INDIGESTION OR DYSPEPSIA.
Dyspepsia is really a Greek word, and means bad digestion or difficult digestion. Indigestion means essentially the same thing. Now the words indigestion and dyspepsia refer to a con . dition of digestion, but that condition, bad or difficult digestion, may arise from a great multi tude of causes. A person might suffer to-day from indigestion due to one cause, and might next week suffer again from indigestion from a cause so different as to make totally different treatment necessary, so that practically the two kinds of indigestion from which the person suffered might as well be considered two differ ent diseases. The term indigestion, or the term dyspepsia, is thus used to cover a great number of diseases, which have this much, and perhaps only this, in common, that, owing to them, the food is not digested properly, in good time, or in comfort, and thus the main symptom arises from which the disease is named—some feeling of discomfort or actual pain connected with the presence of food iu the stomach and bowels. Now it is essential that this should be properly understood. Very many people go to a doctor and announce to him that they are troubled with indigestion, and expect that, without more ado, he will order them a medicine that will remedy, without delay, their complaint. if he begins to make inquiries they answer impa tiently : " Oh I I know very well what is wrong ; it is just indigestion." In the same way people will turn up some dictionary of medicine and expect to find, under the head "Indigestion," some definite statement of treatment, which they have only implicitly to follow to be healed of their plague. Now such a view of the prac tice of medicine is an utterly mistaken one, and perhaps no disease shows better how mis taken it is than this one.
If reference be made to what has been de tailed in pages 202 to 204 about the process of digestion, it will be noticed that there are various stages in the process; that one part of the process is performed in the mouth, another part in the stomach, a third part in the bowel ; that the part performed in the mouth consists of (I) chewing and (2) the action of saliva on the starchy parts of the food, that in the stomach of (3) the action of gastric juice on albu minous parts of the food, that in the bowel of (4) the action of bile on fat, (5) the action of pancreatic juice on starch, albumin, and fat, and (6) the action of intestinal juice on various elements of the food. Now if any of
these stages be imperfectly performed the whole process may be interfered with. In a piece of machinery the stiffness or irregularity of one small wheel may affect the working of the whole machine. No one would go to an engineer and say: "My engine works badly," or "My engine works with difficulty," and then expect to be told that the doing of some par ticular thing would make it right. Everyone knows the engineer would carefully examine till he found the exact place where the difficulty was, and then he would be in a position to say what would rectify if. Let us look at digestion in that light. If a person eats hurriedly, bolts his food, the first part of the process (chewing) is not properly performed. The result is that the food passes in masses into the stomach, and not broken down into very small pieces. The juice of the stomach gets acting only on the outside of the lumps of food, cannot get inti mately mixed with it, cannot attack much at a time, and so the process is delayed; perhaps twice the time is occupied that there would have been if the person bad taken the time and trouble properly to break down the food in the mouth before passing it on to the stomach. Suppose, however, the food is properly chewed, when it reaches the stomach, owing, perhaps, to the general health of the individual, suffi cient gastric juice may not be poured out, or there may be always enough in quantity, but of poor quality. The juice may contain too much acid, or too little acid (p. 203), or may be not active enough with pepsin (p. 203), and in various other ways this stage of the process may be badly performed. Again, everything may be properly performed in the mouth and in the stomach ; but, when the food reaches the small intestine, bile (p. 205) may be deficient owing to some fault of the liver, and the digestion of fat is interfered with ; or the pan creatic juice (p. 204) may not rightly discharge its duty, and so digestion, which up to this point had gone on properly, is arrested, or in some way interfered with, and indigestion arises.