In the so-called functional disease of the stomach, chemical research has removed much that was obscure, and will do still more to clear up the pathological changes induced; and the investigation of the physiological connexions of the sympathetic nerve and the branches of the semilunar ganglia will enable us more correctly to estimate the very varied symptoms produced in dyspepsia, many of which have their origin in this source. The chapter on the Duodenum presents us with instances of disease which closely simulate disease of the pyloric extremity of the stomach. The next chapter is on Gastro-Enteritis and Enteritis, diseases in which correct diagnosis is very important; in the latter class of disease especially life may be easily sacrificed by time thrown away, and by improper treatment; in the former, with judicious diet, warmth, demulcents, &c., recovery generally takes place. Whilst we strongly recommend, in many of these instances of gastro-enteritis, the avoidance of mercurials, the value of salines, of bicarbonate and chlorate of potash, and carbonate of soda, are well known to those who have carefully watched the effect that has followed their administration. In the chapter on Strumous Disease of the Intestine and Peritoneum we have sought to show that these are only part of a general perverted nutrition, and that, in many instances, disease in other organs is entirely obscured by the more marked affection of the abdominal viscera; here, also, we should strongly urge the avoidance of mercurial medicines and of drastic purgatives; the lives of many delicate children are sacrificed by worm powders and quack nostrums administered in these diseases. The next class of cases in Chapter VIII. is on diseases of the Cæcum and its Appendix. We have shown that very many instances of cæcal distension and of local enteritis arise, as well as the more serious class consequent on perforation of the appendix; we have given numerous instances of these forms of affection, and their perusal will show the great similarity in the symptoms and their general course. Dr. Burns, in a valuable paper in the Medico-Chirurgical Transactions, described, several years ago, some of these affections. It would appear that the symptoms of cancerous disease of the cæcum are different from simple cæcal enteritis and perforation; and that in many cases we may discriminate the character of the complaint. It will be found that treatment may do much to relieve and to assist the cure of cæcal disease; the pain seeks for rest, but it is well after the acute pain has subsided, still to maintain absolute repose for several days. The bowels are often confined, but the use of purgatives generally aggravates the disease without effecting the desired operation; it is better obtained by the application of leeches and by opium; the use, also, of mild mercurials with opium, in these cases, appears to hasten the subsidence of the morbid condition. In the ninth chapter we have pointed out the characters of the several forms of Diarrhoea, but we are well aware that diarrhoea is merely a symptom of very varied conditions, and that in many instances it passes almost imperceptibly into dysentery. Dysentery and Colitis are the subject of the tenth chapter; and the instances we have adduced show that inflammation of the colon, of most severe form, arises in our own country. Most of the writers on this subject are those who have observed it abroad in its worst forms. In some of the cases typhoid fever was simulated; in others, perforation of the colon had taken place; in one there was pyæmia and commencing suppuration in the liver; in several chronic cases the secondary effects were shown in producing contraction of the intestine, perforation, and artificial anus, &c.; as regards abscess in the liver, in one the abscess had dried and contracted; in another, fresh diseased action was set up around it, and abscess in the brain the result. We must confess that in some of the most severe forms all treatment is ineffectual to cure, whilst it partially soothes and relieves; but in the great majority of instances demulcents by the mouth, and enemata, astringents used in a similar manner, opium, ipecacuanha, &c., avail to stay the disease, and shorten its duration. We had intended to have given some observations on Asiatic cholera, but for several reasons have not done so; firstly, because although the disease manifests itself more apparently in the disturbed functions of the alimentary canal, it has not been clearly shown that the disease is really one affecting alone or principally the abdomen; and secondly, all the facts known in reference to this disease are better and more clearly given in the report drawn up by Dr. Baly and Dr. Gull. In the chapter on Typhoid Fever, we have merely described the condition of the abdominal affection, without entering into the general question of fever, and its treatment;-in the latter, it is well to guard against the danger of so freely administering opiates to check diarrhoea as to lead to cerebral oppression, and excessive engorgement of the lungs, from imperfect performance of the respiratory function. In the chapter on Colic, we have cursorily spoken of the simpler forms of the disease, and have separated the more severe forms of ileus internal strangulation, intussusception, and cancerous disease of the colon, in Chapter XIV. It will be found that whilst the latter conditions bear strong general resemblance in producing often fatal constipation, they may, in many instances, be distinguished, the one from the other; intussusception having close resemblance to simple colic, and, in not a few instances, accompanied by discharge of bloody mucus, or with actual diarrhoea; this latter symptom sometimes arises even with cancerous disease of the sigmoid flexure. We have very strongly urged the avoidance of drastic purgatives, calomel, colocynth, and even milder purgatives, and as strongly recommend the free administration of opium; the cases detailed almost uniformly show, that where purgatives were given, vomiting, pain, and distress were increased, whilst these and other symptoms were, on the contrary, relieved by opium. Opium, in such cases, appears to be the best means of procuring relief to the bowels, if it be possible. In the chapter on Worms, we have designedly been as brief as possible. The cases of Suppuration in the Abdominal Parietes, and of Perforation of the Intestine from Without, are an interesting series; many of them obscure in their diagnosis, and very varied in their course. Great care is required, attention to the symptoms as they become fully developed, and the avoidance of hastily aggravating the symptoms by too active treatment. The cases we have recorded might have been given at greater length, and on each one fuller remarks made; such has not been the design of the work, but rather in a very few words to point out the peculiarities of each, embodying in more general deductions the apparent conclusions derived from the whole. It is hoped that what has been adduced will shed some light on the difficulties which, often present themselves in the daily practice of the profession. 22, WIMPOLE STREET, CAVENDISH SQUARE, September, 1857. |