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the heart and great vessels may occasion syncope: for it may be supposed, that the violent exertions. made in palpitations may either give occasion to an alternate great relaxation (1178), or to a spasmodic contraction; and in either way suspend the action of the heart, and occasion syncope. It seems to me probable, that it is a spasmodic contraction of the heart that occasions the intermission of the pulse so frequently accompanying palpitation and syncope.

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1188. Though it frequently happens that palpitation and syncope arise, as we have, said, from the organic affections above mentioned, it is proper to observe that these diseases, even when in a violent degree, do not always depend on such causes acting directly on the heart, but are often dependent on some of those causes which we have mentioned above as acting primarily on the brain.

1189. I have thus endeavoured to give the pathology of syncope; and of the cure I can treat very shortly.

The cases of syncope depending on the second set of causes (1174), and fully recited in 1185, I suppose to be generally incurable; as our art, so far as I know, has not yet taught us to cure any one of those several causes of syncope (1185). The cases of syncope depending on the first set of causes (1174), and whose operations I have en

deavoured to explain in 1177, et seq. I hold to be generally curable, either by avoiding the several occasional causes there pointed out, or by correcting the predisponent causes (1184). The latter, I think, may generally be done by correcting the debility or mobility of the system, by the means which I have already had occasion to point out in another place.

CHAP. II.

OF DYSPEPSIA, OR INDIGESTION.

1190. A WANT of appetite, a squeamishness, sometimes a vomiting, sudden and transient distensions of the stomach, eructations of various kinds, heart-burn, pains in the region of the stomach, and a bound belly, are symptoms which frequently concur in the same person, and therefore may presumed to depend upon one and the same proxiIn both views, therefore, they may be considered as forming one and the same disease, to which we have given the appellation of Dyspepsia, set at the head of this chapter.

mate cause.

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1191. But as this disease is also frequently a secondary and sympathic affection, so the symptoms above mentioned are often joined with many

others; and this has given occasion to a very confused and undetermined description of it, under the general title of Nervous Diseases, or under that of Chronic Weakness. It is proper, however, to distinguish; and I apprehend the symptoms enumerated above are those essential to the idiopathic affection I am now to treat of.

1192. It is indeed to be particularly observed, that these symptoms are often truly accompanied with a certain state of mind which may be considered as a part of the idiopathic affection; but I shall take no farther notice of this symptom in the present chapter, as it will be fully and more properly considered in the next, under the title of Hy. pochondriasis.

1193. That there is a distinct disease attended always with the greater part of the above symptoms, is rendered very probable by this, that all these several symptoms may arise from one and the same cause; that is, from an imbecility, loss of tone, and weaker action in the muscular fibres of the stomach: and I conclude, therefore, that this imbecility may be considered as the proximate cause of the disease I am to treat of under the name of Dyspepsia.

1194, The imbecility of the stomach, and the consequent symptoms (1190), may, however, frequently depend upon some organic affection of the

stomach itself, as tumour, ulcer, or scirrhosity; or upon some affection of other parts of the body com municated to the stomach, as in gout, amenorrhoea, and some others. In all these cases, however, the dyspeptic symptoms are to be considered as secondary or sympathic affections, to be cured only by curing the primary disease. Such secondary and sympathic cases cannot, indeed, be treated of here; but, as I presume that the imbecility of the stomach may often take place without either any organic affection of this part, or any more primary affection in any other part of the body; so I suppose and expect it will appear, from the consideration of the remote causes, that the dyspepsia may be often an idiopathic affection, and that it is therefore proper ly taken into the sysm of methodical Nosology, and becomes the subject of our consideration here.

1195. There can be little doubt, that, in most cases, the weaker action of the muscular fibres of the stomach, is the most frequent and chief cause of the symptoms mentioned in 1190; but I dare not maintain it to be the only cause of idiopathic dyspepsia. There is, pretty certainly, a peculiar fluid in the stomach of animals, or at least a peculiar quality in the fluids, that we know to be there, upon which the solution of the aliments taken into the stomach chiefly depends: and it is at the same time probable, that the peculiar quality of the dis solving or digesting fluids may be variously chang

ed, or that their quantity may be, upon occasion, diminished. It is therefore sufficiently probable, that a change in the quality or quantity of these fluids may produce a considerable difference in the phenomena of digestion, and particularly may give occasion to many of the morbid appearances mentioned in 1190.

1196. This seems to be very well founded, and points out another proximate cause of dyspepsia beside that we have already assigned: but, notwith standing this, as the peculiar nature of the digestive fluid, the changes which it may undergo, or the causes by which it may be changed, are all matters so little known, that I cannot found any practical doctrine upon any supposition with respect to them; and as, at the same time, the imbecility of the stomach, either as causing the change in the digestive fluid, or as being induced by that change, seems always to be present, and to have a great share in occasioning the symptoms of indigestion; so I shall still consider the imbecility of the stomach as the proximate and almost sole cause of dyspepsia. And I more readily admit of this manner of proceeding; as, in my opinion, the doctrine applies very fully and clearly to the explaining the whole of the practice which experience has established as the most successful in this disease.

1197. Considering this, then, as the proximate