In such cases too, we often see the conjunctiva red, the eye inflamed, and the features altered. In proportion as the disease advances, and the sufferings increase, the attention becomes estranged, till coma ensues. In the meantime we observe irregular contractions of the facial muscles, grinding of the teeth, subsultus tendinum, and various convulsive movements. The patients throw off the bed-clothes, when they are sensible, complaining that the internal heat which devours them is ten times more insupportable when the chest is covered. They try all kinds of positions in bed ;sigh deeply; and show in their countenances the expression of intense agony. If they are questioned respecting the nature and seat of their pains, they apply the hand to the epigastric region, but cannot clearly describe their sufferingsthe sense of internal burning is the only one which is distinct to them. We must therefore ground our diagnosis on the tout ensemble of the symptoms, and especially on the instantaneous relief produced by cooling drink. The muscular force is not exhausted in these cases, for the strength is quickly recruited after a crisis-which is not the case in those malignant and typhous fevers resulting from deleterious miasms.

In respect to the respiratory system, we observe sometimes a cough, with teazing pain; a glairy or mucous expectoration streaked with blood, or white, like that of peripneumony, at the period of resolution; a general pain in the chest; a laborious respiration in sanguineous subjects. The voice is often lost from a sympathetic paralysis of the laryngeal muscles.

During the first days of acute gastritis the pulse is full, hard, and often as strong as in pneumonia, particularly if the pectoral symptoms above-mentioned are present-a proof of sanguineous plethora in the pulmonary parenchyma. In lighter shades of gastritis, and when the vital powers have been reduced by pain, the pulse is sharp, irregular, of even intermittent-towards the close of life imperceptible. Heat of skin is considerable, during the violence of the acute stage. M. Broussais has always found it dry and harsh. The skin is cold when the disease is on the decline-and cannot be brought to a natural warmth when the disease is verging to a chronic state. The cutaneous secretions are suppressed; and the breath is fetid in a few days after the circulation becomes much increased.

B. Chronic Gastritis. This may be a primitive affection, or the sequela of an acute attack. It is produced by the same causes as acute gastritis; but from peculiarity of con

stitution, or force of cause, it is unaccompanied by those violent commotions in the system which arrest the attention in the other species.

"The patient complains of pain across the base of the chest, deepseated in the epigrastric and hypochondriac regions-generally more considerable in the right side, and sometimes so high up as to be thought in the chest. This pain is constant and very troublesome -sometimes burning, lancinating, pricking, and confined to a very circumscribed spot, especially when the stomach contains any acrid or irritating substances. It is very frequently accompanied by a sense of constriction. Some patients complain of feeling as though a ball of large size were pressing against the diaphragm--others as if a bar were fixed across the stomach, preventing their swallowing food or drink. Of all these sensations the lancinating and stinging pains are those which acquire the greatest degree of intensity. The others are so faint that the patient seldom demands relief from them till the strength becomes considerably reduced." 214.

The appetite always fails, and when the disease exists in its greatest degree, there is a general abhorrence of food. When there is any remains of appetite, the digestion is quite imperfect. Aliments are usually thrown up soon after eating-especially if too much food, or food of a stimulating nature, have been swallowed. Those who, from a milder degree of the disease, or idiosyncrasy of stomach, do not vomit, are oppressed, during the gastric digestion, with a sense of load at the stomach, nausea, acid, corrosive or fetid eructations, rumination, and exasperation of the usual pain. There are some patients who only experience eructations, inquietude, malaise, and mental perturbation. The pulse rises a little, and the skin warms, during gastric digestion, but sink to their usual level when the digestive process is finished. For a considerable time the bowels are as costive, as though a scirrhus of the pylorus existed; but ultimately, in the majority of cases, there is diarrhoea, with colic, tenesmus, and stools mixed with blood-a proof of the extension of the disease. Then the breath and even the perspiration exhale an odour manifestly steroraceous.

These sufferings, even when not very severe, are badly borne by the sick, who become dejected, impatient, taciturn, discontented, and not disposed to enter into the details of their ailings. They have an air of suffering in their countenance; the conjunctiva, lips, and cheeks, being of a deep red colour, verging towards that of tincture of logwood, as are also the tongue and whole interior of the mouth, excepting along the centre of the former, where a thin mucous list may be seen. In a few subjects M. Broussais has observed, the tongue very much loaded, the breath offensive, and a Vol. II. No. 5.

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bitter taste in the mouth-but these are exceptions, and the diagnosis must be drawn from the tout-ensemble of the symptoms, not from any one class exclusively.

As soon as chronic gastritis is completely established, the cellular and adipose membrane becomes nearly absorbed, with but little diminution of the muscles; when these last are much extenuated, the disease is without hope. At all times, however, the skin is drawn tight over the muscles, sinking in in their interstices, so that it cannot be pinched up but with difficulty, even in those places where it is usually very relaxed. In no other species of marasmus has M. Broussais seen this degree of adhesion so strongly marked. This character of the skin, together with its colour, being a brown, inclining to yellow, offer two of the most constant diagnostic signs of chronic gastritis.

