ber of cases, gastric irritation does not, at the beginning, create that degree of disturbance in the animal economy which may clearly indicate the nature of the disease, and therefore it passes, among the generality of observers, for what are vaguely termed bilious and stomach complaints. How are we, in such cases, to discover the true state of affairs? An inquiry into causes, modes of life, climate, occupation, &c. will often furnish us with strong grounds for presumption, and an attentive observation of the progress of the complaint will do the rest. Gastritis so slight as not to be recognised by the general symptoms, enumerated in their proper place, will not, M. Broussais thinks, be materially injured by the administration of an emetic. A temporary mitigation, indeed, of the symptoms generally ensues. The relief, however, is only temporary; but the subsequent recurrence of the symptoms is a valuable diagnostic. Whenever therefore we find fever, pain, and anorexia developed, after such a process, there is no longer any doubt upon the subject, and then rigid abstinence, with the bland diluents, before described, are to be immediately insisted

on.

In the summer of 1806, M. Broussais had a great number of these cases under his care. He began, in all cases, with the plan of abstinence and diluents, and the majority of the cases speedily got well. Where anorexia, bitter taste in the mouth, nausea, dryness of the skin, eructations and flatulence continued, then the patients were vomited, and the appetite immediately returned. The bowels, however, in these cases, required purgatives to clear away the saburra remaining in them. In some cases, indeed, febrile movements continued after the operation just mentioned, and in these a kind of bilious fever ran a course of four, five, or six days. Even here there was nothing else required than aperients and diluents-no bitters, no tonics were given. There was another class of patients that came under M. Broussais's care, with the following obscure symptoms:paleness of the countenance, without any yellow tingesome trifling appetite for breakfast, but not afterwardafter eating any thing in the evening, a sense of plenitude, as though they had over eaten--no pain, but a sense of undefined weakness, with tottering of the limbs, habitual constipation, and slow pulse. When to these patients' were given bark, bitters, or other kinds of tonics, then the pulse was raised, febrile heat, and other pyrexial symptoms, excited, and in a short time unequivocal gastritis was developed. M. Broussais therefore treated these cases in the same manner as chronic phlogosis of the mucous membrane

of the stomach, and firmly believes, that, by so doing, he saved a great number of lives.

"Those physicians," says our author, "who have profited by the lessons of M. Pinel, well know that this experienced practitioner never lost an opportunity of recommending the most mild vegetable and unirritating regimen to those hypochrondriacal, melancholic, vapourish, and (supposed) obstructed patients, who, after having exhausted the whole catalogue of deobstruents, stomachics, purgatives, &c. &c. applied to him to put an end to their suf ferings. Numbers have I seen cured by him, after abandoning their drugs, to live only on panada, milk, eggs, and fruit. But it is not easy to persuade the upper classes of society, especially after they have been habituated to spirituous liquors, to betake themselves to food and drink which they consider as insipid, and which, for a short time, appear to be productive of debility. Yet they have but to persevere, for some time, and they will find this regimen not only very pleasant, but a most effectual mode of restoring them to health." Tom. II. 341.

p.

We shall pass over M. Broussais's observations on the treatment of complications of gastritis with intermittent fever, in order to come to the methodus medendi in phlogosis of the mucous membrane of the intestines.

VII. The phlogosis in question but rarely affects the lining membrane of the small intestines. When it happens, in particular cases, to pass the valve of the colon, and ascend towards the stomach, it generally proves fatal. M. Broussais therefore only treats, in this place, of phlogosis of the mucous membrane of the colon-and first of the treatment in acute colonitis, as the grand preservative from the chronic state. Although M. Broussais considers dysentery to be essentially inflammation of the inner coat of the intestines, yet he believes that, as the same miasmal causes (animal or vegetable) which produce typhus, and other contagious fevers, produce dysentery, so the phlegmasiæ, in these cases, are so modified by the causes, and rendered so intense, as often to end in gangrene before art can interfere to prevent such a fatal termination. It is perfectly evident that the wide-wasting dysenteries of our colonial possessions would almost invariably destroy their victims under the French system of treatment, and therefore M. Broussais. very wisely declines entering on the subject at all. He confines his observations to those simple phlogosed states of the lining membrane of the large intestines particularly, which, attacking a man in perfect health, do not acquire violence, excepting by maltreatment. From the moment that acute colonitis is declared, the patient must not only abstain from all stimulating drink, but from every kind of alimentary

substance capable of leaving any focal residue in the bowels. Notwithstanding the atrocity of the pain, and the sense of debility with which the patient is overwhelmed in the intervals, we must not depart from the foregoing principle, so long as emaciation is absent.

The medicines which M. Broussais has found most proper to diminish the intestinal irritation, are the mucilaginous and farinaceous substances. In high states of irritation, he thinks that gum water only should be allowed-rice water is then too stimulant, because it requires some digestive effort. Even the simplest mucilaginous drinks are not to be indulged in too freely, lest by their very bulk they should act as extraneous bodies. This plan must be persevered in, as long as the stools are frequent, and the tenesmus violent. Meanwhile fomentations and cataplasms over the whole abdomen will be very useful. All kinds of enemata he considers as worse than useless, excepting in the very onset of the disease, where fæces may be keeping up additional irritation. In such cases their expulsion should be attempted, first by oily or mucilaginous lavements, and, if thatbe not sufficient, by manna or other mild purgatives.

"Au reste, tous ces moyens évacuans ne sont indiqués qu'autant que les excrémens sont opiniâtrement retenus. Le plus souvent ils sont inutiles, parce que le premier effet de l'irritation dyssentérique est de débarrasser l'intestin de toutes les matières qui y séjournaient. Cela étant fait par la nature, il suffit à l'art de ne pas fournir de nouveaux excrémens." Broussais, 356.

