 
 cative of a diseased condition of the stomach are obscure. These 
 remarks apply equally to chronic as to acute diseases. 
 
 The integrity of the intellectual powers is unquestionably modi- 
 
 'Clinique M6dicale, Case 30, p. 676. 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 169 
 
 fied by the condition of the material organ, through which these 
 symptoms are made manifest: hence is it that we find different 
 states of the mind dependent upon different conditions of the san- 
 guineous circulation in the brain. I have shown, in the preceding 
 cases, the influence exercised by diseases of the stomach upon the 
 condition of the circulation in the brain in the production of various 
 forms of cerebral congestion, and its termination in serous and 
 sanguineous apoplexy. I shall now bring forward some examples 
 to illustrate the influence which these modified conditions of the 
 circulation in the brain, the result of gastric irritation, exercise 
 upon the condition of the intellectual powers, and the production 
 of diseases of the mind. 
 
 I was consulted by the friends of a middle-aged lady, in the 
 summer of 1834, for symptoms connected with a disordered con- 
 dition of the mind, which they fancied depended upon her general 
 health. The patient was subject to extraordinary fits of irritability. 
 She complained of uneasiness in the region of the stomach, which 
 was hot, tender, and the seat of a strong pulsation, but had no 
 other symptom indicating gastric disease. She was materially 
 benefited by leeching the epigastrium, and by the exhibition of 
 warm stomachic aperients: these remedies had always a marked 
 effect upon the condition of the mind. I afterwards lost sight of 
 the patient, but learned that she became a confirmed maniac. 
 
 A poor woman had been ill for many months with vomiting after 
 meals and a sense of broiling in her stomach, accompanied by in- 
 describable sensations of uneasiness in the part, which did not 
 amount to pain, but produced the utmost degree of despondency. 
 Stimulating medicines and a full diet were resorted to by her medical 
 attendants. She soon became completely insane, but ultimately 
 recovered. 
 
 A young man, mentioned by Pinel, swallowed some cigars: 
 inflammation of the stomach followed, which terminated in melan- 
 choly and suicide. 
 
 A soldier, whose case is likewise alluded to by this author, swal- 
 lowed a glass of brandy containing gunpowder: mania succeeded, 
 which lasted several months. 
 
 I was consulted by R. V., some time since, for uneasy sensations 
 connected with his stomach. These constantly distressed him, but 
 were worse after eating. He had occasional vomiting, distension 
 of the stomach, eructations, and slight uneasiness in the epigastric 
 region. He received little benefit from medicine, but was so far 
 relieved by leeches and a blister to the stomach, that he returned 
 to his occupation, fancying himself well. I was suddenly sum- 
 moned to him some time afterwards, and found him suffering from 
 great mental uneasiness, accompanied by pain in the head, heat in 
 the forehead and temples, acute pain in the epigastrium, which the 
 patient could cover with his finger, frequent vomiting of sour fluids, 
 pinched and anxious countenance, cold skin, and a small, frequent 
 pulse. He has never been quite free from uneasiness after his 
 
170 PARKER ON THE STOMACH. 
 
 meals since my first attendance: but the paroxysms of pain now 
 succeeding a meal are terrible till it is rejected by vomiting. His 
 nights are restless: and if he sleep at all, he is tormented by dreams 
 of a most extraordinary character, intensely vivid and distinct. In 
 the waking state he is visited byJiallueinations^of all kinds, the 
 most common of which is that of a large bird, which flying against 
 his head with great force, produces, as he imagines, his headach. 
 In the day, the desire to commit suicide is almost irresistible, and 
 his wife is obliged to remove all dangerous instruments from his 
 presence. 
 
 Small numbers of leeches applied over the epigastrium, succeeded 
 by a blister, using internally a combination of rhubarb with the 
 muriate of morphia, at the same time restricting my patient to a 
 mild, unstimulating diet, completely cured his stomach, whilst his 
 mind was restored to its accustomed tranquillity with it. This is 
 an example of the first degree of those forms of mental excitement 
 the result of gastric irritation, which occasionally terminate in 
 lunacy or mania, and of which I have just reported some c^ses. 
 This patient would most certainly have destroyed himself had he 
 been treated with stimuli, or suffered to indulge in a mixed, full 
 diet, which created any irritation in the stomach during the process 
 of digestion. 
 
 I have reported in the earlier parts of this work some cases of 
 morbid states of the stomach dependent upon large losses of blood; 
 these forms of disease occasionally produce affection of the mind 
 much resembling those which result from other causes. 
 
 A lady had been subject for some time to large losses of blood 
 from the uterus. When I first saw her, the chief complaint was 
 of the stomach. She had internal heat and broiling, uneasiness, 
 sensations of something at work within, nausea, vomiting, and 
 great pain after eating. The epigastric, region was hot, and the 
 seat of a strong pulsation; manual examination of it produced in- 
 describable feelings of dread and anxiety. Her mental distress was 
 extreme, and the anxiety, restlessness, and irritability verged very 
 closely upon a state of perfect mental alienation. I recommended 
 a full diet, and ordered the carbonate of iron to be taken with myrrh 
 and rhubarb. The patient speedily recovered from this plan of 
 treatment. So closely do symptoms, depending upon totally oppo- 
 site states, resemble each other. 
 
 In enquiring into the influence of the stomach upon the brain, 
 we must commence with a notice of the period of digestion, since 
 we observe the condition of the brain, and that of the intellectual 
 powers to be most materially modified by this process. A full 
 meal determines in the brain a degree of evanescent congestion, or 
 turgescence which continues as long as the process of digestion 
 lasts. The effect of this state of the circulation in the brain is 
 variable in different individuals; in some it inclines to stupor, in 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 171 
 
 others to loss of memory, it disposes a third to rest, whilst in a 
 fourth it produces restlessness. 1 
 
 That condition of the stomach which I have described as active 
 hyperemia, in many instances reacts upon the brain; and by pro- 
 ducing a similar state of that organ modifies and changes its mode 
 of action. In case 1, we observe this condition of the brain to be 
 accompanied by disorder in the functions of the senses, the vision 
 was indistinct, there was ringing in the ears and giddiness. In 
 case 2, a similar condition of the brain consequent upon the same 
 state of gastric irritation, we have the intellectual powers affected, 
 the patient lost the faculty of memory, and the tone of the mind in 
 other respects weakened. 
 
 In both these instances we observe the first degree of that dis- 
 turbance in the brain which in more acute forms of disease, termi- 
 nates in coma, apoplexy, or mania. Passing on to a more serious 
 degree of complaint in the stomach, we recognise the confirmed 
 inflammatory state, combined in various ways with derangements 
 of the sensibility of the stomach, and consequently with different 
 conditions of nervous and vascular excitement in the brain. 
 
 The morbid states of the stomach which most materially influence 
 the condition of the brain are three: 
 
 1. Inflammatory states. 
 
 2. Diseases of its sensibility. 
 
 3. Disordered states of its secretions. 
 
 In practice, however, none of the states will be found single and 
 uncombined. We find the inflammatory state constantly existing 
 with the disease of sensibility, and the disordered state of the secre- 
 tions sometimes depending upon inflammation, and in others, due 
 to different forms of nervous disease in the stomach. 
 
 The affections of the brain which succeed to these forms of irri- 
 tation in the stomach are various, and may be classed in the follow- 
 ing order: 
 
 1. Evanescent stupor, or drowsiness. 
 
 2. Coma. 
 
 3. Fatal forms of cerebral congestion. 
 
 4. Effusion. 
 
 5. Convulsions. 
 
 6. Variations in the conditions of the intellectual powers. 
 
 a. Excitement, delirium. 
 
 b. Melancholy, depression. 
 
 c. Loss of one or more of the mental faculties, as me- 
 mory, &c. 
 
 7. Alterations in the functions of the senses. 
 
 The ferain appears to be influenced through the medium of the 
 stomach, in most instances, by the direct transmission of irritation 
 from one organ to the other. The relations between the mucous 
 
 1 See the chapter on the physiological influence of the Stomach upon the 
 Brain. 
 
172 PARKER ON THE STOMACH. 
 
 membrane of the stomach and the brain are so intimate, that we 
 find if the circulation in the stomach be accelerated, if this organ 
 be in a state of hyperemia, or active congestion, the same state is 
 produced in the brain. Whatever excites the stomach quickens 
 the circulation in the latter organ. These remarks are well illus- 
 trated by some of the preceding cases, and it is from this circum- 
 stance that we find persons subject to stupor, and great drowsiness 
 after eating, become suddenly apoplectic after a meal. Richond 
 has recorded three cases, and I have detailed two, of patients becom- 
 ing suddenly apoplectic, or comatose under the influence of gastric 
 irritation, which had suddenly assumed an acute form. 
 
 We must remember, as Broussais has very justly remarked, that 
 neither medicine nor food can influence the condition of our organs 
 except by modifying the condition of the stomach. And he assures 
 us that when we observe the eyes and the face redden from intoxi- 
 cation, it is because the mucous membrane of the stomach has 
 itself first suffered from this state. 1 It is, however, when the sto- 
 mach, previously morbid, is thrown into a state of increased irri- 
 tability by food greater in quantity than the digestive powers can 
 easily dispose of, or of a nature which is not easily acted upon by 
 the secretion of the stomach, that we observe the forms of sympa- 
 thetic irritation in the brain that I have already noticed. 
 
