Imatges de pÓgina

exactly with what Pinel, in his Nosographie Philosophique, has laid down as characterizing chronic inflammation of the stomach and bowels.

Of the four phenomena exhibited in the living body, during inflammation, two only can leave traces in the dead these are, redness and swelling-ulceration being a consequence of these. Whenever M. Broussais discovered these traces in the mucous membrane of the stomach, post mortem, he made diligent inquiries whether the other two phenomena, heat and pain, had been present during life. in a great majority of instances this was found to be the case ; but when it was doubtful, Broussais examined very strictly, other patients similarly affected with those who died, and he constantly observed proofs of a morbid increase of sensibility in those tissues which, on dissection, showed redness and tumefaction. Here then were three of the phenomena of inflammation unequivocal; and as to the fourth-heat-it is not easy to ascertain its presence in chronic inflammations. It was, however, evidently developed when any irritating substances were taken internally.

Thus, then, M. Broussais adds, the signs of phlogosis of the internal surface of the stomach are, imo during life, certain lesions of function rcferrible to a surplus or morbid sensibility of the mucous membrane--2ndo On dissection, redness and ulceration of this tissue.

M. Broussais is well aware, indeed, that many physicians will refuse the name of inflammation to the above-mentioned redness of the membrane--unless it is arrived at a high degree of intensity, and accompanied by pyrexia. To these objections he replies by an ample presentation of facts, in which the links that unite the most evident with the most obscure gastric phlegmasiæ may, he thinks, be readily recognised. Our author then details the histories and dissections of twenty-seven cases, occupying between sixty and seventy pages of the second volume, before he enters on the regular description, etiology, pathology, and treatment of the disease.

We shall follow an inverse order;-first presenting an analysis of the didactic and descriptive part, and then selecting a few examples in elucidation of principles embraced or assumed.

1. Etiology. A phlogosed state of the mucous membrane of the digestive organs in general, is produced by whatever throws an undue degree of excitement on that tissue--principally by the impression of the atmosphere on the external, and aliments on the internal, surface of the body. Previous disease also may sometimes excite this affection. The eti

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ology differs somewhat according to the gastric or intestinal seat of the disease. Thus our author conceives that the predisposing causes of gastric phlogoses are such things as tend to accumulate the susceptibility or excitability of the tissue, whether by a general action on the system, or a local one on the organ itself. The former is exemplified by atmospheric heat--the latter, by the introduction of alimentary substances which have the property of keeping a greater degree of action or excitement in the stomach than is consistent with the general harmony of the system.

In respect to those predisposing causes which act on the system generally, M. Broussais makes several important observations on the heat and electricity of the atmosphere. The former of these agents renders more excitable the living fibre, and under high temperature reaction is more energetic than in low. When high temperature, however, is longcontinued, or very great in degree, the excitability loses in power by exhaustion. Hence, old residents in tropical and other hot climates have a more languid circulation, and less reaction, in acute diseases, than the inhabitants of hyperborean latitudes. Our author believes, that, although the stimulus of atmospheric heat on the skin causes an increased secretion from that extensive surface, and consequently draws an over-proportion of fluids towards the periphery, yet that the irritability of the mucous membrane of the primæ viæ is, at the same time, increased, and rendered more liable to take on inflammatory action, when stimulants or irritants are improperly applied. M. Broussais admits that, under these circumstances, there is a corresponding increase of the biliary secretion—but considers it as the effect, and not the cause of irritation in the mucous membrane_" et la surabondance de la secretion bilieuse, autre effet necessaire de l'irritation de la muqueuse.” We look on the phenomenon in quite another light--we consider the increased secretion of bile as the effect of increased stimulation on the surface and the irritation in the primæ viæ as often the effect of this redundant and vitiated biliary secretion. We are glad to find the fact (however explained) confirmed by the testimony of a Broussais, who is equivalent to a score of closet sceptics among our fire-side travel. ters and practitioners of the present day.* Our author's


* Our intelligent readers need not be told that all extremes approximate, and that intense cold, and more especially alternations of cold and heat, by driving the blood occasionally from the surface to the interior organs, produce the same effect as intense heat, in disposing to visceral inflammation.

reasonings on the action of electricity in predisposing the mucous membranes to phlogosis, are not very clear to us, and therefore we shall not bewilder ourselves or our readers by noticing them.

The predisposing causes which act directly on the stomach and bowels, are, as we before said, the stimulating substances swallowed by the mouth, for whatever purposes. These may produce phlogosis of the mucous membrane, even without the aid of predisposition from atmospheric causes acting on the surface. The following passage may be perused with advantage by more than our colonial readers.

“If men would take care to diminish the stimulants which they swallow, in proportion to the increased excitability of the stomach produced by the atmospheric heat of our summers, or of tropical climates, until they became acclimates, they would assuredly escape inflammatory affections. But when they sit down to table, they forget the precepts of Hygiene. They will retrench nothing from their former habits of indulgence. They swallow the same quantities of meat, spices, wine, coffee, liqueurs, as though they lived in the frozen zone, or their stomachs were in an ordinary state of excitability. Nay, such is the force of prejudice, that they consider this regimen as necessary to resist the debilitating effects of the climate! If, after an incendiary repast of this kind, a devouring thirst is kindled up, they would, if possible, quench it with more wine and spirits ; but happily Nature compels them to have recourse to simpler fluidsand thus the antidote is every day opposed to the poison.” Tom. II. page 191.

