- Email: [email protected]
LECTURES ON THE THEORY AND PRACTICE OF PHYSIC,
membrane. To understand the nature of diarrhœa, therefore, you must take into
LECTURES
account the two circumstances
now men-
tioned, viz. the increased peristalticmotion,
ON THE
and the increasrd secretion from the mucous membrane, both of which take place when this membrane is in a htate of inflammation. BY DR. CLUTTERBUCK. Diarrhœa, or purging, however, may take place without any inflammation of Theatre, General Dispensary, Aldersgate- the mucous membrane, and, in fact, withstreet. out any actual disease of the intestines Their natural action may be simply increased from a variety of LECTURE XXIX. causes, in which they tlremselves have no direct concern. Thus purgative medias well as various other drugs, cines, tl e Mucous Membrane of Inflammation of have this effect; but in this case, in geof the Intestine. neral, the purging continues no longer Gentlemen, than till the irritating substance is disINFLAMMATION of the mucous mem- charged So, if the functions of the brane of the intestines is attended, after stomach are imperfectly performed, there a time, with increased sec’etion and con- may be acid or putrescent matter geneseqiient discharge ; and the affection is rated there ; and this passing into the termed diarrhœa, or purging. Now it is intestines may irritate them, and produce neces,ary that yon shonld know how increased evacuations. Again, a larger purgingis effected ; for some of the terms quantity of bile may be secreted by the in general use convey a very false idea liver, or bile of a more acrid quality; or of the thing. Puring is frequently said the bile may be pent up for a time by to be owing to relaxation, or weakness of gall-stones, and then snddenly poured the bowels ; implying, that they are pas- ont : either of these may produce temAn abscess of the sive on the occasion ; which is qnite con - porary diarrhoea. trary to the truth, and leads to improper liver, or of any other part within the abtreatment. The immediate catse of the domen, bursting into the intestine, may discharge of the contents of the intestines produce the same effect. All these may is the muscular action of the canal, ex- take place without any disease of the erted in an undulatory or worm-like man- intestines themselves; and the effect will ner, and callt-d accordingly the vermicu- be ereater or less, according to the states lar, or peristaltic motion. This action is of in itability of the canal. But often the mucous membrane begreater or less at different times, and the evacuation is in proportion. All purging, comes actually inflamed from these or therefore, implies greater action on the other causes ; and, as in other parts of part of the intestines; and consequently similar structure, increased secretion folthe terms rrlnxation and -weakness are im lows ; the muscular fillies of the intesproper. The system in such cases may tine become at the same time more irribe altogether weak, but the intestines table and active, and thus increased disthemsehes are always in a state of in- charges, or purging, takes place. This creased action in diarrhœa. The dis- inflammation may be excited by any of charge, again, is facilitated by the con- the causes above enumerated, when aptents being rendered more tiqnid ; and plied with more than the usual intensity; this effectproduced hy a more copious and then the purging will continue alsecretion taking place from the mucous though the cause has been removed, or THEORY AND PRACTICE OF
PHYSIC,
themselves.
[No.146.
[June 17, 1826.]
354 ceases to
duce it,
act,
Cold, likewise,
especially
tremities, and in
if
applied
some
persons
continue may course.
