W0410 MEDICAL ESSAY BY [DR.] CALVIN MCQUESTEN
Jan 1 1828
From: Bowdoin College, Brunswick, Maine, [U.S.A]
Nosologists2 have given this name to a disorder arising from a morbid action of the functions of the stomach without any general well marked symptoms of fever or any local disease. It is a disorder complicated in its nature; being often induced sympathetically, its primary seat being in some other organ immediately or more remotely connected in the process of digestion. Its pathology is not well understood. In fact but very little is known respecting the healthy action of the stomach, and still less of its morbid actions. Dyspepsia may be said generally to arise from a deficiency or excess of the gastrick [sic]3 juice from a vitiated and depraved secretion of the salivary and gastrick fluids and a want of tone in those organs themselves. What part in the process of digestion the salivary and gastrick fluids have we cannot decipher, though we doubt not but that they have a very important part.
We know that after the food is received into the mouth that during mastication it is mixed with the saliva and after being received into the stomach it there unites with its own peculiar secretion and while it remains there it undergoes the first and most important step in the process of digestion, and what part the action of the stomach effects is entirely beyond our knowledge. Hence it is very obvious why a derangement in any of these functions should cause indigestion. When the foods have remained in the stomach till it is formed into [schyme?] it is then propelled through the pylorick orifice into the duodenum where it unites with the bile and the fluid secreted by the pancreas and the nutrient part is prepared to be taken up by the lactick and conveyed through the [?] glands to the thorasick duct and from thence to the lungs. During its passage through these organs it becomes more perfectly animalized vivified and fitted for the support of animal life. Hence it is very obvious that disease in any one of these organs should render digestion imperfect, and cut short the supply of nutrition which the continual wasting of the system requires.
The symptoms of dyspepsia (says a late writer) are extremely diverse. They may be divided into such as are referable to the stomach itself or its sympathies with other parts of the body. Among the first may be enumerated loss of appetite, nausea, heart burn, a sense of fulness, distention or weight in the stomach, a feeling as if a ball was lodged in the esophagus, acid or foetid eructations pyrosis, or the vomiting of a clear liquor, often in vast quantity and [?] or sensation of sinking or fluttering at the pit of the stomach.
To the second head of dyspeptic symptoms may be referred many many others, costiveness, or an irregular state of the bowels, with a morbid appearance of the evacuations, pain of the back and turbid urine, a disagreeable taste in the mouth, especially on first waking, toothaches, palpitations, pulsation in the epignetium, irregularity of the pulse, a difficulty of breathing, giddiness, and headache, sometimes referred to the face but more generally to the back part of the head, languor, lassitude, and a great depression of spirits with fear of death, or of impending evil. The tongue is evenly coated, yet though sometimes perfectly clean with a more than natural redness. The mouth and [fances?] are generally moist; though sometimes there is a considerable degree of ephemeral feverishness when the mouth may be dry and some thirst. There are sometimes very anomalous pains arising from simple dyspepsia without the presence of any perceptible local inflammation, which may perhaps be referred to a want of energy in the nervous system or the nerves participating in some unknown way in the general debility. The influence which local disease in any distant part has over the functions of the stomach and a disordered state of the stomach has on local disease, I am unable to explain, but that such influence does exist and should be taken into consideration in our treatment no one will deny. But it is not my design to speak particularly of dyspepsia when it is merely symptomatick of some other known disease.
The exciting causes of primary dyspepsia are irregularities in diet and regimen. One of the most common and perhaps the most fatal in its effects is the abuse of alcoholick liquors. These act primarily on the stomach and secondarily on the brain and nervous system. They stimulate the stomach to a high degree and by a long continued use of them so far diminish its excitability that this organ either acts languidly from the ordinary stimuli of common food or eventually refuses to act at all. Its energies and sensorial powers are so exhausted that it requires an extraordinary stimuli to produce an ordinary effect. They act on the brain by diminishing the secretion of sensorial power, and on the nervous system by causing the trembling hand and faltering speech which are the characteristicks of the intemperate man.
Irregularities in diet as occasionally disturbing the stomach to an inordinate degree and thereby rendering it incapable of performing its healthy action is a cause of dyspepsia. The taking in of indigestible substances, habitual full living, particularly the too frequent indulgence in animal food and taking a little and often are common sources of dyspepsia.
