clay-coloured matter, sometimes of a dark watery fluid, and at others, not varying materially from a healthy state. The disease is usually mistaken for a common diarrhoea, until strong constitutional symptoms, as great febrile oppression, dry crusted tongue, thirst, vomiting, or a rapid exhaustion, of the vital powers, excite the attention and anxiety of parent and practitioner. Dissection, in these cases, usually shows irregular patches of inflammation in various parts of the inner surface of the intestines, especially the ileum, often covered with minute vesicles or ulcerations. In cases terminating with coma, effusion in the brain is found often preceded by a remarkable paucity of urine.

Of the chronic form of mucous inflammation, in general, Dr. Abercrombie does not say much. He thinks it may be a sequela of the acute disease, or an idiopathic affection. When it has continued for some time, we find the patient withered and emaciated, generally with diarrhoea, either constant or alternating with a constipated state of bowels, the appetite being variable and capricious, sometimes good or even voracious. The food often produces uneasiness until it is evacuated imperfectly digested.

If by opiates or astringents the diarrhoea be restrained, the gastric uneasiness is generally much increased, and vomiting is sometimes excited. In other cases, vomiting regularly alternates with diarrhoea, the remedies that relieve the one aggravating the other. The abdominal pain, though generally existing, is various in character, being sometimes in the shape of tormina preceding the evacuations—in others, more permanent and increased by pressure. The matters evacuated are very various-sometimes fluid and feculentfrequently white-and sometimes a mixture of half-digested articles, with recent bile, or brownish mucus, the production of the diseased surface. "In some cases there are discharges of venous blood, which may either appear in the form of coagula, or as a dark pitchy matter, giving a dark colour to the whole of the matter discharged. The autopsial observations of our author, on the chronic form of the disease. differ, in some respects, from those of M. Broussais, and therefore, we shall introduce a quotation from the former in this place.

"The appearances on dissection show the disease in various stages. In some cases, even after the symptoms have existed for a considerable time, we still find it in the form of irregular patches of a fungous appearance, and a dark red colour, slightly elevated above the healthy parts. In others, we find distinct small ulcers, with round elevated edges, and sometimes more extensive irreguJar ulceration, with ragged edges. Frequently the coats of the in

testines are thickened at the ulcerated parts, sometimes to such a degree as considerably to diminish the area of the intestine. In such cases, the ordinary symptoms of the disease are apt to alternate with attacks of obstinate costiveness, and they are frequently fatal by ileus. In some cases, instead of ulceration, the inner surface of the diseased parts is studded with numerous tubercles, of various sizes, and sometimes an extensive tract of intestine is found covered with smooth cicatrices of ulcers, which have healed. In some of these cases, the symptoms have continued, and gone on to their fatal termination in the usual manner. In others, this appearance is found after the symptoms have ceased, and the patient has died of some other disease. Cases have also occurred in which the patients died of emaciation, after the symptoms had ceased, apparently from these cicatrices being so extensive as to interfere with the process of absorption." 328.

Dr. Abercrombie justly observes, that there is great reason to believe, that the class of disorders under consideration exists in a degree short of actual inflammation, but sufficient to produce a host of those anomalous affections of the chylopoietic organs which, of late, have forced themselves on the attention of various physicians and surgeons. Indeed we are firmly persuaded that, to irritation of the mucous membrane of the stomach and bowels, together with the various sympathetic disorders of other organs, the consequence of this irritation, are owing nine-tenths of human afflictions-and that the more this subject is studied, the more power will we have over diseases which have generally proved obstinate or intractable. It was from this conviction that we brought forward the present article, and hope it will not fail to excite to farther investigation.

VI. Treatment. M. Broussais thinks he may hazard one fundamental rule, in the treatment, which is without exceptions-namely, that when the internal surface of the alimentary canal is phlogosed-that is, when its sensibility and temperature are exalted-its texture tumefied, and its nerves in pain, it cannot bear, with impunity, the application of irritating substances on the contrary, our prime curative indication is to bring into contact with it, matters the reverse of stimulant. The upper and lower portions of this canal, that is, the stomach and intestines, are somewhat differently acted on by the same substances, and therefore require to be considered separately.

A. Treatment of Gastritis in general. M. Broussais thinks that this is simple and easy. This inflammation requires 1 TIME to subside before aliments are introduced into the stomach-2ndo medicines to facilitate the favourable

termination of the disease. The first precept or rule is to be most rigidly observed. Meat, the farinacea, and fruit ought to be prohibited in gastritis. The best drink is a very dilute solution of gum tragacanth, which is less irritating than gum arabic, the extractive or colouring matter of the latter being somewhat stimulant. While we forbid the use of aliment, or drink of an alimentary nature, so that the stomach may be at rest till the phlogosis is resolved, this resolution may be accelerated by blood-letting, sedative, topical, and other external applications. General bloodletting, our author thinks, will seldom be of service—excepting in very acute forms of the disease, when the strength of the pulse, the dyspnea, or the sympathetic cough, unequivocally demand that measure. Local bleeding, especially by leeches placed over the epigastrium, is of more certain benefit. Yet even this is only an auxiliary, and gives but temporary relief if unaided by internal emollients and sedatives. Of the internal sedatives the vegetable mucilages and acids are by far the best. The former must be simple, pure, and free from extractive or aroma, as linseed, althea, quince seeds, gum tragacanth, and others that are perfectly insipid. The decoctions, infusions, or solutions of these substances should be made, if possible, with distilled water, and be very dilute, otherwise they are apt soon to dis-. gust the patient.