may pro. to the exmore
and go
This disease
than
through the usual
has sometimes
proved
in others, owing to predisposition. This fatal in twelve hours ; but vhen about to sweats come predisposition may be constitutional ;for terminate favourably,andwarm other symptoms in some the intestirres are at all times so on, and the pain
irritable, that the slightest irregularity cease. will produce purging. This irritability of Causes.—Cholera morbus rarely appears the intestines i, in general, greater in except towards the end of summer, and the morning than at the latter part of it is observed to confine itself chiefly to the day. A predisposition to such dis- the month of August ; it prevails with eases exists remarkahly in hot climates ; greater frequency and violence the longer but in what way the effect is produced it and itotter the summer proves; this, is difficult to understand. A similar pre- therefore, may be considered as tlie pre. disposition to such affections is observed disposing cause. The immediate, or ex. also towards the end of summer in tem- citinr causes are exposure to cold, indi. perate climates, and has been ascribed
to gestible matter of any kind taken into this the stomach, but especially pntrescent mo- substances. Crabs and other shell fish derate use of fruit rather tends to lessen readily produce it in certain individnals, the predisposition, by lessening the irri- Inhaling putrid vapours will likewise octability of the system altogether. casionally produce it. Arsenic (and proNow the inflammation of the mucous bably other mineral poison’-) give rise to membrane may be in different degrees, symptoms that are not distinguishable and more or less extensive ; and the dis- trom cholera produced by other canses. ease has received different names accordTheory of Cholera Morbus.—There is ingly. When, for example, the whole great reason to believe that this disease tract of the alimentary canal is thus consists in an inflammation of the mucous as well as affected, (stomach intestines) the disease has been called cholera mor- membrane of the whole tract of the alibus; when it affects pretty generally the mentary canal (including the stomach) increased secretion of bile being only small intestines, we call it diarrhœa ; and when the larg-e intestines principally, it secondary, and the result of irritation, as These three are in other cases of violent vomitiug and is termed dysentery. therefore essentially the same, and differ purging. The pain that precedes as well chiefly i’ extent, and the particular seat as accompanies the disorder, and which which they occupy. As, however, there often remains, with heat an(] tenderness is some differellce in regard to the treat- to the touch, after the evacuations have ment, it will be necessary to speak of ceased ; the furred tongne, and other febrile symptoms that succeed the coldthem separately. ness, are all signs of abdominal inflamma. tion. Besides that the disease is brought 1. Cholera Morbus. on by many causes that act immediately the mucous membrane, and which can Definition.—" Vomitingand purging of on bilious matters, tormina, with cramps of have no direct influence on the iiver,the the legs." supposed seat of the disease. This view of the nature of cholera, yon will find useHistory.-The symptoms of this disease in practice ; for the disease is most - are, violent pain in the stomach and successfully treated by means that art bowels, quickly followed by enormous adapted to the cure of inflammation o vomiting and purging of bilious matters, the mucous membrane in general. whence the name cholera, bile or choler The treatment of cholera is very simple, being supposed to be the actual cause ot and has not been materially improved the disease. There is great depression since the time of Sydenham. In most of strength ; the pulse is small, frequent,cases, it may be said to cure itself*; tire and often very irregular. Other symp vomiting and purging cea’sittg ’spontatoms often present are, hiccup, cramps neousiy, after a short time. It is btst at of the tegs, and coldness of the extremi- 1 first to encourage the disreharges, 6y
eating fruit;but though excess in may excite immediate purging, the
the
ful
ties. Cholera is often
I giving warm water freely, or, if you choose, with’idio., mucilaginous drinks, though these are of accompanied no moment. ’By proceeding in this way, pathic fever, which may co ntinae after) two ends are answered-every thing: that the cholera has subsided. T here is then be present of an irritating quality headache, brown tongue, p ostration the muscular strength, wit the other is got rid of; while the increased secretion from the mucous membrane, tends to symptom-, of ordinary fever, and
ofmay
which
,
!
