SPEC. XI. B E. Gastritis erythematica. Erythematic inflammation of the stomach. GEN. VII. far it is the same I do not know. It is certainly not the suppurative. Whatever it is, it may be considered in some of its effects to be in direct opposition to the ad hesive and suppurative inflammations: for where the adhesive most readily produces adhesions, there the erysipelatous does not, as in the common cellular membrane; and where the adhesive seldom takes place, excepting from extreme violence, there this inflammation (if erysipelatous) has a tendency to produce adhesions, as in canals or outlets. It also opposes, in some degree, the suppurative, in being backward in producing suppuration even in those places where suppuration most readily takes place, such as canals and outlets; for there, as above observed, it more readily throws out the coagulating lymph. Whatever the inflammation may be, it is cer tainly attended with nearly the same kind of constitu→ tional affection. The fever in both appears to be the same, viz. accompanied with debility, languor, &c."*; 11 The erythematic inflammation of the stomach comes on more insidiously than the adhesive; and is best characterised by the inflammatory colour of the fauces, for it usually spreads to these, and the lowness and rapidity of the pulse. The inflammation often extends through a great part of the alvine canal as well as the esophagus ; and, after a subsidence of the sickness, produces diarrhoea, and mucous discharges from the bowels. It is sometimes so gradual and tardy in its progress as to produce little fever, or even local disturbance, for many days or even weeks. De Haen+ has repeatedly referred to this sort of gastritis, and Hennings has described it more at length +. Diagnostics. Remedial process. If this variety of gastritis be excited by acrid or poisonous substances, a brisk emetic should be exhibited with as much speed as possible; and afterwards such antidote as the character of the poison may point out: * On Blood, &c. p. 270. + Rat. Med. Part VI. IX. XIV. passim. # Beschreibung der Kennzeichen und Kunder Entzündung des Magens und der Gadärme. SPEC. XI. 6 E. Gas opposing acids to alkalines, and alkalines to acid erosives, GEN. VII. and the most active stimulants to narcotics. When the cause is internal, mild, diluent, and cooling drinks are tritis to be employed freely. The infusion of roses will often prove one of the most serviceable medicines we can make use of; blisters should be applied and repeated, and the bowels kept cool by laxative clysters. thematica. Erythematic inflammastomach. tion of the Found also on other oc Inflammation of the stomach is also found in the one or the other of its varieties, as an occasional symptom casions. in aphtha, measles, small-pox, and other exanthems; and, perhaps, in repelled herpes, scabies, and similar eruptions. tion of the pancreas. We may here observe that the PANCREAS is also some- Inflammatimes, though rarely, affected with inflammatory action; and that in this case the symptoms are a combination of empresma Gastritis and e. Hepatitis. There is pain and distention in the epigastrium, with frequent vomiting. There is also a defined tumour seated higher than the liver, and generally more polarized, but always accompanied with some degree of jaundice from its pressure on the bile-ducts. The affection often yields to depletion by cupping, brisk purgatives, and blistering*. GRIPING PAIN IN THE BELLY; TENDERNESS, AND VÒMIT SPEC. XII. IN inflammation of the stomach the pain is seated high- GEN. VII. er, and is rather burning than griping; this last, also, has usually some degree of hiccough, and great dejec • Inflammation and Enlargement of the Pancreas. By Edw. Perceval, M. B. &c. Trans. King's and Queen's College, Dublin, Vol. 1. p. 128, 1824. GEN. VII. SPEC. XII. tion of the How distinguished from gas tritis. Why ac by a syno tion of mind: neither of which belongs to inflammation of the intestines; and it is by these characters that the two are to be distinguished from each other. Stoll adds, that intestinal inflammation is also accompanied with a suppression of urine: but we cannot rely upon this as a specific symptom. Our opening remarks upon gastritis, in respect to the nature of that disease in France, apply to the present as well. Enteritis, also, exhibits two varieties: a Adhæsiva. Adhesive inflammation @ Erythematica. Pain very acute, fever vio lent; vomiting frequent ; and costiveness obstinate. Pain more moderate; fever less violent; little vomiting, and diarrhoea instead of costiveness. Of these varieties the former is more frequent in this species, as the latter is in the preceding *. The causes of both, as also of the accompanying fever, companied being a synochus, may be understood from the remarks already offered upon gastritis; the intestines partaking in a very considerable degree of the character of the stomach. chus. General causes. E. Ente ritis adhæsiva. Adhesive. To the causes enumerated under gastritis may be added some natural or accidental organic mischief in some part or other of the intestinal canal, as ventral, inguinal, or other hernias, or introsusceptions of various