state. In several instances the ulcers were detached GEN. VII. and assumed a carbuncular appearance*. SPEC. XI. Empresma tion of the result. In most of these examples there can be no question Gastritis. of the existence of idiopathic gastritis or enteritis: but Inflammathe simple fact of the existence of numerous instances stomach. of fever, and fever too so violent as to prove fatal, without General any such accompaniments, together with the certainty that inflammation and even gangrene of particular parts of the alimentary canal are, in numerous instances, effects instead of causes of fever, are a sufficient ground for regarding fever and inflammation either of this or any other kind as distinct diseases, and prove a complete subversion of M. Broussais's hypothesis. Inflammation of the stomach may be either of the adhesive or the erythematic character; the latter is the more common t; and the species hence offers us two varieties with considerably different symptoms; which are chiefly, indeed, the result of the peculiar nature of the fever that accompanies this inflammation, already stated to be a synochus, or fever commencing with caumatic, but terminating in typhous, symptoms. For this kind of fever it is not difficult to account. We have often had occasion to state that the stomach is the common centre of sympathy; it is also an organ of acute sensibility; and it is hence impossible for it to suffer from inflammatory action without suffering severely, and without extending its affection very widely. The natural consequence is, that there must be great, and general, and sudden debility, and the fever, though commencing with excess of action, may soon lead to total atony, and fatal consequences. a Adhesiva. Adhesive inflammation of the stomach. B Erythematica. The pain very acute; the fever With an erythematous blush Clinique Medicale, ou Choix d' Observations, &c. publiée par G. Andral, Fils, Doct. en Med. Première Partie. Fièvres. Paris, 8vo. 1823. ↑ J. P. Frank, De Cur. Hom. Morb. Epit. Tom. 11. p. 250. Fever different according to the different nature of the inflamma tion. Erythematic inflamma tion of the stomach. extending to, and visible in the fauces; pain more moderate; fever less violent; pulse low and quick, Dr. Cullen seems to have been the first writer that distinctly pointed out the nature of these two varieties, which he has unnecessarily advanced to the rank of species, and later writers have justified the expediency of a distinction. This distinction, as already remarked, is produced by the nature of the accompanying fever; and consequently, in a considerable degree, by the nature of the constitution in which the disease occurs. The fever is perhaps in every instance a synochus, the cause of which we have just stated; but, while in a firm and robust habit the febrile course has, comparatively, but little tendency to pass from the entonic action with which it commences, into a dangerous languor and atony, in relaxed and irritable habits it is apt to run into this stage almost from the first, and the synochus degenerates rapidly into a typhoid character. In both varieties the causes are alike; as external or internal cold suddenly applied in a heated state of the stomach, acrid substances, or excess in eating. The acrid substances chiefly recorded are jalap and other drastic purgatives taken in excess; oil of vitriol; corrosive sublimate; and very large doses of nitre, or quantities swallowed by mistake, as an ounce, or an ounce and a half, of both which we have an example in the Journal de Médicine*. It is also said to have sometimes been produced by a severe paroxysm of cololithus +; and occasionally to have followed upon trichosis Plica, the matted hair of Poland‡. A sudden chill by swallowing cold water or some other fluid on a heated frame has been a frequent cause: as has also repelled gout, indigestible food, and especially ardent spirits drunk profusely. Laflize, Tom. LXXI. Souville, Tom. LXXIII. ↑ Caltschmied. Pr. de Ægro inflammatione ventriculi demortuo calculis, &c. Jen. 1757. De la Fontaine, Chirurg. Med. SPEC. XI. Empresma Inflamma The symptoms are sufficiently detailed in the specific GEN. VII. 'definition. Several of them are those of cardialgia; but in the latter there is neither fever nor vomiting. The Gastritis. most decisive signs are those of a permanent local pain, tion of the and general emaciation; these, as M. Chardel has justly stomach. observed *, increase with the prolongation of the disease, Diagnostics. till both become extreme, and even opium will scarcely "relieve the former, in whatever quantity administered. In a few cases the food is not rejected for several days; and as the bowels are constipated, and the digestion is imperfect, it remains in the stomach, and forms a tu1mour sensible to the pressure of the hand, which, upon rejection, disappears. The presence of this tumour is peculiarly characteristic of an inflamed state of the pyJulorus; as its absence is of the same state of the cardia; for in this last case the contraction of the cardia renders deglutition extremely difficult, and the food is for the most part rejected without reaching the stomach. From the close sympathy of the stomach with other organs, the disease has sometimes been accompanied with delirium, and in a few instances with hydrophobia. Where the inflammation is violent it destroys