 It is in these circumstances, more particularly, that we observe 
 the brain sympathising with the stomach, and remark those infinite 
 variations in its functions which follow a meal, in patients suffering 
 from the varied forms of gastric irritation. The brain sympathises 
 with the stomach very readily, when the former organ is healthy 
 and the latter diseased; but, when the brain is previously diseased, 
 we observe sympathetic irritation to be still more readily excited in 
 it by a diseased stomach, and, under such circumstances, the affec- 
 tions of the brain very quickly assume an alarming, and even fatal 
 character. 
 
 When the brain once begins to sympathise with an irritable sto- 
 mach, and we witness alterations in the function of the latter organ, 
 such as drowsiness, headach, succeeding a meal, or an attack of 
 indigestion ; we shall find that the least circumstance determines a 
 repetition of the irritation, and hence is it that the symptoms 
 observed in the brain recur more or less after every full meal, whilst 
 the gastric irritation lasts. It is this continued repetition of slight 
 irritations, which ultimately lays the foundation in the brain of 
 organic changes, appearing slight perhaps to the mere pathologist, 
 but which by the irritation they produce in this organ terminate 
 ultimately in fatal effusion or congestion, when the morbid state of 
 the stomach, from some accidental cause, becomes suddenly worse. 
 Case 5 is an illustration of the correctness of these remarks. Most 
 
 l The hundred and twentieth aphorism of this Physiologist, and his com- 
 mentary upon it in the Commentaires des Propositions, &e. t. i. p. 153, are 
 well worthy of perusal on these sympathies. 
 
INFLUENCE OF ITS MORBID STATES ON THE BRAIN. 173 
 
 of the cases, also, collected and recorded by M. Richond, in his work 
 on the Influence of the Stomach upon the Production of Apoplexy, 
 corroborate the importance of this proposition. 
 
 The organic changes determined in the brain by continued or 
 constantly repeated gastric irritation are various ; they are more 
 commonly found to consist in opacities of the arachnoid, effusions 
 of turbid serum, and states of increased vascularity of the substance 
 of the brain. It should be borne in mind, that diseases of the 
 stomach destroy life, riot so much by the changes produced in the 
 organ itself, as by the sympathetic diseases which are established 
 in the course of years, in other organs, by continued or constantly 
 repeated irritation in the stomach. The stomach is necessary to 
 life from the circumstance that by it the nutritive fluid is prepared 
 which supports life. All persons, however, conversant with patho- 
 logic researches, are aware that the function of digestion is some- 
 times well performed by a stomach frightfully disorganised, and 
 we have no supposition of the existence of disease until anatomy 
 reveals it to us. Persons not at all emaciated, and in whom ail 
 the functions appear to be properly performed, having occasionally 
 extensive disease of the mucous membrane of the stomach. It is 
 by the reaction of the stomach upon other organs that life is com- 
 monly destroyed; by the production of diseases which tend to fatal 
 terminations in organs more important to life than the stomach, 
 as the lungs, heart and brain. 
 
 I have brought forward numerous cases in the several divisions 
 of this work, illustrating these points. 
 
 Whilst, however, the sympathetic diseases produced by the sto- 
 mach, in organs essential to life, render the condition" of these 
 organs special objects of attention, it must be remembered that the 
 state of the stomach which produced them demands equal atten- 
 tion; since, whilst the latter remains, the sympathetic irritations 
 will be constantly disposed to recur, as long as their exciting 
 cause remains. 
 
 CHAPTER XIII. 
 
 OF THE TREATMENT. 
 
 THE treatment of diseases of the stomach may be divided into 
 two grand sections dietetic and medicinal. Of the former enough 
 has been said in the writings of Paris, Johnson, Wilson Philip, 
 Abernethy, and others, to render a recurrence to it here unneces- 
 sary; the latter must be framed to suit the particular group of 
 symptoms manifested by different individuals; and for this purpose, 
 we shall distribute the symptoms into several classes, taking the 
 
174 PARKER ON THE STOMACH. 
 
 predominant symptoms which demand the chief attention as the 
 type of disease in the class to which it belongs. 
 
 1. Of the treatment of those forms of stomach disease whose prominent 
 symptoms are pain and constipation. 
 
 In the affections of the stomach which are characterised by 
 these two predominant symptoms, we have internal pain of a more 
 or less violent character, occurring at various periods after a meal, 
 which sometimes increases to such an extent as hardly to leave the 
 patient free for an hour, the pain occasioned by one meal not 
 having subsided, before it it is again called forth by a second. 
 These forms of disease are commonly accompanied by constipa- 
 tion, which invariably aggravates the patient's state; and yet the 
 common forms of aperient remedies cannot be borne, on account 
 of the great additional disturbance they create. I will detail a 
 case as a type of this class of symptoms: A lady, aged forty-two, 
 had been subject to attacks of pain after food for fifteen years, they 
 were now increased to such an extent that she was never free 
 from distress, mixed food produced agonising pain, and even thin 
 cold gruel occasioned considerable uneasiness. The bowels were 
 obstinately confined, she passed three or four days without an 
 evacuation, which was then only artificially induced; the tongue 
 was red and smooth, the pulse frequent; the epigastrium was 
 scarcely sensible to pressure. She had emaciated much during 
 the two months previous to my attendance. Leeches and counter- 
 irritants were used to the epigastric region without much relief, 
 but the patient lost all pain, the bowels were relieved, and in a few 
 weeks she was completely established by confining her to farina- 
 ceous and milk diet, and giving the following medicines. R. Pulv. 
 rhaei gr. iv., morphise muriatis gr. yV M. ft. pil. ter die sumend : 
 c. cochlear. iij. larg. rnisturae sequent. R. Infus. cascarillee 3 vii., 
 magnes. sulphatis g ss, magnes. carb. pond. 3 iss, tinct. aloes, gss, 
 acidi hydrocyanic! tflxv., tinct. humuli 3 ii. M. capital cochlear. iij. 
 larg. ter die. These medicines acted freely, without occasioning 
 pain or any uneasiness. They were employed by the patient for 
 three months with the greatest benefit, occasionally increasing the 
 quantity of morphia. 
 
 I have not found material benefit from leeches in such forms 
 of disease as these, nor generally from counter-irritants. I believe 
 the best of the latter that can be employed are blisters, powdering 
 the denuded surface of the latter with a grain or more of the ace- 
 tate or muriate of morphia. I have seen a number of cases of 
 constipation of this kind, which have been aggravated by drastic 
 and cold saline aperients, yield almost magically to the combina- 
 tion I have just mentioned. Enemas had also been totally ineffi- 
 cient in relieving the constipation. These forms of disease appear 
 dependent upon a slight inflammatory affection of the stomach 
 occurring in patients of great nervous susceptibility; sometimes 
 
INFLUENCE OP ITS MORBID STATES ON THE BRAIN. 175 
 
 they are accompanied by tenderness in the epigastrium, a red, 
 loaded tongue, frequency of pulse, and evening accessions of fever, 
 whilst at others, the tongue is pale, the pulse small, but not fre- 
 quent, the skin cold, and tenderness in the epigastrium entirely 
 absent. In the former of this class of symptoms, I should consider 
 the disease one of sensibility, combined with a trivial degree of 
 inflammatory action ; in the second, a disease of sensibility alone. 
 To the former of these diseases, Barras has applied the term "gas- 
 tro-enteralgie avec lagastro-enterite chronique;" certainly, in many 
 cases, the symptoms of inflammation are decidedly present, whilst 
 in others the disease of sensibility exists without this complication. 
 In the former state small local depletions are of service, but, if the 
 loss of blood be large, the nervous symptoms are invariably aggra- 
 vated ; three, four, or six leeches applied from time to time are 
 of great service ; a larger number frequently increase the pain, 
 and add to the debility of the patient, which if the disease has 
 continued a long time, is, in many cases, very great. The con- 
 stipation should be relieved by the form of remedy I have given, 
 or a similar one. The following I have found of great service, 
 leeching, or blistering, the epigastrium at the same time, if ten- 
 derness be present. 
 
 R Magnes. carb. pond. 3i., bismuth subnitratis gr. v., morphiae 
 muriatis gr. 11^ ft. pulvis ter die snmendus. 
 
 This is chiefly useful after the constipation has been removed. 
 After the bowels have, by appropriate treatment, been brought to 
 act well without medicine, and the whole of the symptoms of in- 
 flammatory disease have subsided, a combination of the muriate or 
 the acetate of morphia with the carbonate or sulphate of iron ; or 
 the syrup of morphia with the muriate or the ammoniated tincture 
 of iron, will generally be found serviceable in preventing the 
 recurrence of pain. 
 
 The indications under this head are to remove pain, to obviate 
 constipation, by which it is invariably aggravated, to subdue con- 
 comitant inflammatory action, and to enable the stomach, when 
 these intentions have been accomplished, to fulfil its offices again 
 properly. 
 
 2. The treatment where vomiting and diarrhoea are the predominant 
 
 symptoms. 
 