After the mucilaginous substances, the vegetable acids stand next in order of utility-but they must not be employed indiscriminately. The acetic acid does more harm than good. The lemon, of all fruits, furnishes the best acid for the drink of a patient labouring under gastric inflammation. After citric comes the pure tartaric acid; but it must be given extremely diluted. Orange juice diluted in water is beneficial, but the patient generally soon tires of it. The gooseberry and raspberry are better. The acid of the mulberry is too penetrating, and if employed, must be very largely diluted. The mineral acids are poisons in these cases. The vegetable acids above mentioned, are only to be employed so as to give a light and agreeable acidulous taste to the water or ptisans used for drink. Saccharine vegetable acids too are to be very sparingly given, as the sugar is slightly stimulant in itself, and, if not digested, runs into the spirituous fermentation. M. Broussais has not employed the carbonic acid, though he thinks it might be useful. Blisters to the region of the stomach do as much harm by their general excitement of the system, as they do good by their local revulsion. He thinks the same observation is applicable to all the other vesicatories or rubefacients. If

then, irritation of the skin generally propagates a sympathetic irritation to the internal coat of the stomach, we might expect that such applications to the surface as produced pleasing sensations there, would sooth the gastric affection. Experience, he says, corroborates this. The patient naturally craves for pure cool air, throws his arms out of the clothes, and bares the chest and epigastrium. He has found it extremely useful in this complaint to keep the surface over the stomach wet with cold, or at most, tepid evaporating lotions, by means of cloths. The application of ice, if the weather be hot, is serviceable, in many cases. "Let not," says our author, "practitioners despise these means last enumerated, as useless or superfluous. I have derived from them the greatest advantage. I have seen patients freed from pain and gastric malaise, almost instantaneously by the application of flannels, wrung out of emollient decoctions, to the epigastric region. The soothing of pain and the increase of perspiration generally resulted from this measure, and were of incalculable benefit." These observations apply to gastric inflammation in general; the different periods and varieties of the disease require corresponding modifications.

And here we solicit the patient and attentive consideration of our brethren. However we may undervalue the inert practice of our French cotemporaries, in acute diseases generally, we are convinced that their treatment is singularly judicious and appropriate in the peculiar class of the phlegmasiæ now under investigation-not only because the phlegmasiæ do not bear so well the depletory treatment of this country, as far as regards blood-letting; but, secondly, because the system of purgation here is particularly miscalculated to allay irritation and inflammation of the inner surface of the stomach and bowels. In fact, we have not been in the habit of sufficiently attending to the great difference of symptoms and treatment, dependant on the structure in which the inflammation is seated. Let us then divest ourselves of all foolish prejudice, and listen to the dictates of reason and experience.

B. Treatment of Acute Gastritis. The prevention of this disease may be easily gathered from a contemplation of the causes. When gastritis is unequivocally manifested by the symptoms already enumerated, we must not dread debility by cutting off every species of food, and every kind of drink but the bland fluids alluded to, from even drunkards and gluttons. During the first days, then, of acute gastritis, nothing should be permitted internally, but small quantities.

at a time, of dilute lemonade, or the other fluids above indicated. This absolute prohibition should continue till the febrile movements and sympathetic nervous disturbance cease. Then, and not till then, should we venture on even the farinaceous decoctions, or the infusions of the saccharine fruits, as apple or pear tea, &c. Nor till this period should veal or chicken broth be allowed. Next, in order of aliment, but not for some days after the farinaceous regimen, panada, bouilli, soup, may be cautiously ventured on. Solid aliments should be abstained from till every symptom is gone, and repeated proofs are offered of the return of the digestive powers. Then they should be of the lightest and tenderest kind, and small in quantity. Here M. Broussais introduces an instructive case in illustration, which we shall insert, but considerably condensed in language.

M

"Case XXVIII. 48 years of age, stout and muscular, had lived, during the last four years, an irregular life, in respect to food and drink, accompanied by some gastric derangements, which were removed from time to time, by gentle evacuations, diluents, and tonics. In October, 1807, he committed a great debauch in eating and drinking, and was seized, after retiring to bed, with sudden vomiting and purging. Every kind of drink which he swallowed was instantly rejected, and the stools became black and fetid, but passed without any pain. The pulse was unaffected. This cholera continued four hours. When over, the debility seemed extreme. Antispasmodics, tonics, &c. But soon the pulse rose in force and frequency-the skin became hot-the mouth dry-the tongue coated. In short, he soon presented the characters of low or adynamic fever, and his physician prescribed wine and water. The pulse keeping up, no stronger stimulants than the above were exhibited, and in three or four days the febrile symptoms disappeared. His physician now permitted a little light food and two or three glasses of claret, to recruit his strength, while some rhubarb and manna were given to procure some stools, constipation having succeeded to cholera. Stools were procured, and two days passed thus, in supposed convalescence. But on the third day, the tenth from the attack, high fever, red eyes, loquacious delirium, great restlessness, and surprising change of countenance took place. The idea of typhoid fever now took possession of the physician's mind, and camphorated decoction of cinchona, with stimulant antispasmodics were prescribed. These being ineffectual, recourse was had to sinapisms to the legs. The disease increased, and next day (11th) M. Broussais was called to the patient, who presented the following symptoms :-face distorted-eyes haggard, with the conjunctiva of a deep red colour-countenance that of a person insane, or in the last stage of putrid fever-tongue clean-skin dry and hot-pulse hard, frequent, and rather strong-constipated bowels-all the excretions checked-no gastric or abdominal pain on pressure. When asked how he did, he replied very well.'