the want of due nutrition from that which accompanies the commencement of the disease, and arises merely from the morbid condition of the stomach, or from painful impressions on this organ.

The thoracic symptoms in this stage of the disease consist of more or less permanent dyspnea; a dry and harassing cough; pain in the side, most frequently the left, and which is sometimes seated in the muscles of the chest; and, in some few cases, palpitation of the heart. The symptoms alluded to in the foregoing remarks appertain to the first stage of the disease, and which, as we shall hereafter show in a more particular manner, the author considers chiefly to consist and originate from a state of debility of the stomach; but, he says,

"At various periods of the disease, for the most part after repeated derangement of the hepatic function, comes on a permanent tenderness on pressure, sometimes but slight, of the soft parts close to the edge of the cartilages of the false ribs on the right side, after they have turned upwards to be joined to the sternum. This spot is often very circumscribed, and always lies about half-way between the end of the sternum and the place at which the lowest of the cartilages begins to ascend; and the cartilage itself near the tender part often becomes very tender, not unfrequently, indeed, much more so than the soft parts. The patient, in general, is not aware of this tenderness till it is pointed out by the physician.

"This symptom never exists long, and to any considerable degree, without the pulse becoming hard, and it often, at the same time, becomes rather more frequent than in health. There is no other symptom of the disease before us to which I am so anxious to call the reader's attention, as to what I have here termed a hard pulse, because on it much of the proper treatment seems to depend. It sometimes happens, especially when the tenderness in the epigastrium is considerable, that the pulse becomes such as would on all occasions obtain the name of hard; but more frequently the hardness is only to be distinctly perceived by examining the pulse in a particular way.

"Those who have been much in the habit of examining the different states of the pulse, must be aware that its hardness is most perceptible when a slight degree of pressure is employed. A certain degree, by greatly compressing the vessel, will give some feeling of softness to the hardest pulse; and a slight degree of hardness is not perceptible with the pressure generally employed in feeling the pulse. If the pressure be gradually lessened till it comes to nothing, it often happens that a distinct hardness of pulse will be felt before the pulse wholly vanishes under the finger, when no hardness can be distinguished in the usual way of feeling it.

"This is in no degree the case in a healthy pulse, nor even in the first stage of the disease we are considering. But when the tenderness of the epigastrium is at all a prominent feature, it may always be perceived: that is, there is then a certain degree of pressure, sometimes very slight, under which the pulse gives a decidedly wiry sensation to

the finger, the degree of pressure under which the hardness may be perceived denoting its degree.

"I consider the occurrence of the tenderness of the epigastrium and hard pulse as dividing the disease into two stages; because, from the time of their appearance, at whatever period this happens, we shall find its nature, and consequently the plan of treatment suited to it, changed.

"These symptoms are generally accompanied with others, indicating some degree of feverishness. The chilliness of which the patient has long complained is now sometimes, and independently of any change of temperature in the surrounding medium, interrupted by languid and oppressive fits of heat; and the hands and feet, instead of being uniformly cold, as in the earlier stages, often burn, particularly during the first part of the night, while at other times they are more obstinately cold. The thirst also often increases; and sometimes there is a tendency to partial sweats in the morning, especially if the patient lie longer than usual."

The tenderness of the epigastrium, having existed for some time, generally becomes at length attended by some degree of fullness in the part, and extends downwards along the edge of the cartilages of the ribs. This fullness of the right hypochondrium is permanent, and thus differs from that which occurs in earlier periods, and which is generally relieved, and sometimes removed, by the effects of cathartics; and not unfrequently spontaneously disappears, and returns again.

After indigestion has proceeded to this extent, it is not unfrequent for the disease of some organ, or part which had previously participated in the effects of the disorder of the stomach, now to become more obstinate and severe, and at length the most prominent affection; and, indeed, the chief and most serious malady, and such as cannot be removed without an appropriate mode of treatment directed expressly to the part itself.

The symptoms enumerated as those of the second stage mark conditions which cannot, the author observes, continue long without change of structure, which ushers in what he considers as the third stage of the disease; and, he remarks, "it is a curious fact, and one of the greatest importance in the treatment, that the organic affection rarely takes place in the original seat of the disease, but in other organs with which the stomach sympathizes, the liver, pancreas, spleen, mesenteric glands, lower bowels, heart, lungs, brain, &c. ;" and, when the body is examined after death, the patient is often said to have died of disease of some of these parts. Another very interesting remark of the author is, that, when disease fixes decidedly on one organ, the others are, to a certain degree, and sometimes wholly, relieved. The establishment of the secondary affection generally relieves the dyspeptic symptoms; and even a secondary

disease may be removed by another supervening on it. What is merely nervous irritation in organs affected by sympathy, will at length terminate in inflammation; and the recognizance of such a change having taken place is of great importance in regard to the treatment of the disease. These, and various other more or less interesting circumstances in the history of the disease, are noticed by the author; and it is from his having, justly, attributed a high degree of importance to them, that he has been induced to make his observations on the treatment, in which they are particularly considered, occupy the greater part of the work. It is, indeed, we think, the manner in which he appreciates these conditions in a therapeutical point of view, that constitutes the chief practical value, as well as the more original part, of his treatise.