 In many cases these symptoms exist together, or vomiting comes 
 on occasionally, when an habitual state of relaxed bowel is con- 
 stantly present. In other cases, vomiting may be present with 
 constipation, or diarrhoea may exist without vomiting. In the 
 great majority of instances, both these symptoms are dependent 
 upon a chronic irritation of the gastro-intestinal mucous mem- 
 brane, of the inflammatory kind. It is a common circumstance to 
 find persons, indulging in the pleasures of the table, with bowels 
 constantly relaxed, at the same time they have total loss of appe- 
 
176 PARKER ON THE STOMACH. 
 
 tite, whilst the tongue is foul, the papillae elevated, and the front 
 and edges of the organ vividly red. At times headach or thirst is 
 added to the other symptoms. The most simple aperient in many 
 of these cases will produce profuse evacuation. I have noted 
 many of these cases continuing for months together. Suddenly 
 the symptoms of acute gastritis have been manifested, and the epi- 
 gastrium, which was not before tender, has become so sensible that 
 the slightest pressure could hardly be borne. 
 
 A gentleman, aged forty-eight, had suffered from this state for 
 many months, his bowels were habitually relaxed, two or three 
 loose evacuations daily; a small dose of rhubarb or magnesia pro- 
 duced six or seven stools, he had no appetite, and a loaded tongue, 
 vividly red at the point and edges. He had not the least epigas- 
 tric tenderness. At times severe vomiting, with increased diar- 
 rhoea, would come on, unattended by pain, in which state he found 
 relief from a combination of blue pill with opium, and the mist, 
 cretce with conf. opii, and hydrocyanic acid. These symptoms 
 suddenly assumed an acute form, he had fever and acute pain in 
 the epigastrium, pressure in this region could hardly be borne, 
 whilst every thing taken into the stomach produced most severe 
 pain. These symptoms were subdued by daily relays of leeches, 
 at the same time the patient took internally the hyd. c. creta with 
 p. ipecac, co. and the hydrocyanic acid in almond emulsion. Un- 
 der this plan the appetite became good, the tongue clean, and the 
 bowels lost that disposition to irritability which they exhibited be- 
 fore the appearance of the acute attack. 
 
 In all cases of this kind, the great point in the treatment is to 
 allay the irritability of the mucous surfaces by mild opiate, antacid, 
 or absorbent remedies; no active measures should be resorted to, 
 they invariably aggravate the patient's condition ; a mild, unstimu- 
 lating, nutritious diet, consisting of milk and farinaceous aliments, 
 with such medicines as the hyd. c. creta, with p. ipecac, co., two 
 grains of the former with one of the latter for a dose, the carbonate 
 of soda with morphia if much acidity be present, or a gram or two 
 of rhubarb with the same anodyne, are the best and safest reme- 
 dies to be employed ; the hydrocyanic acid also may be given with 
 these remedies in the raistura cretae. Should the epigastrium 
 become tender, it must be leeched ; after the repetition of local 
 depletion two or three times, if the tenderness continues, without 
 much heat of skin, blisters may be employed, and the surface pow- 
 dered with morphia, or dressed with an ointment containing three 
 or four grains of this salt to the ounce. 
 
 It is this form of gastro-intestinal irritation which so frequently 
 precedes the development of hepatic and pulmonary diseases. 
 Andral has noticed the tendency to irritation in the lungs of 
 patients so affected. I have collected the cases of several indi- 
 viduals, who seem disposed to hepatic diseases, and who, if these 
 irritations are suffered to remain unchecked, speedily become 
 jaundiced. 
 
ON THE TREATMENT. 177 
 
 3. Treatment of the more acute forms, characterised by great epigastric 
 tenderness and irritability of the vascular system. 
 
 When we find the more acute forms of gastric inflammation, 
 arising in persons predisposed to great vascular excitement, with 
 increased heat of skin, accelerated pulse, throbbing of the heart, 
 and giddiness after a meal, continuing during the whole period of 
 digestion, and accompanied by great sensibility of the epigastrium, 
 our first treatment must consist in the local abstraction of blood 
 from this region ; this should be continued daily in small quanti- 
 ties proportionate to the strength of the patient, whilst any heat 
 or tenderness remains, or whilst the arterial system is excited by 
 taking food. In the intervals, the stomach should be covered by 
 a fomentation of hops, poppies, or an aqueous solution of opium, 
 whilst we limit the patient to a strict dietetic discipline tepid 
 gruel, or thin farinaceous food ; and give him internally such reme- 
 dies as the following: R. acid nitro-muriatici M. xl., morphias 
 muriatis gr. to gr. j., syr. simp. i., aquae distillatas g vii., M. capt. 
 cochlear. iij. larg. 4 tis horis. These are exactly the forms of 
 gastric inflammation, which Broussais has taken as a type of the 
 whole series; and here we agree with him that aperient medicines 
 are decidedly hurtful, not only augmenting the tendency to irrita- 
 tation of the stomach itself, but also increasing the vascular excite- 
 ment, and disposition to the occurrence of sympathetic affections 
 of other organs, as the heart and brain. 
 
 A gentleman, about 45 years of age, had suffered from vomit- 
 ing, flatulence, and fulness after his meals, for some time, with 
 tenderness and great heat in the epigastrium, acceleration of pulse, 
 throbbing of the carotids, palpitation, stupor, giddiness, and ina- 
 bility to think after having eaten. The daily application of leeches 
 to the epigastrium relieved the symptoms to convalescence; at 
 the same time the patient took internally the mixture prescribed 
 above. In this case a tea-cupful of food (even gruel) brought 
 on the symptoms in their usual form. There are two remarkable 
 points illustrated by this case: the inflammatory form of a great 
 majority of cases of simple indigestion, marked in the first in- 
 stance by mere fulness after a meal, which was the primary 
 symptom in this case; and the great importance of limiting the 
 patient, in such diseases as the present, to just so much food as 
 may be digested with comfort, without stimulating the mucous 
 coats of the stomach to a degree which may excite the heart or 
 arterial system. In such forms of disease as the present, the mode 
 of local bleeding proposed by Roche might be adopted with great 
 benefit i. e., to apply leeches to the epigastric region, at the 
 periods only when the febrile or arterial excitement comes on ; 
 for, in many instances, this is only manifested after the periods of 
 taking food. In the intervals, the patient is comparatively well; 
 hence, the great point in the treatment is to diminish the excita- 
 12 d park 12 
 
178 
 
 PARKER ON THE STOMACH. 
 
 bility of the stomach to impression at the time when food is taken 
 into it. Dr. Roche was of opinion that the inflammatory condi- 
 tion of the stomach, and the irritability consequently manifested, 
 was not much relieved by bleeding in the intervals of the acces- 
 sions of vascular excitement, which were manifested, as in the 
 present instance, after a meal. 
 
 4. Treatment where fulness, distension and acidity, with flatulence and 
 eructations after eating, are the predominant symptoms. 
 
 To this class of symptoms the term indigestion is most fre- 
 quently applied. These symptoms mark a condition of the stomach 
 in which active hyperemia, or morbid fulness of blood, not amount- 
 ing to inflammation, is the pathologic character of the disease. 
 This is the first step to chronic gastritis, but it is not the disease. 
 In these forms, when the stimulus of food is absent, the coats of 
 the stomach return to their customary state, and the patient is well 
 till another full meal brings on again the congested condition of 
 its mucous membrane. Taking this condition of the stomach as 
 one of its primary morbid states, we may see how easy is the pro- 
 gression into confirmed chronic inflammation, and its terminations 
 in changes of colour and consistence, softening, ulceration, or 
 cancer. The treatment of this form of disease must depend, in a 
 great measure, upon the addition of other symptoms to the pre- 
 dominant ones, just now detailed, such as pain after food, epigas- 
 tric tenderness, diarrhoea, or constipation. If the epigastric ten- 
 derness be not marked, and the bowels, as they commonly are, full 
 and confined, we may commence the treatment by removing the 
 use of stimulants from the plan of alimentation, and limiting the 
 patient to milk and easily digestible food. It is here that aperi- 
 ents, judiciously administered, are of great service; but we must 
 bear one thing in mind in their exhibition, viz., that the stomach 
 and bowels being in a morbid state, are particularly sensible to im- 
 pression, in these forms of disease ; and hence the administration 
 of purgative medicines, although clearly indicated and properly 
 chosen, is sometimes followed by a degree of relaxation of the 
 bowels approaching to hypercatharsis. I have seen this state pro- 
 duced over and over again, when the symptoms of hyperemia of 
 the stomach were present, and the bowels at the same time con- 
 fined. For the same reason does digitalis produce vomiting when 
 exhibited in this state of the stomach, complicated with disease of 
 the heart. Stimulant diuretics in dropsies or hepatic diseases are 
 productive of the same evils, where this state of stomach is present. 
 The forms of aperient remedies I am generally in the habit of em- 
 ploying in these states are the following: R. Pil. hyd. gr. ii., 
 pulv. rhaBi gr. iii., ipecac, co. gr. i., mucilaginis q. s. ft. pil. ii. 
 These may be taken twice or thrice a day, with two or three table- 
 spoonfuls of the mixture prescribed in the first section. If the 
 flatulence be distressing, a combination of the pil. hydr. with the 
 
ON THE TREATMENT. 179 
 
 pil. galbani co. is of great service. At other times, the blue pill 
 may be used with the extract of hyoscyamus. These remedies 
 should be given with different proportions of the mixture, accord- 
 ing to the circumstances of the case. 1 have found great benefit 
 from exhibiting the pills and mixture one hour before dinner, once 
 in the day, and repeated before the evening meal, if the bowels 
 require it. 
 