kinds; or infarctions from coprostasis, scybala, or enterolithus. The plica polonica, or matted hair, is said by De la Fontaine to be a cause of this species, as other writers affirm it to be of gastritis. The progress of the FIRST VARIETY usually commences with a sense of coldness or shivering, and an uneasiness in some part of the belly, at first remitting or intion of the termitting, but gradually acquiring permanency, and rising into an acute pain. The pain now spreads over Description. the whole abdomen, which is tense and tender to the inflamma bowels ⚫ Frank, ut suprà. Tom. 11. § ecxxxvi. p. 250. a E. Enteri flammation of the 1 bowels. touch, though less so than in peritonitis; there is great GEN. VII. flatulency accompanied with occasional spasms that shoot backward to the loins, usually obstinate costiveness, and tis adhesiva. unconquerable vomiting, though sometimes diarrhoea Adhesive inand tenesmus. The pulse is small, hard, and frequent, but has sometimes been soft: the tongue dry; thirst extreme; urine high-coloured, small in quantity, and discharged with difficulty; the breathing is laborious; and from the contraction of the abdominal muscles the patient is perpetually bending forward". If no beneficial change take place, all these symptoms become aggravated; instead of feculent stools, there is an ineffectual straining, with a small mucous discharge; and with the increase of the retching the feces burst through the valve of the colon, and are occasionally thrown up from the stomach. At length the torture suddenly diminishes; and the patient appears to have obtained relief: but his pulse intermits, his face grows pale, his extremities cold, convulsions succeed, and he sinks in death. 2 vd The general termination, therefore, when unfortunate, Prognostics, is that of gangrene; for it is rarely that the inflammation runs into a suppurative state. If in the course of the first two, three, or even four days, a free feculent discharge can be procured from the bowels, the vomiting and pains will gradually diminish, the pulse abate in quickness, and the patient be in the way of recovery... In treating this complaint, it is hence of the utmost Curative plan. importance to procure free evacuations, for the cure depends almost entirely upon our success in this respect. Yet the difficulty is often very great, and increased from the tendency of the stomach to reject whatever medi cines are introduced into it. Most practitioners com- Venesection mence with bleeding, which they urge very copiously, how far a and repeat every six or eight hours, according as the pulse will bear the lancet. The remarks we have made upon this practice, under GASTRITIS, will apply to the pre sent species. If the disease occur in a patient of a hardy useful. A J SPEC. XII. GEN. VII. and vigorous habit, and particularly if we have an opa E. Enteri- portunity of employing venesection within the first day tis adhæsiva. or two, we shall commonly find it of essential service: Adhesive in- but if we do not succeed, we shall assuredly hasten the flammation of the bowels. In what stage of gangrene, and abbreviate the term of remedial operations. And hence, unless free bleeding can be employed early, and the constitution evinces a tolerable portion of vigour, there is no inflammation in which the lancet is less likely to be serviceable, or may become more mischievous. To local bleeding, even under the conditions we are now supposing, there is less objection; but we have less chance of benefit by it than in peritonitis. From the first, therefore, we must attempt cathartics. If the stomach will retain the milder, as castor oil, neutral salts, or senna, these are by far the most adviseable; cient power. as our object should be to diminish instead of increasing cases mischievous. Cathartics mild rather than harsh, if of suffi But acrid not necessa tive of in flammation. Explained. the irritation of the intestines. But in the first species this is rarely the case; and we must hence, without loss of time, apply to those that are more acrid; as calomel in combination with the colocynth pill: assisting their operation by injections frequently repeated, and in as large quantity as the bowels will retain them. It does not necessarily follow that the irritation of purgatives these more acrid purgatives will add to the inflammarily augmen- tory irritation; nor do we always, or even commonly, find any such effect. For, firstly, the operation of the two irritations is very different; and by exciting the former we may even diminish or take off the latter by a transfer of action, in the same manner as we take off inflammation from any other organ by the application of a blister to some neighbouring part. Secondly, the direct effect of the cathartic is to restore a natural action, the peristaltic action of the intestines, which it is the direct effect of the inflammatory action to oppose. And thirdly, we find, in fact, the beneficial influence of such a practice, not only generally, but almost uniformly, and are incapable of accounting for it upon any other principle. Opiates when to be given. Opiates would be desirable through the whole course |