Mental emotions, intense study, disappointed hope, the depressing passions as grief, fear, anxiety, sedentary habits of life, the want of air and exercise, great fatigue of body, excessive evacuations such as flooding & bleedings at the arm, leucorrhea or protracted suckling may be enumerated among the exciting causes of dyspepsia.
Often dyspepsia is caused sympathetically by some other organ labouring under disease. It will be important to the practitioner to discriminating between those cases and ideopathick dyspepsia, as his attention must in fact be directed to the local disease. The liver may be affected with functional or structural disease. The stomach lining being one of the great centres of the system and very intrinsically connected with the liver readily sympathises with it and its functions are unnaturally affected by a deficiency or excess or vitiated secretion of the bile. Whether the bile be only an excrementitious matter having no part in the process of digestion but merely stimulating the bowels enabling them to discharge their faecal matter or not, we know that a healthy excretion of the bile is of great importance and that a healthy action of the stomach will not long exist without it. An acquaintance with the structure and physiology of the part will greatly assist us in our diagnosis and treatment in all cases of dyspepsia combined with other local disease.
The prognosis in dyspepsia is favourable if the treatment commence early before the constitution is much impaired, or any vital organ is seriously affected. Sometimes it will be beyond the power of the Physician to remove the exciting cause. In such cases all his attempts to recover his patient will be fruitless. He should forcibly impress on the mind of his patient the necessity of submitting himself to a new mode of life and of avoiding everything that has a tendency to excite or aggravate the disease. Should the disease originate from fashionable follies and dissipation the first step in the treatment should be to remove the patient from these scenes of fascinating hilarity to those of a more sober and rational nature. When it is caused by a too liberal indulgence of the table the change, though quite as necessary should be made more gradually. Everyone knows that sudden changes even in a healthy constitution are severely felt; but great changes may be effected by degrees without any encroachment on the general health. The same rule may be observed in this disease, though the patient is already labouring under debility yet we should recollect that the system is not strengthened in proportion to the quantity of load received but in proportion to that which is perfectly digested.
When dyspepsia has been brought by on by a sedentary habit of long and close application to study these habits must be broken through and some others take their place that will give sufficient exercise to the body and relaxation to the mind. Mingling with social company and passing an hour in cheerful conversation walking in the open air and horse exercise practised regularly every day are among the best which we can suggest.
Before entering on the medical treatment it may be proper to mention that but little dependence can be placed on medicine unless strict attention be paid to diet and exercise. The diet should be composed of those articles that are most easily digested. The particular kinds that may best agree with the patient can only be ascertained by trial. When there is a tendency to abcescency [sic] vegitable [sic]4 food excepting some of the [?] will not be advisable, when to putridity animal food should be used very sparingly.
The most precise regularity should be observed with regard to the time of meals. Three or at most four times in the twenty-four hours are as often as he should ever by allowed to eat. The principle meal should be taken in the middle of the day, the breakfast and supper being very light. But little liquid should be taken at the time of meals for it will too much dilute the salivary and gastrick fluids. Generally solid food will be best but the condition of the patient will be our best guide on this point. Exercise should be regularly persevered in. Those kinds that afford the most amusement to the patient and draw off his mind from his complaints are most suitable. The proper time for exercise is about two hours before he takes his regular meals in that he may have an hour for rest before eating. When the patient cannot bear active exercise those of a more passive nature should be substituted as friction with a flesh brush or gestation in a carriage.
