OBSERVATIONS ON DISEASES OF THE ALIMENTARY CANAL, ANFIBRARY CESOPHAGUS, STOMACH, CACUM, AND INTESTINES. FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS; ASSISTANT PHYSICIAN TO GUY'S 4801 HII 1857 PREFACE. DISEASES of the Stomach have, during the last few years, received considerable attention, and our medical literature has been enriched by the labours of Budd, Handfield Jones, Chambers, Brinton, and others. Much, however, still remains to be done; and whilst some of the facts contained in the present volume will tend to confirm what is already known, other new ones will be found which, we trust, will repay an attentive perusal of its pages. The greater part of the facts recorded in the chapters on diseases of the œsophagus, and on organic diseases of the stomach, have already appeared in the pages of the Guy's Reports for 1855 and 1856; and those in connexion with diseases of the intestine were intended originally to be printed at the same time; such was found to be impossible, on account of the limited space allowed to each contributor. It has been designed to illustrate the diseases treated upon, by cases which have come under our personal observation, with a few remarks upon them, and some general deductions. During the period of our curatorship of the Museum at Guy's, and demonstratorship of Morbid Anatomy for several years, very numerous opportunities were presented of noticing these diseased conditions in their varied phases; and we would tender our sincere thanks to those colleagues who have permitted the mention of instances under their care. Although we have sought definitely to distinguish some marked classes of diseased conditions, we should be very unwilling to regard them as entities superadded to the human frame, but rather, to quote the words of Sir John Forbes, "as new phases of vital manifestations." Life may be considered as the resultant of certain forces, manifested in the performance of functions combining together for one harmonious purpose; it has received very varied appellations, each indicative of our inability to discover its real character; thus, we have had vital force, power of growth, nutrition, development, organization, nature, &c., each new observer considering himself more clear-sighted than his predecessor, although he has merely substituted one term for another. This living force is in close correlative relation with other physical forces, and the fuller investigations of physiological science show that the same are in operation, the force of gravitation, of chemical action, &c., in the living organism, as without it; modified, it is true, by another, namely, life. And as in the science of physics generally, so in the study of living phenomena, we must always bear in mind that a like cause always produces a like effect. Vague observation, and the superficial remarks of some writers, would lead us to suppose that, in living phenomena, the same cause is followed, at first by one effect, then another; interpreting fixed realities by prejudice rather than by reason. Some phraseology is necessary to express our meaning and ideas, and one great difficulty is overcome, if we can understand that the same words convey to each the same thought. It may be convenient, as we have mentioned, to regard life as the resultant of certain forces, and disease as a deviation from the normal direction. If any of the forces which are in natural operation be modified in intensity, a deviation is the result, and diseased action produced, the resultant being necessarily changed; still the tendency is such, that on the withdrawal of the modifying force, the normal course is reassumed. Not only may it be natural force which has led to this departure from the healthy state, but new force is added, as much as when the earth in its orbit is disturbed by the attraction of some other celestial body. In diseases, many sources of change arise-modifying forces thus syphilitic or miasmatic poison, small-pox, &c., alter the character of every function; new substance is added as much as in the voltaic battery, in which the fluid in one or other cell may be changed by any substance added to it; this may be merely of the kind already existing, or a foreign body; in any case, the phenomena-the same in general development—is modified. Such, to some extent, is the case in pathological change. These changes produced by perverted nutrition, or altered vital forces, are in many instances of such a character, that no examination of the structure itself could discern the state which had been produced; as fruitless would it be to search in the nerve of a limb for the altered force which had led to spasm, as to expect to find a telegraphic message by a microscopical examination of the wire, although the structure of both had been transiently modified by the disturbance of the forces they transmitted. If the character of the change in disease is one, which, like a polar force, reverts to its former condition, no trace can be found on inspection, but, in many instances, obvious structural changes are the result. Diseased action, however, as generally manifested, is the resultant, not of one, but of various changes in the normal condition, and very few persons are literally in perfect health. The living forces are modified by hereditary tendency, as struma; to this, perhaps, is added syphilis, to that miasm; still further sudden changes of temperature, improper supply of nourishment, of heat, and light; each of these may act as fresh sources of deviation from the normal healthy direction of living action, superadded to the resultant produced by the previous combination. Some have supposed that acute disease quickly passes off, and that with the subsidence of the more marked symptoms no trace is left behind, but very generally this is not the case; the attentive study of pathology will soon convince of the contrary; new exciting causes of disease arise, perhaps of a different character, but the resultant (to revert to the previous phraseology of forces) was not precisely the same, the former |