With regard to the circumstances which dispose the sympathetic disease to affect one part in preference to another, the author says, "we have reason to believe that this is chiefly determined by different parts in different individuals being more liable to disease than others, and therefore feeling more the cause of irritation which affects the whole system. Thus, in children, who are disposed to inflammation and subsequent effusion in the ventricles of the brain, indigestion often terminates in bydrencephalus internus. From about fifteen to thirtyfive years of age, the disposition to affections of the lungs is greatest, and it often produces phthisis. At a more advanced period, a tendency to disease of the rectum prevails, and in old age to affections of the heart and head,-the latter, however, of a different nature from those to which children are subject; and we still observe the tendency of indigestion to produce the disease to which the system is disposed, whatever be its seat." When noticing more particularly those particular secondary affections, the author gives a hint of his notions of the pathology of gout. "When a tendency to this disease exists," he says, "it may be induced by any cause that produces, and for a certain time keeps up, indigestion. In some the disposition to gout is so great, that it appears without being preceded by symptoms of derangement in the first passages; but, in the majority of cases, it is preceded by these symptoms, and the tendency to them seems to constitute a considerable part of the hereditary disposition to gout."

This pathology nearly agrees with that of Broussais, who regards gout as merely a sympathetic affection of disease of the digestive organs, as we have already mentioned in this Journal. It is on the principle of the secondary disease relieving the primary, or other secondary diseases, in indigestion, that depends the danger which attends an interruption of the regular its of gout. The sympathetic disease," Dr. Philip says,

"being prevented from taking the course which the disposition to affection of the extremities give it, seizes on the part, generally an internal one, which next to these is most liable to disease; and, on the other hand, if any thing so affects any of the vital parts during a fit of the gout, as to render it considerably the weakest part, the sympathetic disease sometimes leaves the joints, and seizes on the internal part, producing what is called retrocedent gout. It is evident that the risk of both these accidents will be greatest where the powers of the system are most impaired." We have a voluminous modern work on Gout, known to most medical men, which does not contain so much real information of this discase, nor even so much information of practical utility,-notwithstanding its pretensions,as those few remarks of Dr. Philip. But, from writers who are not physiologists, we should expect nothing but vague, perplexed, and obscure, delineations of all such diseases as involve any of the more abstruse operations of the animal economy.

The alternation of gout and gravel has been a perplexing circumstance to most writers on these diseases. It has already been stated that the formation of lithic acid, to a certain extent, is a frequent symptom of indigestion; and it is sufficiently proved that the ordinary gravel is concreted lithic acid. There is, then, no difficulty in comprehending, after what has been said of the etiology of gout, how this alternation should occur; as it is in the intervals of gout that indigestion chiefly prevails, the affection of the joints relieving that of the stomach.

Having discussed this part of his subject, the author treats of the causes of indigestion; and, he remarks, as it is impossible to understand the operation of the remote causes, or the nature of the symptoms of this affection, without the knowledge of the digestive process, our attention must be directed to this subject.

"It has been ascertained, (says the author,) by the experiments of Spallanzani and others, that the stomach secretes a fluid capable, even out of the body, of converting the food into such a mass as that into which it is changed in the stomach, immediately before it is sent into the duodenum. This fact leaves no room to doubt that it is by the agency of the above fluid that the food undergoes the change which is effected on it in the stomach; and it appears, from the observations of Mr. Hunter, that such is the power of this fluid that it often corrodes the stomach itself when deprived of the vital principle by which it is enabled to resist its action. When to these facts we add, that, by means of the muscular power of the stomach, the food, when duly prepared by the action of the gastric fluid, is propelled into the duodenum, we state the sum of our knowledge on this subject. These facts, however, are far from affording an explanation of the digestive process. It does not appear, from the observations of any of the authors here referred to, by what means the fluid which is secreted by the coats of the stomach is uni

formly applied to the food, nor upon what principle the food which is prepared for the duodenum is separated from the rest.

"Mr. Hunter found that, even when part of the stomach itself had been dissolved by the gastric fluid, the food last taken remained wholly unchanged. This fact alone is sufficient to militate against the idea assumed by some, that, by the muscular power of the stomach, the food is so moved as to be continually in the act of being mixed together and with the gastric fluid, by which its uniform solution is effected. According to this view of the subject, also, it would be difficult to account for the gradual discharge of the contents of the stomach into the duodenum. This intestine must either for a long time cease to receive any food from the stomach after every addition made to the contents of the latter, or receive food in every different stage of solution, an imperfection in a natural process which is opposed by every thing we know of the animal economy."

The results of the author's researches on this subject constitute, as we think, the most valuable of his contributions to physiology. Dr. Philip has examined the stomachs of about a hundred and thirty rabbits immediately after the animals had been killed in the usual way, which is by a blow on the back part of the head, at various periods of digestion. The first thing that strikes the eye on examining the stomachs of rabbits which have lately eaten, the author observes, is that the new is never mixed with the old food. The former is always found in the centre surrounded by the old food, except that, on the upper part between the new food and the smaller curvature of the stomach, there is sometimes little or no old food. The line of separation between the two is distinctly evident. The food which touches the surface of the stomach is more digested than any other found in the same part of the stomach; and (unless the animal has not eaten for a great length of time,*) the food in contact with the surface of the stomach is in very different states of digestion in different parts of the organ. It is least digested in the small curvature, more in the large end, and still more in the middle of the great curvature. The foregoing remarks apply to the cardiac portion of the stomach; the food in the pyloric portion is always found in a state very different from that just described. It is more equally digested; the central parts differing less from those which lie near the surface of the stomach. It is evident, however, that all the change effected in the stomach is not completed when the food enters this portion of it, because it is found the more digested the nearer it approaches to the pylorus. It appears that, in proportion as the food is digested, it is moved along the great curvature, where the change in it is rendered more perfect, to the pyloric

It appears that the stomach of the rabbit is not able so to contract as to obliterate its cavity, for some part of its contents always remains.