The medical treatment consists primarily in catharticks, mercurial alternative tonicks, stimulants, absorbents and gentle laxatives. Active purging in this disease is inadvisable. Emeticks have been recommended and in acute cases the stomach is loaded they may be used merely to evacuate its contents but their use should not be continued. In such cases of severe attacks of dyspepsia when the constitution is robust and the person not habitually liable to it an emetick and cathartick may be advantageously combined. From then to five grains of tart. antinomy followed in about twenty minutes with a scruple of ipecac may be given afterwards allowing the stomach gradually to recover its tone. Or a brisk cathartick may be administered composed of calomel5 scammany and gambage of each equal parts with two parts of aloes. In common habitual dyspepsia active catharticks are inadmissible. But gentle laxatives and such as possess something of a tonick power will be very useful. As a laxative rhubarb is perhaps the best in the whole Material Medicine given in small doses about the time the patient takes his food; it very gently increases the action of the stomach and bowels effectively obviating the costiveness that often accompanies dyspepsia without causing weakness or any other very unpleasant sensation. It possesses very considerable tonick with some astringent properties and when the bowels are relaxed it may be given in very small doses either alone or with 1/4 or 1/2 a grain of calomel. Aromatiks may be used at any time with other medicines when they will have a tendency to obviate any unpleasant effects or relieve any disagreeable symptom.
When the patient is troubled with acidity in his stomach the absorbents or [altalies?] may be given to counteract it but they must not be depended upon for a radical cure. Here bitters such as give tone to the animal fibre and stimulants are indicated. Columbo gentian cinchona eleutheria and serpentina are among the best articles of this class. Care should be taken that these medicines be not continued too long. Our object should be merely to restore the tone of the stomach to its healing action and then one remedy should be discontinued. When the patient is afflicted with foetal eructations proceeding from a putrid state of the food in the stomach the powder of charcoal recently prepared and kept close from the air though a simple is a very valuable remedy. It corrects the foetid by its antiseptick preparation and at the same time acts as a mild aperient. The acids both mineral and vegitable may be tried. The mineral acids should never be long continued. When it is necessary to continue the use of acids long the vegitable should always be preferred. There are some cases of simple dyspepsia that after having resisted the usual remedies readily yield to mercurial alternatives. The particular circumstances under which this remedy should be used must be left to the judgement of the practitioner. The compound calomel Pill or the Blue Pill may be given at night from 5 to 10 grains of the former or 3 or 4 of the latter followed the next morning with a small dose of rhubarb.
1 Calvin graduated from Bradford Academy, Massachusetts in 1825 as a teacher, and taught for two years. He may have contiued his studies and/or written a few essays or speeches in 1826; however, it is also possible that the date is incorrect inthe Calendar and on the microfiche. In 1827 he returned to school to study medicine at Bowdoin College in Brunswick, Maine. We have very little in the Whitehern collection from his medical studies, except for one lengthy paper on the subject of Dyspepsia (W0410) which is undated, but we have dated it as 1828. This paper is particularly interesting for its admission that very little is known about the function of the stomach.
2 A person who studies and classifies or diagnoses diseases (WNCL).
3 The writer uses the "ick" construction for all words ending in "ic."
4 This spelling "vegitable" is used throughout the essay.
5 (A) "Calomel--A colorless, white or brown tasteless compound, used as a purgative. Calomel, or chloride of mercury, was a popular cathartic or laxative which accomplished little other than purging... In spite of these drastic side effects (salivation, soreness and/or inflammation of the gums... sometimes even loss of teeth due to recession of gums), calomel was a valuable purgative, even though the dangers of the cumulative effects from the drug were not known. Soon after the turn of the century, however, castor oil became a substitute for calomel." "Calomel medicine." December 10, 2003. "Various Treatments and Frequencies of Use." From the notebooks of: Dr. Samuel Overton (1821-97). http://www.rootsweb.com/~txsmith/Pioneers/Childress/treatment.html
(B) "Calomel: Synonyms: Mercurous Chloride; Calogreen; Mercury Monochloride; Mercury Chloride. WARNING! HARMFUL IF SWALLOWED, INHALED OR ABSORBED THROUGH SKIN. CAUSES IRRITATION TO SKIN, EYES AND RESPIRATORY TRACT. MAY CAUSE ALLERGIC SKIN REACTION. MERCURY COMPOUNDS AFFECT THE KIDNEYS AND CENTRAL NERVOUS SYSTEM." "Calomel." December 10, 2003. MSDS Material Safety Data Sheet. http://www.jtbaker.com/msds/englishhtml/c0550.htm
see also W2469, W6374 for notes on 19th C medications such as Calomel (mercury based), Chlorodyne and Paragoric (Opium). These medications were used frequently throughout these letters by the McQuesten family. Notably Calomel was used in the treatment of tuberculosis for Ruby McQuesten. See W6135.