 If much tenderness and pain exist in the epigastrium, if the 
 pulse be full and hard, the tongue red and dry, small relays of 
 leeches will be of great use. I have frequently cured these indi- 
 gestions by this remedy alone; four or six leeches, every two or 
 three days, applied during the period of digestion, requesting the 
 patient, at the same time, to abstain from all stimulating aliments, 
 and to live upon thickened milk, sago, or farinaceous food, sub- 
 stituting cocoa for coffee or tea. 
 
 Much stress is laid by the French physicians on the use of 
 mucilaginous and acidulated drinks during active hyperemias, or 
 inflammatory states of the mucous coats of the stomach. This is 
 a treatment which is too much neglected in this country, as well 
 as that of anodyne fomentations to the epigastrium. The experi- 
 ments of Dr. Beaumont 1 show that, during fits of repletion or of 
 gastric derangement, from over stimulating or other causes, or 
 during feverish states of the constitution, the mucous coat of the 
 stomach becomes dry and covered by red patches; this is the state 
 that may be supposed to occur two, three, or four hours after a full 
 meal, the period of its occurrence being marked by thirst. This 
 condition of the mucous coat is also present during ordinary fits 
 of indigestion, and hence the propriety of defending the sentient 
 extremities of the gastric nerves from the rude impression of 
 alimentary substances, when the stomach is in this state, by mild 
 tepid acidulous or mucilaginous drinks, taken in small quantities. 
 Broussais assures us that he has frequently prevented the passage 
 of mere indigestion, of the inflammatory form, into confirmed 
 gastritis, by exhibiting small portions of drinks of this character 
 during the accession of the fits of indigestion after a meal. We 
 know that the sentient extremities of all nerves, throughout the 
 economy, must be kept in a moist state, in order that they may be 
 enabled to fulfil their customary functions. For this purpose, we 
 find the extreme branches of all nerves covered by particular 
 fluids. If these fluids be dried up, the nerve no longer transmits 
 a true impression to the brain, and its organic, as well as its 
 animal sensibility becomes destroyed, or morbidly exalted. Itard 
 has attributed one species of deafness to absence of the fluid in 
 which the extremities of the auditory nerves are distributed, in the 
 semicircular canals and cochlea, in the internal ear. 
 
 I do not think that revulsives, such as blisters, the tartar emetic 
 
 'Experiments and Observations on the Gastric Juice and the Physiology 
 of Digestion. Plattsburg, 1833. 
 

 180 PARKER ON THE STOMACH. 
 
 ointment, or plaster, or frictions with croton oil are generally 
 beneficial in affections of the stomach of this character, in fact in 
 diseases of this order generally, unless the disease be perfectly 
 apyretic. I have seen them, if applied whilst any vascular excite- 
 ment is present, productive of great mischief. 
 
 The outline of the treatment, given by Dr. Stokes, of chronic 
 gastritis, in the article of that name in the Cyclopaedia of Practical 
 Medicine, is well suited to the incipient forms of inflammatory 
 indigestion. This consists in small local bleedings, diet, and seda- 
 tives, such as the salts of morphia, and hydrocyanic acid. Tho 
 combination of these two latter remedies, in various forms, with 
 mild aperients, is, however, of singular use in various forms of 
 disease of the stomach. I have given some forms of combination 
 in which these remedies may be employed. Dr. Chauffard, of 
 Avignon, 1 employs chiefly, in these forms of indigestion or gastric 
 hyperemia, small bleedings, with anodyne or acidulous drinks. 
 He appears to have been very successful in his treatment of die 
 inflammatory forms of indigestion. 
 
 I shall now offer a few remarks on the principal remedies 
 employed in diseases of the stomach. 
 
 Bleeding, general and local. General bleeding in diseases of 
 the stomach, even of the inflammatory kind, is inadmissible, except 
 perhaps in very severe forms of acute gastritis, where a single 
 bleeding might be employed at the commencement of the treat- 
 ment, prior to local depletions from the epigastrium. The testi- 
 mony of most authors is against general bleeding. Broussais was 
 singularly unsuccessful in its employment, even in cases of acute 
 disease, which we shall see by reference to his cases thus treated. 2 
 Local bleeding is, on the contrary, one of the most efficacious 
 remedies that can be employed in all affections of this kind. It 
 should not precede the use of other remedies, but when these 
 seem to be productive of little benefit, or mere temporary amend- 
 ment, judicious local depletion from the epigastrium should be em- 
 ployed. This remedy may be resorted to in all cases where ful- 
 ness of blood in the mucous coat of the stomach is suspected, from 
 whatever cause it may arise : even in cases of extreme emaciation 
 from long continued disease, two, three, or four leeches will some- 
 times alleviate symptoms which no medicine will benefit. In 
 cases of acute inflammation, leeches may be employed freely to 
 the number of fifteen or twenty at each time. If, however, acute 
 or sub-acute gastritis arise during the progress of an affection of 
 the heart or the liver, the depletion must be more cautiously em- 
 ployed, recollecting that we have to deal with a constitution already 
 enfeebled, or rendered irritable in consequence of long continued 
 disease. In cases of confirmed chronic inflammation of the sto- 
 mach, more benefit will be derived from the daily application of 
 
 *De la Saignee, et des Emolliens dans les Indigestions. 
 * Cases 5, 6, 7, art. Influence of the stomach upon the lungs. 
 
ON THE TREATMENT. 181 
 
 small relays of leeches to the number of six or eight, than from 
 one large depletion where more are employed. I consider the 
 quantity of blood taken at a time in cases of this kind to be of 
 extreme importance. Unpleasant nervous symptoms very com- 
 monly accompany diseases of the stomach of the inflammatory 
 kind, and a trifling degree of inflammation sometimes produces an 
 affection in which the nervous symptoms predominate over the in- 
 flammatory ; hence local depletion, although of vast utility, should 
 be employed with care and caution, for it is a very common cir- 
 cumstance to see large depletions of this kind succeeded by an 
 aggravation of the concomitant nervous symptoms. The largo 
 local bleedings resorted to by Broussais, and the physicians of the 
 French physiologic school, have been productive of infinite mis- 
 chief. If we peruse carefully the work of Barras, Des Gastral- 
 gies et des Enteralgies, we shall be convinced that many of the 
 cases related by him of nervous affections of the stomach and 
 bowels were the result of large local bleedings, the use of fifty, 
 sixty, or even eighty, and a hundred leeches at each application. 
 Many of the examples reported by M. Barras, which are considered 
 by him merely nervous diseases, and which were so at the time he 
 was consulted, requiring nothing but full diet and steel for their 
 cure, were, in the commencement, diseases of the inflammatory 
 kind, the patient having been rendered irritable and nervous by 
 the large bleedings and rigid abstinence employed at the com- 
 mencement of the treatment. De Larroque, whilst he illustrates 
 the utility of moderate depletions from the epigastrium in inflam- 
 matory diseases of the stomach, irritating the lungs, loudly ex- 
 claims against the large local bleedings practised by many of the 
 physicians of the physiologic school. The period of bleeding is 
 also of importance. Many forms of gastritis are strictly periodical; 
 in others, the prominent features of the disease, as pain and disten- 
 sion of the stomach, heat of skin, and quickened circulation are 
 only present after meals. It is during these accessions that bleed- 
 ing should be employed; it is at these periods very much more 
 useful both as a palliative and curative remedy, both in producing 
 present relief, and preventing: the recurrence of future attacks, than 
 when resorted to at other times in the intervals of the exacerba- 
 tions of disease. 
 
 Aperients. Many physicians appear to regard all gastric irrita- 
 tions as mere suburral states, and consequently employ strong dras- 
 tric aperients for their cure. By others, all aperient remedies are 
 condemned, as likely still more to excite a membrane already red- 
 dened by irritation. I have shown that there are many forms of 
 stomach disease, in which constipation is a prominent and distress- 
 ing symptom, adding materially to the inconvenience and suffer- 
 ing of the patient; in such cases, although aperients are indicated, 
 and of the greatest utility when properly selected, they frequently 
 add to the disease and suffering: already present, if violent and not 
 combined with sedatives. The best aperients that can be used in 
 
182 
 
 PARKER ON THE STOMACH. 
 
 these diseases are combinations of the pil. hydrargyri with rhubarb 
 or aloes, combined with the pil. galbani co., the extracts of hops, 
 lettuce, or hyoscyamus, or the salts of morphia. Calomel, com- 
 bined with the pil. aloes cornp. and some sedative, is also in certain 
 cases useful. The proportion of the mecurial for each dose should 
 rarely exceed one grain. These remedies, with solutions of the 
 neutral salts in bitter infusions, to which the hydrocyanic acid is 
 added, are the forms of aperient which I have invariably found 
 most useful; they operate freely without pain or uneasiness, and 
 generally afford the patient very marked relief. 
 