Our author goes on to enumerate the long list of “dishes . tortured from their native taste," and inebriating liquors which especially among the predisposed, lead, sooner or later, to inflammatory affections of the digestive apparatus. In this list he very properly includes also the farrago of stomachic tinctures, and quack medicines which the credulous and unwary are constantly pouring down their throats, for the purpose of relieving, but actually with the effect of aggravating the states of irritation prevailing in the chylopoietic organs. Among the predisposing causes also may be classed unpleasant emotions of the mind, especially grief.

It is almost needless to say, that these predisposing causes, if long continued, or excessive in degree, become exciting causes of the inflammatory state. What has been said of the predisposing and exciting causes of gastritis will apply, as nearly as possible, to enteritis. ' M. Broussais makes many acute observations on the effects of atmospheric impressions, and the reception of miasmal impregnations in the system, in the production of diarrheal and systematic affections ; but

his remarks are familiar to the English, who have long ago investigated these points. It may be proper to state, that M. Broussais considers dysentery as neither more nor less than intlammation of the mucous membrane of the intestines-and he makes an increased secretion of bile an occasional cause of the disease-an assertion that convinces us he never laboured under dysentery himself, or examined with care the stools of many dysenteric patients. Till within these few years an increased secretion of bile was considered the sole cause of cholera ; but now it is pretty well proved, that it is a mere effect, and sometimes not at all present in the disease. In his etiology of irritation and phlogosis of the gastro-intestinal lining, M. Broussais includes almost every thing which we place in the etiology of fever, as the effluvia from crowded bodies of men, unhealthy food, depressing passions, great fatigue, poverty, &c. &c. This must be carefully borne in mind; for the reader is to recollect, that we are not exclusively on the subject of common unequivocal gastritis, especially as effecting the peritoneal covering of the organ, but on those irritated or phlogosed states of the inner surface of the digestive tube, accompanying (whether as cause or effect) a great portion of what are termed idiopathic fevers. The reader may not go the whole length of M. Broussais's doctrines; but it will be highly to his advantage to study with the profoundest attention, and divested of prejudice, the contents of this analysis. We shall now proceed to the developement of symptoms in these phlogoses of the mucous membrane of the digestive tube.

II. Symptomatology of Gastritis. The first premonitory symptom is generally a sense of heat in the region of the stomach, during gastric digestion--at first, of a rather agreeable kind, ceasing when the stomach is empty, and succeeded by a farther craving for food. After these prelusive phenomena have continued for some wecks, or even months, according to the intensity of the causes, the person begins to perceive that this sense of gastric heat becomes unpleasant, and is coupled with a sympathetic heat of the skin, which is dry and rough. The tongue becomes dry and hotter than natural, with slight sore throat, broken rest, nervous irritability, heat and pain in the head. Now commences a kind of aversion to animal food and fermented liquors-sometimes thirst. When the disease sets in unequivocally, after these premonitions, it exhibits two forms. determined, as it would seem, by temperament.

A. Acute Gastritis of the Mucous Membrane. The first

symptom is sometimes a violent vomiting, resembling cholera morbus. The patient throws up every thing that he swallows; then bilious, mucous, or even sanguineous looking matters ; going very frequently to stool at the same time. Fever is a necessary accompaniment of this form of the disease. Sometimes gastritis declares itself without vomiting-but always with violent pyrexia, not preceded, in Broussais's experience, by a cold stage or shivering. The patient complains of a burning internal heat, and generally of a soreness in the pharynx. The tongue appears red and clean, or covered with mucus, except when the patient has been some time without drink. The thirst is considerable the desire for cold acidulated drink is as great as the aversion for every other kind of liquid. If the phlogosis does not extend to the intestinal tube, there is constipation.If it reach the colon, there is diarrhea with tenesmus. There is deep-seated pain in the epigastric, and especially in the right hypochondriac region, but not exasperated without a certain degree of pressure. This pain is sometimes lancinating, and accompanied by a sense of constriction. It'manifestly diminishes after the patient has swallowed cold aqueous drink, especially if acidulated. Very often the vomiting ceases, in a few days, although the other symptoms persist. At other times it continues or supervenes, in the course of the disease, and the patient is harassed with constant nausea, which appears to him to be occasioned by some globular body rising upwards, and painfully compressing the lower part of the chest. Each fit of vomiting is followed by a temporary ease, of very short duration, the patient incessantly demanding emetics-a symptom still more common in peritoneal inflammation than in acute gastritis. The absolute impossibility, which the patient supposes, of swallowing any thing, appears referrible to the contracted and highly irritable state of the upper orifice of the stomach. Such are the principal symptoms in acute gastritis; but several of them may be absent-even pain itself does not exist, in some cases, where the inflammation is most intense. Our diagnosis must therefore be assisted by a rigid observance of the sympathetic troubles produced by this pblogosed state of the mucous membranes of the digestive organs. The first class of these appertains to the head, affecting the functions of the senses, and the movements of the voluntary muscles. Headach may or may not exist. Aberrations of the intellect, corresponding with the moments of greatest suffering, are more steady in their appearance.

* I have seen,' says our author, “men as completely delirions as in fevers the most malignant, or phrenitis itself."

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