We agree with M. Broussais, that it is the part of the physician to prevent, as far as possible, the formation of excrementitious matters in the intestines by means of rigid abstinence; yet such is the determination of fluids to the mucous membrane of the bowels, that the most severe regimen will not prevent a great generation of morbid and acrid secretions there. On this account, oily laxatives are frequently necessary in the course of dysentery, though we condemn, as much as he can do, the daily administration of purgatives, in a disease, the principal feature of which is high irritation, if not inflammation of the lining membrane of the intestines. M. Broussais calls in the assistance of the warm bath, rubifacients, blisters, and frictions, when the dysentery appears to be the result of a violent crisis, or a metastasis of inflammation or irritation from some other tissue. "Opium, dans tous ces cas, et fort utile; mais tous ces moyens sont, pour ainsi dire impuissans, sans le concours du régime que nous avons recommandé." Our author affirms, that this strict abstinence succeeded, in almost all

cases, however violent, provided the patient came early under his care. We cannot say nay to this practice, never having given it a fair trial; but we have no hesitation in believing that it would, at all events, be an excellent basis, or groundwork for the treatment of dysentery in this country, and even in the colonies. We should not certainly trust to it alone, knowing, as we do, the indomitable nature of the disease when suffered to advance towards alteration of structure in the intestinal lining membrane. Broussais seems to despise all means of turning the tide of the circulation towards the surface of the body by internal medicines, and also to dread opium, excepting in some particular cases. Yet we can assure him, and it is now universally known in this country to all who have had any experience in the disease, that a combination of sudorifics and anodynes, with a proper proportion of a mercurial preparation, is by far the most powerful means we possess in allaying the intestinal irritation, and determining to the skin. In this country very severe bowel complaints may be safely and effectually treated with cretaceous mixture and tincture of opium, after each liquid motion, while five or six grains of the blue pill, with a quarter of a grain of opium, and three or four grains of antimonial powder, are taken twice, thrice, or oftener in the 24 hours. During this time the patient should be confined to bed, and the Broussaian regimen strictly adopted.

Treatment of Chronic Enteritis. A diarrhea continuing after the 30th day must depend, M. Broussais thinks, on organic derangement of the mucous membrane of the colon. In general, however, it is kept up by improper regimen or medicines only. In all cases it is a chronic phlogosis, the treatment of which, he conceives, may be fixed by invariable rules. These rules may be easily anticipated by what has already been said. The food must be such as leaves the least feculence to pass along the intestines; and, of course, the quantity should be no more than the stomach and duodenum can digest, otherwise the remains, when mixed with bile and mucus, will undergo fermentative and other decompositions in the tract of the intestines, which, with the gases evolved, create much irritation there. On this account, gentle tonics are serviceable, by strengthening the tone of the stomach; but care must be taken that their action does not go beyond the stomach, otherwise they are likely to aggravate the complaint. The remains of animal food, our author thinks, are much more injurious than those of vegetable; but of vegetables there must be much selection the farinacee alone are admissible in chronic bowel

complaints. Barley, wheat, and rice, are preferable to all others. Bread produces too much feculence. Fine flour boiled with milk, forms (as we have experienced) a most excellent diet for chronic dysenteries. Broussais cured great. numbers of patients in the military hospitals by this diet.

"Dans la pratique civile, il y a, pour entretenir la nutrition d'un diarrhéique, sans lui laisser beaucoup d'excrémens, mille ressources dont on est privé par les régemens des hôpitaux militaires. On trouvera dans les semoules, les gruaux, les pàtes ou vermicelles, pourvu qu'ils soient très-fins, des moyens de varier agréablement la nourriture, en combinant ces diverses substances avec le lait, la crême, les œufs, le sucre, selon le goût du malade et le degré de sa faculté digestive." 262.

When the digestion is pretty good, meat broths may be cautiously allowed. Whenever they render the stools more frequent, they are to be discontinued, at least for a time. Sweet and ripe fruits, rejecting the seeds and rinds, may be sometimes allowed as a variety.

In chronic phlogosis of the mucous membrane of the colon -in other words, chronic bowel-complaints, our author reduces the list of medicinals to two classes-stomachics and anodynes. When the general erethism attending the commencement of the complaint is completely subsided, but some local pain remains, M. Broussais prescribes solutions of gum tragacanth rendered gently anodyne by Sydenham's laudanum, varying the dose from 12 to 50 or 60 drops of the tincture. These medicines will not be serviceable unless combined with the rigid regimen before alluded to. As the dysenteric symptoms subside, gentle tonics, and gradually increasing aliment are to be allowed. Astringents, at all times, M. Broussais thinks, augment the phlogosis by checking the alvine evacuations. A little wine, or an infusion of cinchona or canella alba extremely weak, is sufficient to solicit the stomach to a resumption of its functions towards the close of the disease. Ipecacuan, as a vomit, our author has not found useful, excepting at the very beginning, when the stomach happens to be loaded. It does not possess, he thinks, any anti-dysenteric properties. action of vomiting he does not believe to possess any power in checking the increased peristaltic motion of the intestines. When phlogosis of the mucous membrane of the bowels is the cause of the purging, vomiting cannot arrest it. If the diarrhoea depend on irritating matters in the primæ viæ, then it does harm by checking the operation of nature in removing them. In short, it is not the mere symptom of purging that we are to combat, but the cause of the phenomenon.

The

From a number of experiments made with tincture of