 Sedatives. This is an important class of remedies in diseased 
 conditions of the mucous membrane of the stomach. In all forms 
 of inflammation, there is mostly an exalted state of the sensibility 
 of the part inflamed. The peculiar organisation, however, of cer- 
 tain nerves, particularly those of the ganglionic system, and the 
 system of the par vagum, render the exalted sensibilities of the 
 mucous surfaces of the stomach and intestines inappreciable by 
 the brain, unless they pass a certain limit. Hence, in some in- 
 stances, inflammatory disease of these organs proceeds to actual 
 disorganisation, without the patient being aware of its existence; 
 whilst, in others, a slight degree of inflammation will produce in- 
 tense febrile excitement. It is from a knowledge of the peculiar 
 sensibilities of these parts that we may see the great use of seda- 
 tives in the treatment of their inflammatory or other forms of dis- 
 ease; and it is, also, from this circumstance, that I never prescribe 
 an aperient remedy in diseased conditions of the stomach, without 
 combining it with some preparation of morphia, the hydrocyanic 
 acid, or the extract of henbane. The best sedative that can be 
 employed is the muriate of morphia. In all inflammatory affections 
 of the stomach, this remedy, combined with aperients or with alka- 
 lies, or given merely to allay pain or irritability, is of great use. 
 Others, however, may be given according to circumstances, such 
 as the acetate of morphia, the hydrocyanic acid, the lip. opii seda- 
 tivus, or the extracts of hop, lettuce, or henbane. These are the 
 chief sedatives of use in such affections, and perhaps they answer 
 all the necessary indications. They are generally more useful in 
 combination with alkalies or aperients than when given simply and 
 uncombined. The external application of sedative remedies to the 
 epigastric region, in many painful affections of the stomach, I have 
 found of very great service, whether these affections are primitive, 
 or whether they result from organic change. In cases of extreme 
 thicknening of the coats of the stomach, of a scirrhoid character, 
 where the suffering patients are almost worn out with constant 
 pain, such remedies, applied over the epigastrium, most materially 
 alleviate the distress. We have no hope, in many of these deplo- 
 rable cases, of eradicating or curing the disease; but still we may 
 afford great ease to the patient, enable him to follow some gentle 
 occupation, and to digest a mild unirritating food without pain, 
 and even with comfort. In many forms of disease, a piece of 
 
ON THE TREATMENT. 183 
 
 flannel soaked in a strong solution of opium, and worn over the 
 epigastrium, affords great relief; or, what is more efficacious, a 
 solution of from two to four drachms of the extract of belladonna 
 in six or eight ounces of water, to be used tepid as an application 
 to the part. A poultice of the leaves may be also applied, or one 
 of hyoscyamus, hop, or poppy. These remedies are highly ser- 
 viceable in all diseases of the stomach accompanied by pain. They 
 may be employed with equal service in acute inflammatory affec- 
 tions of this organ, or where gastric irritation occurs as a compli- 
 cation in fevers and inflammatory diseases generally. 
 
 Antacids and Absorbents. We learn from the researches of 
 Prout, Tiedeman and Gmelin, and Dr. Beaumont, that the gastric 
 juice, during digestion, contains free hydro-chloric and acetic acids, 
 and that these acids are furnished in greater quantity in direct pro- 
 portion to the more or less stimulating qualities of the food. Under 
 a mild farinaceous diet these acids are barely detected. Many dis- 
 eased conditions of the stomach are accompanied by this increased 
 generation of acid in its secretions, and in some instances intense 
 acidity after food forms one of the most prominent and distressing 
 features of the complaint. Great intestinal irritability also frequently 
 accompanies this disposition to the formation of acid in the stomach, 
 and the patient is commonly tormented with tenesmus, or purging 
 of small, watery, hot stools. In these cases it becomes necessary 
 to administer remedies to neutralise this excess of acid, as well as 
 to adopt others to prevent the disposition to its recurrence. The 
 mistura cretse of the London Pharmacopeia, given with large 
 doses of hydrocyanic acid, is here particularly serviceable, more 
 especially in those forms in which intestinal irritation is present. 
 I have found this combination of remedies of singular service in 
 gastric diseases attended with a profuse secretion, or formation of 
 acid. At other times, the ponderous carbonate of magnesia, or 
 soda, combined with morphia and the sub-nitrate of bismuth, may 
 be employed. 
 
 Tt occasionally happens, that intense acidity accompanies or suc- 
 ceeds to a state of great bodily weakness, particularly when this is 
 the result of large losses of blood, as in the cases I have detailed in 
 the section of the work on Diseases of the Stomach produced by 
 Anemia. Here the condition of the stomach is dependent upon that 
 of the constitution generally, and yields to remedies suited to the 
 general affection upon which the morbid state of the stomach 
 appears to depend. In these forms of disease, the various prepara- 
 tions of iron are eminently serviceable : combinations of the car- 
 bonate of iron with myrrh and rhubarb, are perhaps amongst the most 
 efficacious that can be employed. 
 
 Tonics. There are many forms of gastric disturbance which 
 resemble hyperemia, or inflammation, which are not benefited, but 
 rather rendered worse, by a treatment framed to suit such forms of 
 disease; hence it is, that we very commonly see local depletion from 
 the epigastrium and aperient medicines injurious to many affections 
 
184 PARKER ON THE STOMACH. 
 
 of the stomach, which we should have supposed, from the symp- 
 toms which they exhibited, would have been benefited by such 
 remedies. It is because these symptoms depend upon some other 
 cause, and not upon hyperemia or inflammation, that these remedies 
 are not successful ; and yet it is difficult, nay sometimes impossible, 
 to distinguish between vascular irritations of the stomach and other 
 affections of this organ, the results of treatment being occasionally 
 our only guides. 1 
 
 It is in many of these states, that we find tonics succeeding where 
 an antiphlogistic treatment has failed, or been positively hurtful. I 
 subjoin one or two cases, by way of example. 
 
 A gentleman consulted me, complaining of unpleasant symptoms 
 connected with his head and stomach, which invariably harassed 
 him after eating, and during the process of digestion. He had 
 swelling of the stomach, nausea, flatulence, uneasiness and tender- 
 ness in the epigastrium with great drowsiness and stupor. He took, 
 at first, combination of the blue pill with rhubarb, and the stomachic 
 aperient mixture prescribed at page 174. These remedies afforded 
 no relief; the patient was worse after their use, and yet the symp- 
 toms characterising his complaint, both in the head and stomach, 
 resembled very much a condition of hyperemia in both organs, 
 which we see so frequently benefited by such a plan of treatment. 
 I now recommended the carbonate of iron, to be taken in combina- 
 tion with myrrh and rhubarb. The use of these remedies for a few 
 days, completely removed the affection of both organs. This is not 
 a case of rare occurrence ; I have repeatedly noted cases of pain in 
 the stomach, with constipation, heat, beatings, and tenderness in the 
 epigastrium, exactly resembling hyperemia of the stomach, or the 
 nervous centres of the epigastrium, aggravated by leeches to this 
 region, and the use of aperients, yield readily to such remedies as 
 those I have just noticed. 
 
 I have repeatedly been consulted by a young lady, who suffered 
 constant pain in the stomach after eating ; at the same time her 
 bowels were habitually constipated, the epigastric region was hot 
 and tender, and the seat of strong pulsations ; the tongue dry and 
 coated, the papillae vivid and largely developed. No permanent 
 relief was afforded in this case from local bleeding or aperients ; after 
 the complaint had been established for some time they were 
 injurious. Great benefit was derived subsequently from the carbo- 
 nate of iron, with myrrh and rhubarb. 
 
 Tonics are useful in many morbid states of the stomach; which 
 may be referred to four classes ; 
 
 1. Primitive morbid conditions, resembling inflammatory affec- 
 tions, which are aggravated by an antiphlogistic treatment, or by 
 aperients. 
 
 2. States of disease, succeeding to inflammation, which have 
 been benefited by an antiphlogistic treatment in the commencement, 
 
 1 See the remarks on this subject at p. 48. 
 
ON THE TREATMENT. 185 
 
 but where this no longer affords relief, or adds to the seventy of 
 the symptoms. 
 
 3. Various morbid states of the sensibility of the stomach. 
 These are occasionally accompanied by intermittent neuralgic 
 affections in other parts of the body. 
 
 4. States of general debility, and many local symptoms, as pain, 
 nausea, and vomiting, which accompany confirmed organic diseases 
 of the stomach. 
 