The pulmonary system suffers very little in this species of the disease, with the exception of a slight stomach-cough occasionally. Nor is the circulation so much influenced at the beginning as to evince any appreciable febrile movement. When the disease has made progress, then the pulse becomes hard and frequent; the skin, at the same time, being hot, and dry to the touch. There is always an evening exacerbation, with agitation and restlessness. If this train continues unchecked, prostration of strength soon ensues, and the gastritis, in fact, passes into the acute form. If, however, the febrile movement is only marked by frequency of pulse, without heat of skin-or if the patient only experiences a few hours of heat towards the evening, or during digestion, the malady may continue chronic. In all cases, if long protracted, the febrile symptoms subside-and the evening exacerbation ceases to be sensible. Then the skin becomes cold, and of the colour before described, with perceptible wasting of the body. When diarrhea is added, the cessation of pyrexial phenomena is still more sudden and complete.

III. Phlogosis of the Mucous Membrane of the Intestines. or Dysentery. M. Broussais observes, that we rarely find in the bodies of those patients who have died with diarrhea, any signs of phlogosis of the internal surface of the small intestines. Such inflammation is usually found in connexion with gastritis-indeed, where the mucous membrane of the small intestines is found inflamed at all, there is generally inflammation throughout the whole canal, from the cardiac orifice of the stomach to the anus. M. B. in this section, speaks only of inflammation as affecting the colon, which he divides into acute and chronic, though he seems to

feel, that the shades so blend into one another occasionally, as not to be distinguished but in well-marked cases.

A. Acute Species. In this case there are few premonitory symptoms, especially if the disease be very acute. In its highest degree, it is, according to M. Broussais, DYSENTERY. In our author's symptomatology, there are suspicious passages-as, for instance, his mentioning the discharge, at first, of fecal stools, and afterward of bilious ones. Such occurrences we have not observed in one case in fifty, and we have seen more than two thousand cases of dysentery. We can allow, however, for these inaccuracies or perhaps M. Broussais's patients were differently situated from those of our countrymen here, or in the colonies.

The phlogosis of the colon, M. Broussais has seen terminate in gangrene, in the course of a few days, without any other mark of fever than a certain precipitation in the pulse, without any heat of skin. If the patient be vigorous, plethoric, or irritable, the febrile heat is strongly developed, after rigours more or less apparent from the beginning. Then the dysentery is acute and febrile, like the acute gastritis before described. The symptoms of acute dysentery need not be detailed-nor does our author enter into the consideration of complications of this disease with continued fever.

B. Chronic Colonitis. Imo Chronic secondary diarrhoeas are not uncommon symptoms, sometimes a sequel of acute dysentery, and too often, in such cases, the consequence of mal-treatment. Most of these secondary bowel complaints have, at one period or other, symptoms in common with dysentery, as bloody stools, tenesmus, and some febrile movements in the system. 2ndo Primitive chronic diarrhoea. A man, apparently well, becomes affected with bowel complaint, which sets in without fever or pain, and lasts a longer or shorter time, exhausting his strength and flesh, yet without causing any considerable disorder in the harmony of the other functions. This diarrhoea is, like the preceding, the effect of phlogosis in the mucous membrane of the large intestines. It is the lowest grade of chronicity in the disease under consideration, and one which it is important to mark, as being allied with grades where phlogosis is unequivocal. It corresponds with the chronic gastritis already described.

M. Broussais saw a number of people in Italy attacked with diarrhoea, without any other appreciable cause than the influence of climate, and food of an irritating nature, or of difficult digestion. It was accompanied by no other inconvenience than slight colicky pains preceding each dejection. These people continued to attend to their usual avocations.

for some weeks, till the debility and the harassing frequency of stools compelled them to give up. As long as the patient continued his usual occupation and regimen, so long the disease continued ;-and in such cases it was often protracted for six months. But, by degrees, it exhausted the patients. If they were of an irritable constitution-if they had constringing pains of the abdomen, with a contracted, quick pulse, they usually fell into marasmus. Or if they were of a more relaxed and leucophlegmatic habit, (which is often the case in these people) they became dropsical, and died with or without coma, according as effusion did or did not take place within the coverings or cavities of the brain.

"In fine," says our author, "when the irritating causes exalt all at once, the action of the gastro-intestinal mucous membranes so far that pain shall suspend their functions and disturb the harmony of their movements--that is to say, when the gastric or intestinal irritation shall become suddenly so powerful as to cause local pain, vomiting, or diarrhoea, and fever-we have acute inflammation of the mucous membranes. When, on the other hand, these irritating causes exist for some time, without producing more than such a moderate excitement as shall only suspend the gastric functions for a short time, and feebly call forth the play of the sympathies, without greatly disturbing the general harmonies of the system-then we have chronic phlogosis of the same structures." Tom. II. p. 228.

IV. Organic Changes. Every phlogosis of the mucous membrane of the digestive organs, which proves fatal, during its acute stage or state, presents, post mortem, the tissue thickened, dense, reddened in different degrees, and sometimes exhibiting the characters of ecchymosis, or even gangrene. The membrane is sometimes found eroded, or, as it were, gnawed in small isolated spots ;-and, finally, covered or not, with an exudation of various consistence and character. The change of colour from rose red to violet, or even black, does not necessarily prove disorganization of structure.

"An attentive observation has convinced me, that patients have often died from the sole effects of pain, in early stages, and before the inflamed texture (trame enflammée) was broken, or sensibly altered in its composition. This is the fate of those unfortunates to whom cordials have been given, when overwhelmed with debility resulting from the nervous irritation and pain in such sensible structures. I have often resuscitated, with lemonade, men who were without pulse, delirious, and almost in the agonies of death. And those who have died in this state, frequently showed nothing more on dissection, than discoloration, without erosion or fætor, of the mucous membrane."

Here M. Broussais very properly observes. that various