in a few days. If no fatal symptom occur within the first week it terminates for the most part favourably. Shiverings and a remis-osion of pain, are, as usual, marks of suppuration. Of the ADHESIVE VARIETY Mr. Cruikshank has given a bogood illustration in the case of a young lady who died after two or three days' illness, before which she had I been in perfect health. "I was called in", says he, "but she was dead before I got to the house. From her his tory I was at a loss to account for her death: but on opening the abdomen a day or two after, I found the scontents of the stomach in that cavity; that they had sproduced peritoneal inflammation, and killed. On examining the stomach, I found a hole in it large enough to admit the end of my finger. This hole had been formed by absorption of part of the substance of the * Monographie des Degénérations Schirreuses de l'Estomac. 8vo. Paris, 1808. a E. Gastritis adhæ siva. Adhesive inflamma tion of the stomach. Illustrated. SPEC. XI. « E. Gas GEN. VII. stomach from scrophulous ulceration: its edges had adhered by inflammation to the under surface of the small tritis adhæ- lobe of the liver. This inflammation was evidently raised by the powers of the body to prevent the accident which happened: and if no violent vomiting had taken place, and torn this adhesion at this particular time, she might have lived for years notwithstanding the ulcer."* siva. Adhesive inflammation of the stomach. Inflamma tion often slow. this modifi cation. In many cases of this kind the inflammation is chronic chronic and and indeed of long standing; for the diseased parts of the stomach exhibit great thickening and induration. Where the inflammatory action proceeds very slowly it is often astonishing to find how little the general health, Progress of or even the local state of the stomach, is disturbed. For, as in the case before us, it proceeds without being suspected till the ulcer is complete, the external tunic gives way, and the contents of the stomach are evacuated; which irritate, as a foreign body, in whatever situation they are lodged, excite a new and active inflammation, and destroy in a few days. This indeed is the usual ter mination, whatever be the progress. Yet the march of the disease is not always thus quiet or deceitful; for it is often preceded by many or all the ordinary concomi mitants of dyspepsy, as acidity, eructations, flatulency, and oppression of the stomach after eating; often indeed accompanied with emaciation and debility, and not un frequently with hæmatemesis; by which last signs it is chiefly to be distinguished from idiopathic indigestion. The death however is commonly sudden, within a day or two or even a few hours, from the cause just stated. -M. Chardel + has given various examples of this form. M. Gerard and Dr. Abercrombie § others.. Gastritis in its ACUTE form has often been represented in a more dangerous light than it deserves to be: for in neither variety under this modification is it frequently attended with fatal effects under judicious treatment. In the Anatomy of the Absorbent Vessels, p. 122. ↑ Ut supra. GEN. VII. SPEC. XI. tritis adhæ a E. Gas siva Adhesive. A tion of the: stomach.. 1 true adhesive form copious and repeated venesections have been very generally recommended, and have often been found of the highest advantage, particularly in robust and vigorous habits. To be, however, of any decided avail, this plan of treatment should be commenced early; inflammafor the fever is so apt to pass into a typhoid form, that, after the first two or three days, too much inroad will ge nerally have been made upon the constitutional strength to allow of the use of the lancet. If acrid poisons, or excess of eating, be the cause, an emetic should be admi nistered; but otherwise this, as well as all other stimulants, should be avoided. Gentle cooling laxatives, a blister applied to the pit of the stomach, mild nutritive drinks, nutritious injections, and, if the pain or sickness be extreme, doses of a drachm of the syrup of white poppies, and perhaps about five grains of nitre in an emulsion of gum arabic or spermaceti, will generally be found the most successful plan. It is, however, extremely difficult to get any medicine to remain on the stomach; and hence the best preparation is that of pills. If suppuration should Treatment follow, and the abscess burst, a milk diet with the mildest of suppurafood, and in small quantities at a time, is the only plan tion. to be pursued. If a gangrene take place, all further exertion will be in vain: and we may determine its presence by a sudden cessation of pain, coldness about the præcordia, and languid or intermitting pulse, which are its sure attendants. Under the chronic form we have just noticed, Dr. Abercrombie has found sulphate of iron in the proportion of two or three grains three times a day, a valuable and decisive remedy, and it is well entitled to attention *. in the event inflamma B E. GasUpon the ERYTHEMATIC VARIETY the following retritis ery marks of Mr. Hunter are too valuable to be omitted: thematica. and they are the more valuable as they apply to disorders Erythematic of other internal cavities besides the stomach. "There tion of the is", says he, "an inflammation which attacks internal stomach. canals which is classed with the erysipelatous; but how Explained Ut suprà. by Mr. Hunter. |