 I have shown in the former parts of this work, that there are 
 certain forms of irritation in the stomach which succeed to affec- 
 tions in the first instance inflammatory, which are benefited by a 
 tonic treatment. The disease, at first one of inflammation, having 
 been subdued, terminates in one of debility ; and the remedies found 
 useful in the earlier forms of the affection, become decidedly injurious 
 in the latter. "We often find pain, distension, acid eructations, 
 nausea, and vomiting, with tenderness in the epigastrium, succeed 
 to irritations which have been, at the onset, benefited by leeches to 
 the epigastrium, warm aperients, and a rigid diet. These symptoms 
 are very liable to come on as the sequel to inflammatory affections 
 of the stomach which have been treated with large losses of blood 
 from the epigastric region. Most of the cases detailed by M. Barras, 
 cured by tonics and a full diet, were diseases of debility in the sto- 
 mach produced in this way. The great art in managing affections 
 of the stomach of this kind is to mark the point at which the disease 
 ceases to be inflammatory and passes into one of debility or of sen- 
 sibility. It is at such a time that the antiphlogistic plan should be 
 abandoned, and tonics and a fuller diet substituted for it. I have 
 frequently been consulted by patients who have been reputed the 
 subjects of confirmed chronic gastritis ; they have been pale, ema- 
 ciated, tormented with pain and sickness, and have had stomachs 
 so sensible that they could hardly take the least particle of food 
 without pain. These persons have been treated with leeches to 
 the stomach, which have at first afforded relief; subsequently, by 
 different modes of counter-irritation, blisters, and the tartar emetic 
 ointment : still they go on getting worse, the gastric symptoms con- 
 tinue and they are supposed to be suffering from an incurable 
 chronic gastritis. These cases were originally inflammatory affec- 
 tions ; the inflammation has been subdued, and passed on to a dis- 
 ease of debility. This has been accompanied by its peculiar symp- 
 toms, which have been supposed to depend on a continuance of 
 the inflammation when they were due to an opposite cause. By 
 placing such cases on a full diet, and exhibiting freely the carbo- 
 nate of iron, the symptoms have soon given way, and the patients 
 have speedily recovered their usual health, all the unpleasant 
 symptoms connected with the stomach speedily subsiding. The 
 combinations of the carbonate of iron with the muriate of morphia, 
 in such cases, if much pain exist, or with rhubarb, if constipation be 
 present, are perhaps among the best remedies that can be employed. 
 
ANALYTICAL INDEX. 
 
 CHAPTER I. 
 
 PAGE. 
 
 On morbid states of the stomach characterised by increased vascularity, . 
 
 Two primitive morbid states common to the stomach ; affections of its sensibility 
 and vascular irritations, ..... 
 
 The first primitive morbid state, one of fulness of blood in its mucous coat, 
 
 Symptoms by which it is indicated, ...... 
 
 Case, illustrating its pathology, . 
 
 This condition of the stomach one of hyperemia distinct from inflammation, 
 
 No distinct line to be drawn between hyperemia of the stomach and inflammation ; 
 the difference in degree, not in kind, .... 
 
 Terminations of hyperemia of the stomach ; if continued may end in true inflam- 
 mation of this organ, or produce disease in the liver, brain, lungs or heart, 
 
 Inflammatory and feverish diseases generally accompanied by active hyperemia of 
 the stomach ; importance of ascertaining the state of the stomach before framing 
 the plan of treatment in any disease, . . 
 
 State of the stomach at the commencement of the eruptive and continued fevers, 12 
 
 CHAPTER II. 
 
 On morbid states of the stomach dependent upon anemia, 
 
 Laborious and painful digestion occasionally succeeds to large losses of blood from 
 
 different organs of the economy, .... 
 
 Case, illustrating the symptoms and mode of treatment of this state of the stomach, 13 
 Case nausea, vomiting, acidity, &c , succeeding to large losses of blood from the 
 
 uterus; cured by tonics, . ... 
 
 Case, resembling inflammation, depending upon the same cause ; cured by tonics, 14 
 Case of the same kind; cured by tonics, . 
 
 Physiological observations on these forms of disease, . ... .15 
 
 CHAPTER III. 
 
 General review of the symptoms and sympathies dependent on vascular irritation 
 of the stomach, ........ 
 
 Inflammatory nature of some forms of indigestion, 
 
 Symptoms ; state of the tongue in the primary forms of vascular irritation of the 
 stomach, . . . . . . . . 
 
 Of the state of the epigastric and hypochondriac regions, . .18 
 
 Of the symptoms of vascular irritation of the stomach, observed in the organs of 
 respiration, ........ 
 
 In the organs of circulation ; state of the pulse and heart, 
 
 Of symptoms presented by the brain and senses, . 
 
 Of the variable seats of pain accompanying these states, . 
 
188 ANALYTICAL INDEX. 
 
 
 
 CHAPTER IV. 
 
 PAGE. 
 
 Of confirmed inflammatory affections of the stomach, . . . .23 
 
 Of inflammatory affections of the stomach accompanied by a peculiar condition of 
 the tongue, ......... 23 
 
 Case aphthous condition of the tongue coinciding with symptoms of chronic in- 
 flammation of the stomach, . . . . . . .24 
 
 This state of the tongue may be purely local, and exist without any affection of 
 the stomach, ......... 25 
 
 The state of the tongue, in stomach diseases, deceptive ; does not afford certain 
 data of the kind or degree of disease existing in the stomach ; first series of facts 
 the tongue natural and the stomach diseased, .... 26 
 
 Case pale moist tongue, co-existing with inflammation and softening of the sto- 
 mach, ......... 26 
 
 Case pale moist tongue, inflammation with softening of the stomach, . . 26 
 
 Case inflammation and softening of the stomach, moist, contracted and pale 
 tongue, .......... 26 
 
 Second series of facts in which the tongue is morbid and the stomach healthy, 27 
 
 Case in illustration, . . . . . . . " . 27 
 
 Third series, in which both stomach and tongue are morbid, . . 27 
 
 Case in illustration, ........ 27 
 
 Case in illustration, ........ 27 
 
 Great vascularity, and development of the papillae of the tongue commonly indi- 
 cative of irritability of the stomach, ..... 27 
 
 Of the symptoms of inflammatory affections of the stomach drawn more particu- 
 larly from the organ itself, ....... 28 
 
 Of the appetite, and sensations produced in the stomach by eating, . . 28 
 
 Of the seats, and characters of pain, ...... 29 
 
 Pain seated in the left hypochondrium when disease is confined to the greater 
 curvature of the stomach, . . . . . . .30 
 
 Pain and tenderness in the epigastrium not pathognomonic of a diseased condition 
 of the stomach. Reasons why this is so frequent, .... 30 
 
 Fulness and distension after meals, . . . . . .31 
 
 Chronic vomiting, ........ 31 
 
 As a symptom of inflamed condition of the mucous coat of the stomach, more com- 
 mon at the commencement of disease, and when the chronic assumes the more 
 acute form, ......... 32 
 
 Case in illustration, ........ 32 
 
 Case in illustration, ........ 
 
 Vomiting may depend upon many other causes than inflammation of the stomach, 
 frequently upon affections of other organs, ..... 33 
 
 Frequent attacks of vomiting, apparently depending on a mere functional affection 
 of the stomach, sometimes lay the foundation of organic disease; case in illus- 
 tration, .... 33 
 
 Manner in which the inflammatory forms of indigestion produce disease in other 
 organs, symptoms by which the extension of disease to other parts is indicated, 
 nature of the disease, produced, . . . . 
 
 Two characters of pain occurring in patients suffering from chronic inflammation 
 of the stomach neuralgic and inflammatory, .... 34 
 
 Case illustrative of that character of pain, strictly dependent upon inflammation, 
 and of the treatment adopted to relieve it, . . . . . 35 
 
 Case illustrative of the neuralgic form of pain which accompanies an inflamed 
 condition of the stomach, mode of treatment suited to it, different from that of 
 the former, ......... 35 
 
 CHAPTER V. 
 
 On affections of the stomach characterised by derangement of its sensibility, 36 
 
 Morbid states of the sensibility of the stomach, lesions of innervation may exist 
 * without inflammatory action, ....*. 36 
 
 Such affections occasionally succeed to inflammation, . . . .37 
 
ANALYTICAL INDEX. 
 
 189 
 
 PACK. 
 
 Diseases of the sensibility sometimes closely resemble forms of chronic inflamma- 
 tion ; case in illustration, . . . . . . .37 
 
 Fatal cases uf chronic vomiting, and pain in the stomach without appreciable dis- 
 ease, .......... 37 
 
 Varieties of form which diseases of the sensibility assume, ... 38 
 
 Succeed to haemorrhages, and to large local depletions from the region of the 
 stomach, . ..... 39 
 
 Frequently combined with inflammatory action, . . . . .40 
 
 Treatment suited to the different forms, ..... 40 
 
 Case Severe pain after eating, accompanied by a discharge of glairy, and acid 
 fluid from the mouth, gradual emaciation from the long continuance of disease. 
 Observations, and mode of treatment applicable to such affections, . 41 
 
 Case Morbid sensibility of the stomach ; great mental uneasiness ; epigastric pul- 
 sation ; nature of those forms of disease; mode of treatment appropriate, 44 
 Case morbid sensibility of the stomach, .... .46 
 
 Case morbid sensibility ; great mental distress, . 
 
 Case morbid sensibility, &c., ...... 47 
 
 Diseases of the sensibility of the stomach, sometimes accompanied by vascular 
 excitement, ......... 47 
 
 General plan of treatment medicinal and dietetic, . . . .47 
 
 Table of the distinctions between the symptoms of nervous and inflammatory dis- 
 eases of the stomach, . . . . . . . .49 
 
 Sometimes closely resemble each other, ..... 51 
 
 Occasionally blended during the progress of disease, . . . .51 
 
 CHAPTER VI. 
 
