c. Faulty Secretion.—Manifestly combined with both the pre ceding conditions, this cause of dyspepsia is perhaps the most frequent and the most difficult to manage. It is related to va rious conditions of health, acting either through the vascular or nervous system, but seems to be also primary and independent of them.
(1.) Hyper emia.—Passing by the form of acute gastritis, we come to the congestion characterizing a fit of indigestion brought on by excess. Here the history of the case, if correctly given,. leads at once to the true diagnosis : the attack is recent ; all the symptoms severe ; the tongue is generally foul and flabby ; the bowels confined, or a good deal relaxed, but without febrile symp toms. A timely emetic, imitating the relief which nature some times provides, might have prevented the subsequent congestion; but when once excited, the irritation may not subside after the ingesta have passed into the bowels ; vomiting may come too late, and persist even for days; the bowels, if unloaded by an aperient, become again confined, or are affected with diarrhoea. Conges tion. of the liver generally plays a ptominent part in such condi tions ; but congestion of the stomach is equally evident as the direct effect of a debauch ; and there is not only perverted secre tion, but irritability dependent on the sort of erythematous condition of the mucous membrane, which the very idea of con gestion implies. Similar results are, no doubt, also traceable when the congestion of the stomach is of that passive form which, in its very marked examples, is accompanied by ha3matemesis, and is produced by obstructed hepatic circulation. General ple ' thora evidently cannot be a cause of dyspepsia, because any interference with the action of the stomach would immediately reduce the quantity of material converted into blood, and of necessity diminish the plethora ; but probably a fit of indiges tion would be more severe in the plethoric individual than in another.
(2.) Amemia,, on the other hand, is unkovrn as a local affec tion, but, as a general condition of system, evidently exercises great influence over the secretion of the stomach. When, there fore, we find dyspeptic symptoms associated with the aspect of thin and poor blo4 the only question can be whether they are wholly dependent upon the amemia, or have any separate cause; and this is best known by ascertaining which class of symptoms, the dyspeptic or the amemic, had the priority in commencement .And if the complex disorder began by the imperfect action of the stomach withholding the due supply of pabulum to the blood, we must still admit that the consequent anemia will aggravate the dyspeptic symptoms ; just as we know that imperfect diges tion, though caused by anemia, necessarily tends to increase that state. It is probably in this way that bad food and chronic wast ing diseases excite„ as they occasionally do, persisting forms of dyspepsia, as they necessarily deteriorate the quality of the blood : bad food does not primarily excite permanent cliaorder.
(3.) In some forms of disease a specific blood-crasis seems to exist, which has a close relation t,o the secretion of the stomach. To this class we might legitimately refer the inaptitude for dige,s tion produced by inflammatory and febrile diseases; but it must rather be restricted to indigestion arising in the gouty diathesis, the dyspepsia of drunkards, &c. In other cases the dyspepsia is more distinctly associated with disturbance of brain and mental excitement; when it becomes difficult to say whether the effect be produced through the medium of the blood or of the nerves.
(4.) There yet remain very numerous instances of dyspepsia, in which faulty secretion seems to be the principal cause of the defect in the digestive power, where we cannot trace it back to any antecedent circumstances, and camiot explain the agency by which it has been e,stablished. Among them we include cases characterized by heartburn, pyrosis, flatulence,- nausea, loathing of food, vomiting disagreeable tastes in the mouth, dre., which occasionally occur in persons in comparative health, and are found to yield to the simplest treatment, but which, in their ha bitual persistence, become so rebellious and intractable.
Under any of these circumstances, the secretion of the stomach may be very variously modified. Thus, it may be deficient in the special principle (pepsin), which acts as a solvent of the albuminous substances; all animal food whatever will be found by the patient difficult of digestion; and as a consequence of its imperfect solution, fetid gases will be evolved, and unalterated fibres will be seen in the evacuations ; or, again, the secretion may be of such a character as to set up a process of fermentation rather than digestion, with the development of acid and flatus. which is very constantly associated with diarrhoea : or there may be excessive secretion, of feeble power, rising up and filling the mouth with tasteless fluid when the stomach is empty. The first of these is the condition most frequently resulting from strain of mind; the second is the common precursor of gout; the third is the usual result of bad and insufficient nutriment : but each of them may be met with casually, or even persisting for a consider able period without any such definite causes.
This short sketch would be incomplete if no allusion were made to the spasmodic pain which attacks persons subject to gouty dys pepsia, and commonly known as gout in the sOmach. Its place would seem to be in that class of cases in which irritability is a prominent symptom, as it is especially marked by violent pain in the epigastnc region ; it is generally, however, preceded by symp toms of faulty secretion, and passes off with a discharge of flatus from the stomach.
It has been already stated that dyspepsia is frequently associated with other chronic diseases : we especially look for anaemia and emaciation in its slighter forms ; and in females for hysteria and functional derangements of the uterine organs. Among its causes we must not forget the possible effect of deleterious agents; not only those which are distinctly recognized as poisons, but those also which bear the name of luxuries, such as tobacco and fermented liquors.. Tubercular diseases may give rise to symptoms of dyspepsia, and they are occasionally also first betrayed by them. The condition of the liver and the functions of the brain must be each inquired into, both as causes and compli cations of disordered stomach. Changes in the character of the urine will be found sometimes dependent solely on the mal-assimilation of nutriment; and sometimes, while affording evidence of disorders especially referable to the kidney, are still very much influenced by the condition of the digestion. Skin diseases, in like manner, have a very close relation to dyspepsia.