The heartburn, or rather a pain and uneasiness at the upper orifice of the stomach; (from the left orifice of the stomach, and to be pained). Called also ardor ventriculi, and properly so, when attended, as it sometimes is, with considerable heat; likewise cordolium, pain or uneasiness about the upper orifice of that organ, and cardiogmus.
Dr. Cullen ranks it as synonymous with dyspepsia; and considers it as arising either from a disease of the stomach itself, or from an affection of some other part, or of the whole habit. Synop. Nosolog. Method. Gen. 45.
This disorder is called soda, heartburn, or spurious cardialgia; pain in the stomach, or the true cardialgia, also cardimona. In the spurious kind the pain is not so great, nor does the strength fail, nor is there any remarkable inquietude. In the true, there is pain in the stomach, or about its upper orifice, but generally about the pit of the stomach: it is sometimes attended with great anxiety, difficulty of breathing, want of strength, inquietude, retching to vomit, coldness, and trembling of the extremities. Sometimes the uneasy sensation extends the whole length of the oesophagus, with a pressure or constriction, and usually attacks by fits.
The upper orifice is the usual seat of this disorder; it is sometimes in the lower; and is occasionally the disorder of the whole viscus. In those who have died of this disorder, on dissection the right orifice only hath appeared to be in an unnatural state.
Were we to be minutely exact, we should refer every cause of cardialgia to the weakened powers of digestion; since, if these are strong, no inconvenience arises from any aliment: so true is the axiom, sanis omnia sana.
To avoid, however, all minute disquisition, we shall refer the causes to a disease of the stomach and its contents, to a disorder of distant parts, or the whole system, with which this organ sympathises. The disease of the stomach, we have said, is weakness; and the disordered contents, from this cause, are acid, oily, acrid, or bilious substances, which its debilitated powers arc unable to combine with the alimentary mass. Acid is generally accused, and the anti-cardialgics are generally alkalis and absorbent earths. It is, indeed, the most frequent cause, whether the disease be idiopathic or symptomatic. The acid swims on the surface of the contents of the stomach, and gives the sensation of burning heat to the cardia. It arises from acescents, rather than acids; from fruit, Vegetables, and saccharine substances. Oily foods arc, however, an equally frequent cause. A red herring, for instance, will often produce it; the fat of meat, butter, and every similar matter will, in many constitutions, bring on the complaint, particularly if the process of digestion is disturbed in its commencement. Acrid is a term too general, yet it is meant to include highly seasoned dishes, pepper, and various spices, which have been long acknowledged as causes, though not frequent ones, of cardialgia. That bile in the stomach is a cause, we cannot so confidently affirm; yet it has been enumerated as such: and if heartburn is attended with a putrid taste on the back part of the tongue, the disease may be pronounced to arise from bile. We suspect, however, that the opinion has arisen from its being an attendant on jaundice; and we well know, that when bile, the usual neutraliser of acid, is absent, it may probably abound. In any circumstance, if the usual mucus of the stomach be abraded, or the organ inflamed, the most common and salutary aliments may occasion this impression from the increased sensibility of the organ: thus it seems sometimes to arise from corrosive poisons; we have seen it from swallowing, by mistake, the volatile sal ammoniac; and in this way it is found to be the effect of inflammation and abscess in the stomach.
In general, as Dr. Hunter has supposed, it is the fumes of these substances rather than the substances themselves which occasion the complaint. The stomach is seldom perfectly full; and, though its action may sometimes raise the contents to the cardia, the contact must be only occasional and temporary.
The more general causes which affect the stomach by sympathy are gout and nephritic complaints. From a fact recorded by Van Helmont, it seems, that any affection of the joints may in this way disorder the stomach. Violent passions have equally produced it. Cold feet seem sometimes to have the same effect, and the relief is then generally preceded by a return of perspiration in the extremities. A recession of eruptions has been supposed to be a cause; and, as in such cases the stomach generally suffers, not without some reason.
To relieve the complaint, the diet should be light, generally of the animal kind: what is drunk should not be apt to ferment; brandy and water, or water in which toasted bread is steeped, will generally agree; or camomile tea, which soothes the spasmodic motions of the stomach. Lime water, the mineral alkaline waters, and distilled water, are proper for common drink.
The cure depends on the cause. As in every instance the stomach is weakened, bitters, and perhaps chalybeates with aromatics, should accompany the appropriate remedies. We need not repeat what we have said of antacids; but, in the heartburn from oily or acrid substances, immediate relief is obtained from sucking gum arabic. If it should arise from bile, vegetable acids will almost immediately remove it. Vomits are often advantageously premised.
When not arising from the contents of the stomach, general warmth, particularly of the feet, is essentially useful; and even rubbing them with flour of mustard has produced good effects. Tonics of every kind arc indispensable additions to the other remedies; and, when from gout, aromatics should be joined. In every species, also, the bowels should be kept free, and the warmer resinous purgatives are best adapted to the complaint. Any external applications that may be thought necessary should be placed on the pit of the stomach.
Cardialgia inflammatoria. See Inflammatio Ventriculi.
Cardialgia sputatoria. See Pyrosis.