 On affections of the stomach characterised by morbid states of its secretions, 52 
 
 A disordered condition of the secretions of the stomach constitutes a third primitive 
 morbid state, ......... 52 
 
 Pathology w f this state, ....... 53 
 
 Its symptoms to be sought for in the stomach itself, or in the sympathetic irrita- 
 tions of other organs, ........ 53 
 
 State of the tongue and epigastric region, ..... 53 
 
 Secretory irritation of the stomach may be combined with inflammation or various 
 affections of the sensibility of the stomach, ..... 54 
 
 Case secretory irritation of the stomach ; sympathetic affection of the head ; cure 
 by emetics, ......... 55 
 
 Case chronic secretory irritation of the stomach ; sympathetic affection of the 
 chest; cure by emetics, ....... 56 
 
 Case secretory irritation of the stomach; sympathetic affection of the chest simu- 
 lating pleurisy, ........ 57 
 
 Case secretory irritation of the stomach; sympathetic affection of the breathing 
 resembling asthma, ....... 58 
 
 Case secretory irritation of the stomach ; sympathetic affection of the chest simu- 
 lating organic disease of the lung, ...... 58 
 
 Secretory irritation, with active hyperemia of the stomach; treatment suited to 
 these forms of combination, . . . . . 59 
 
 Case secretory irritation, with active hyperemia of the stomach ; treatment suited 
 to these forms of combination, ...... 59 
 
 Case secretory irritation, with inflammation of the stomach, . . .61 
 
 Of gastorrhcaa, ........ 63 
 
 Anatomical characters of the disease, . . . . . .63 
 
 Symptoms, ......... 63 
 
 Treatment, ... .64 
 
 CHAPTER VII. 
 
 On the influence of the stomach upon other organs, . . . .66 
 Upon the liver, . ... 
 
 Mode in which the process of digestion acts upon the liver, . .66 
 
 Transmission of sympathies by the mucous membranes, ... 67 
 
190 ANALYTICAL INDEX. 
 
 By the veins, ......... 67 
 
 Physiological influence of the stomach upon the lungs, ... 68 
 
 Through the medium of the nerves, . . . . . .68 
 
 Mechanical influence of a distended stomach, .... 69 
 
 Irritation of the diaphragm, . . . . . . .69 
 
 Sympathies of the mucous membranes of the two organs, ... 69 
 
 Physiological influence of the stomach upon the heart, . . . .71 
 
 Mechanical influence, . . ... . . . 71 
 
 Influence of the process of digestion, . . . '. . .72 
 
 Of active hyperemia, or inflammation of the stomach, ... 73 
 
 Physiological influence (if the stomach upon the brain, . . . .74 
 
 Relations of the brain and the epigastric nervous centre, ... 74 
 
 Influence of the process of digestion, . . . . . .75 
 
 Of active hyperemia of the stomach, ...... 75 
 
 State of the intellectual powers the result of this state of the stomach, . . 76 
 
 Pathological state of the brain, ...... 77 
 
 Brain influenced through the medium of the heart, . . . .77 
 
 State of the brain dependent on that of the sensibility of the stomach, . 77 
 
 CHAPTER VIII. 
 
 On the influence of morbid states of the stomach upon the origin, progress and 
 
 termination of diseases of the liver, ...... 78 
 
 On the primary symptoms of diseases of the liver, .... 78 
 
 Arise insidiously after long continued gastric irritability, . . .78 
 
 Causes, according to Ferrus and Berard, ..... 79 
 
 Influence of hyperemia of the stomach upon the origin of diseases of the liver, 79 
 Symptoms of the earlier forms of hepatic diseases, . . . .79 
 
 Constant coincidence of gastric disturbance with the progress of diseases of the 
 
 liver, . . ....... 80 
 
 Nature of the accompanying affection of the stomach, ... 81 
 
 Primitive forms of hepatic diseases, ...... 81 
 
 Inflammatory affections of the stomach coinciding with diseases of the liver, 82 
 Transmission of disease from the stomach to the liver by means of venous inflam- 
 mation, . . . . . . . . 83 
 
 On some of the symptoms attendant on advanced stages of diseases of the liver, 83 
 
 On the state of the digestive organs in the latter stages of diseases of the liver, 84 
 On the symptoms observed in disturbances of the circulation, . . .84 
 
 On the symptoms observed in disturbances of the organs of respiration, . 8u' 
 Particular cases: Case 1 inflammatory indigestion for twenty-five years; sub- 
 acute inflammation of the stomach ; hypertrophy, with sanguinous congestion of 
 
 the liver, . . . . . . . 89 
 
 Remarks, pathological and practical, on such forms of disease, . . 90 
 
 Case 2 sub-acute inflammation of the stomach and bowels; sudden appearance of 
 
 diseases in the liver, ....... 92 
 
 Remarks, ......... 92 
 
 Case 3 symptoms of chronic gastritis of long standing; schirrous hardness and 
 great enlargement of the liver; great relief afforded by exclusive attention to the 
 
 hepatic disease, ........ 93 
 
 Pathological and practical remarks, . .... 93 
 
 Case 4 gastro-enteritis ; softening and disorganisation of the liver in its left lobe, 95 
 
 Remarks, .......... 96 
 
 Case 5 dyspeptic symptoms for two years ; gastritis ; hepatitis ; abscess of the 
 
 liver ; dropsy, ........ 97 
 
 Remarks, ...... .^ . . 98 
 
 Case 6 dyspeptic symptoms for four years ; redness, with *softening of the sto- 
 mach; abscess of the liver, ...... 98 
 
 Pathological and practical remarks, ...... 99 
 
 Case 7 chronic inflammation of the stomach and duodenum ; cancer of the liver, 99 
 Remarks, ......... 100 
 
 Symptoms observed in the stomach, which precede the development of cancerous 
 diseases of the liver, ........ 101 
 
ANALYTICAL INDEX. 191 
 
 State of the stomach accompanying hjdatids of the liver, . . . 101 
 
 On the influence of the stomach upon the formation of biliary calculi and upon the 
 bile, . .102 
 
 The natural characters of the bile always changed in protracted affections of the 
 stomach, ..... ... 102 
 
 Case 1 dyspeptic symptoms during life; intestinal inflammation; alteration of the 
 characters of the bile, . . . . . . . 102 
 
 Remarks on these forms of disease, . ... 102 
 
 Case 2 inflammatory indigestion for twelve months; discharge of biliary concre- 
 tions per anum, ....... 103 
 
 Case 3 inflammatory indigestion for twenty-five years; confirmed chronic gastri- 
 tis; death from acute gastritis; hypertrophy of the liver; disease of the coats of 
 the gall bladder; gall stones; alteration of the characters of the bile, . 103 
 
 Case 4 inflammatory indigestion commencing at the age of twenty, subsequently 
 confirmed chronic gastritis; alterations in the character of the bile; concretions; 
 diseased condition of the mucous membrane of the gall bladder, . . 104 
 
 Case 5 symptoms of indigestion; chronic gastritis; hypertrophy of the liver; 
 biliary concretion ; alterations of the bile, ..... 104 
 
 Case 6 sub-acute gastritis, schirrous gall-bladder, biliary concretions, . 104 
 
 Case 7 dyspeptic symptoms; chronic gastritis, disease of the gall-bladder; biliary 
 concretion, . . .... 105 
 
 Pathological and practical remarks on the preceding cures, . . 105 
 
 CHAPTER IX. 
 
 On the influence of morbid conditions of the stomach upon certain forms of 
 
 dropsy, ......... 107 
 
 Influence of hyperemia of the stomach upon ascites, .... 107 
 
 State of the stomach modifies the treatment in this disease, . . 108 
 
 Nature of the disease in the stomach, in its complication with dropsy, . 109 
 
 Case in illustration, ..... . . 109 
 
 Slate of the stomach in dropsy accompanying disease of the heart, . . 109 
 
 Case in illustration, . . . . . . . 109 
 
 On the use and abuse of digitalis in dropsy, ..... 110 
 
 CHAPTER X. 
 
 On the influence of the morbid states of the stomach upon the origin, progress, and 
 termination of diseases of the heart, ...... Ill 
 
 Case 1 palpitations after meals for some months; the meals also succeeded by 
 flatulence and nausea; subsequently acute gastritis, with inordinate action of the 
 heart, . . . ... . . . . .111 
 
 Pathological and practical remarks on these forms of disease, . . 112 
 
 Case 2 irregular action of the heart; intermittent pulse, caused by inflammation 
 
 of the stomach; no disease of the heart to account for its irregular action, . 113 
 Remarks on such forms of disease, ...... 113 
 
 Similar case quoted from Cruveilhier, ...... 113 
 
 Causes of irregularities in the heart's action, . . . 114 
 
 Peculiarities of pulse dependent upon hyperemia, or inflammation of the stomach, 115 
 Cases in illustration, ....... 115 
 
 Remarks on the varieties in the condition of the pulse accompanying different 
 forms of disease in the stomach, . . . . . 116 
 
 Of the association of disease of the stomach with disease of the heart, . . 118 
 
 Case 8 disease of the heart; fungoid ulceration of the mitral valve, with inflamma- 
 tion of the mucous coat of the stomach ; great relief afforded to the symptoms of 
 disease of the heart by mitigating that of the stomach, . . . 118 
 
 Practical remarks on the co-existence of these diseases, . . . 119 
 
 Symptoms accompanying them, ...... 119 
 
 Treatment effects of remedies, ...... 122 
 
 State of the stomach in acute affections of the heart, . . . 122 
 
 Influence of the stomach upon organic affections of the heart, . . . 122 
 
 Case in illustration, . . . ... . . . 122 
 
192 ANALYTICAL INDEX. 
 
 .^ 
 
 PAGE 
 
 Influence of protracted gastric diseases upon the physical condition of the heart, 123 
 
 Case in illustration, . . ... 123 
 
 General history of the influence of the stomach upon the heart, . . 124 
 
 Irregularities in its pulsation dependent on gastric irritation, . . . 124 
 
 State of stomach producing them, ...... 124 
 
 Sympathetic irritations of the heart stimulating organic disease, . . 125 
 
 The irregularities in the action of the diseased heart are rendered more severe by 
 
 complaint existing in the stomach, ..... 126 
 
 Pathology of the stomach during organic diseases of the heart, . . 127 
 
 Use and abuse of digitalis, ....... 128 
 
 CHAPTER XL 
 
 On the influence of morbid states of the stomach, upon the origin, progress, and 
 
 termination of diseases of the lungs, ..... 128 
 
 Case 1 incessant cough, depending on inflammation of the stomach ; cured with 
 
 the later affection, . . . ... . 128 
 
 Remarks upon cough depending on affections of the stomach, . . . 129 
 
 Case 2 cough dependent upon chronic inflammation of the stomach; cure with 
 
 the stomach disease, . . . . . . . 130 
 
 Remarks, ......... 130 
 
 Case 3 long continued chronic inflammation of the stomach with cough; profuse 
 
 muco-purulent expectoration, ...... 131 
 
 Remarks, . ...... 132 
 
 Case 4 sub-acute inflammation of the stomach, producing the symptoms of an 
 inflammatory affection of the lungs ; cure of the pectoral by the removal of 
 the stomach disease, . . . . . . . 132 
 
 Case 5 inflammation of the stomach, stimulating inflammation of the mucous 
 membrane of the lungs; healthy condition of the lungs ascertained after death; 
 disease confined to the mucous membrane of the stomach, . . 133 
 
 Remarks, ......... 134 
 
 Case 6 inflammatory affection of the stomach, simulating an inflammatory dis- 
 ease of the lungs ; healthy condition of the lungs ; disease confined to the 
 mucous membrane of the stomach, ...... 134 
 
 Remarks, ......... 135 
 
 Case 7 inflammatory affection of the stomach, accompanied by symptoms resem- 
 bling a similar condition of the lungs; healthy state of the lungs; source of 
 disease in the stomach, ....... 135 
 
 Remarks un the symptoms exhibited in the three last cases, . . 136 
 
 Case 8 inflammatory affection of the stomach accompanied by cough, and, subse- 
 quently, symptoms resembling pleurisy; origin of disease in the stomach alone. 137 
 Case 9 long continued gastric irritation, accompanied by pain in the chest resem- 
 bling pleurisy, and irregular action of the heart. .... 137 
 
 Remarks, . . . . . . . . 138 
 
 Case 10 inflammation of the lungs complicated with, and apparently succeeding 
 to, that of the stomach ; cure of the pulmonary by the chief attention to the 
 stomach disease, ........ 138 
 
 Case 11 inflammation of the lungs complicated with that of the stomach; influ- 
 ence of the latter over some of the symptoms exhibited by the former, 140 
 Case 12 pleuro-pneumonia co-existing with intestinal inflammation, . 141 
 Remarks upon the exhibition of certain remedies in such states of disease as the 
 
 preceding, ......... 141 
 
 Case 13 consumption of the lungs, succeeding to long-continued gastric irritation 
 
 of the inflammatory kind, ...... 142 
 
 Remarks on the nature of such diseases, ..... 142 
 
 Case 14 inflammatory irritation of -.the stomach producing consumption, . 144 
 
 Case 15 consumption succeeding to chronic inflammation of the stomach, . 146 
 General history of diseases of the stomach, in their influence upon the origin, pro- 
 gress, and termination of diseases of the lungs, 
 
 Nature of the symptoms which indicate pulmonary irritation arising in the stomach, 147 
 Cough after food, . . 147 
 
 Indolence of the epigastrium in such states, . . . . 17 
 
ANALYTICAL INDEX. 193 
 
 PAGE 
 
 Mode of distinguishing the pulmonary irritations which depend on morbid states 
 
 of the stomach, ... .... 147 
 
 Hurried and irregular respiration from gastric irritation, . . . 149 
 
 Mode in which irritation extends from the stomach to the lungs, .' . 149 
 
 Nervous irritation of the lung, the result of gastric disturbance, terminates in con- 
 gestion or inflammation, ...... 150 
 
 Various forms of irritation in the lungs, existing without the physical signs of dis- 
 ease ; mode of distinguishing their origin when physical signs of disease in 
 the lung are present, . . . . . . . 151 
 
 Simultaneous occurrence of diseases of the stomach and lungs, . . 151 
 
 Profuse discharges of muco-purulent matter from the lungs occasionally cure dis- 
 eases of the stomach, . . . . . . 152 
 
 False pleurisy from stomach derangement, ..... 152 
 
 Inflammation of the lungs succeeding to, and complicated with, that of the 
 
 stomach ; bilious pneumonia of Stoll, ..... 152 
 
 Tubercular consumption from protracted gastric and gastro-enteric irritation, 154 
 
 Hemoptysis from the same cause, . ... 155 
 
 CHAPTER XII. 
 
 On the influence of morbid states of the stomach upon the origin, progress, and 
 
 termination of diseases of the brain, ..... 156 
 
 The functions of the brain deranged under the influence of diseased conditions of 
 
 the stomach, ........ 156 
 
 Character of these derangements, ...... 156 
 
 Changes in the stomach and brain, upon which these functional affections appear 
 
 to depend, . . . . . ' . . 156 
 
 Sympathetic affections of the brain which accompany the process of digestion, 157 
 Cases 1 and 2 state of the brain produced by active hyperemia or inflammatory 
 
 affections of the stomach, ....... 157 
 
 Case 3 influence of diseased conditions of the stomach, the result of moral im- 
 pressions, upon the brain, ...... 159 
 
 Remarks on these forms of disease, ...... 159 
 
 The brain influenced by the stomach in two ways by the direct transmission of 
 sympathetic irritation frcm one organ to the other, and through the medium 
 of the heart, ........ 161 
 
 Case 4 influence of the stomach upon the brain, through the medium of the heart, 161 
 Remarks on these complications, ...... 161 
 
 Case 5 influence of morbid states of the stomach upon prganic diseases of the brain, 163 
 Remarks on gastric apoplexy, . . . . . . .163 
 
 Case 6 stupor and convulsions dependent on active hyperemia of the stomach, 165 
 Remarks, ......... 165 
 
 Case 7 giddiness, stupor, and affections of the senses, dependent upon an inflam- 
 matory affection of the stomach, combined with a morbid condition of its sen- 
 sibility, . ...... 165 
 
 Remarks on these forms of disease, and the use of aperient medicines in affections 
 
 of the stomach generally, , . . . . . 166 
 
 Case 8 fatal affection of the brain suddenly supervening upon gastric irritation, 167 
 Fatal tetanic convulsions excited by inflammation of the stomach, . . 168 
 
 Influence of the stomach upon the mind, ..... 168 
 
 Cases of lunacy and mania in illustration, . . . . .169 
 
 Mental despondency dependent upon Anemia of the stomach ; cure by tonics, 170 
 
 Influence of digestion upon the brain, . . . . . 170 
 
 Of active hyperemia of the stomach upon the brain, . . . . 171 
 
 Nature of the affections of the stomach which act upon the brain, . . 171 
 
 Character of the affections thus produced in the brain, .... 171 
 
 CHAPTER XIII. 
 
 Of the treatment, ..... 173 
 
 Of the treatment of those forms of disease of the stomach whose prominent symp- 
 toms are pain and constipation, ...... 173 
 
 12 e park 13 
 
194 ANALYTICAL INDEX. 
 
 PAGE 
 
 Of the treatment where vomiting and diarrhoea are the predominant symptoms, 175 
 Of the treatment of the more acute forms, characterised by great epigastric tender- 
 ness and irritability of the vascular system, .... 176 
 
 Treatment where fulness, distension, and acidity, with flatulence and eructations 
 
 after meals, are the predominant symptoms, 
 Of the employment of general and local bleeding in the treatment of diseases of 
 
 the stomach, ........ 180 
 
 Of the use of aperient medicines, ...... 181 
 
 Of sedatives, ....... 181 
 
 Of antacid a.nd absorbent remedies, ...... 183 
 
 Of tonics, .*.,.... 183