355
ake 8ff the inflammation, a8 in the case the feet. Irritating matters of all kinds, of oidinary Catarrh. You may then give introduced into the stomach, or generated be ranked among the occaopium, combined with stimulants of ony there, ateto ot kind, such as spirits, the essential oils, siollal causes the disease. You must bra) in mind what I said, cumphor, &c. The opium may be either whrn in at or small treating of chronic inflammation of dose in a full onre, given and repeated doses; it is difficult to say the intestinal canal, namely, that diarwhich isthe better mndf. Warm fomen- rhœa, or purging, is not always primarily tations should he applied to the abdomen an affection of the mucous membrane, but and the lower extremities ; and if prac- may be a symptom ot a disorgan zed state ticable, the watm bath. Anodyne clysters 0/ the intestine. It is also frequently the conse quence of disease in the mesenteric may also he exhibited with advantage. If, when the vomiting and purging glands, tendering the intestinal canal bave ceased, there remains pain of a more irritable than usual. Treatment. With respect to the treatcontunued kind in the abdomen, with ten deraess to the t, uch, a blister should be ment of diarrhœa, it i,; sufficiently simple, applied; and even blood etting practised, attention always being paid to the probaIn most cases, the disease is if tile pulse or general stren!!;th will allow ble cause left tu itself, when, after a short of it. After an interval of 24 hours or litile more, a mild purgative should be time, as a day or two, it generally ceases given, in order to guard against accumu- spontaneously ; whereas the hasty snplation of matters iu the intestines, which presaion of tt by opiates andastringents, IS often follwved by a relapse, or even a might reproduce the disease. When cholera prevails epidemically, it converaion ot’ it into enteritis, the inflamis observed to occur in various degrees ; mation extending itselt to the general sometimes there is vomiting only, during substance of the intestine. It the disease appear to arise from which bile is thrown up (called then biious vomiting); sometimes there is purg- indigested food in the stomach, a gentle ing, without vomiting ; and sometimes emetic of ipecacuanha, will be proper. It pain, without either vomiting or pur ging is curious to observe how long matters remain undigested in the stomach, (called bilious cholic). Tirtse are all of will the same general natnre, and require the whilst the digested part of the food passes same general treatment to be applied to on. An emetic, tlieiefoi-e, is almost them ; always taking care that sufficient always useful: it may do good, also, upon evecuations are procured before opiates the ptincipte of counter-irritation If the disease arise from fermentation in the ate had recourse to. and consequent acidity, you may give antacids, such as the prepared chalk, 2. Diarrhœa.
l ’
-
hotter
stomach magnesia. or
Acidity
is
a common cause
Definition.—" Frequent evacuation ofof diar thoea in children, and the disease is in general readily cured by the means liquid læces." stated. When diarrhoea arises from cold, inducHistory.—This disease is characterized by a tiequent discharge of thin fæculent ing inflammation of the mucous memmatters, the stools becoming grad nally brane, similar to catarrh, (which is the more watery and less copious, and at most common case) we are not to attempt length slimy, and sometimes bloody ; at- to check it in the first instance, because tended more
or less with griping pains, the evacuation tends to catry off the inthe effect of spasmodic contraction. There flammation ; it is, in fact, the natural is generally also soreness ot the abdomen, cure. If it continue longer, so as to disand often pyrexia, with definient appetite. tress the then remepatient considerably, of The taking food genera.ly produces dies are to be employed. a stool. Sometimes the food passes unNow, if the patient is strong, and there changed, and the disease. is then termed is muth pain or soreness of the abdomen, an unfounded notion that and the febiile lientery, from symptoms run high, even the spleen (lien) was concerned. At other bleeding is proper to a moderate extent, time., the stools are whitish, which was and will greatly facihtate the cure. At to be to ot supposed owing the presence events, mild purgatives should be emch)le, and the affection was then called ployed. The natural purging does not the cœliac passion: probably, however, evacuate the intestines ; for a entirely this appearance arises from an alteration will often bring away feculent in the secretion trom the mucous mem- purgative
all
brane.
Causes.-Diarrhœa is most frequently produced by cold, especially by wetting
matter, after the diarrhœa has existed for many days. All purgatives, however, are not equally proper. Rhubarb is one of the best (though it does not operate as
B2’
356
astringmt, as has often been supposed.)’, Symptoms. -The evacuations in this When the action of the rhnbarb is over, form of disease, are frPquFnt, but small the purging generally ceases : if not, in quantity; thpy are, at the same time, opium in small qnantities will be found alimy, and often ftothy, and consist of the mucus of the colon aiid useful ; such as a quarter or half of a grain, administered three or four times ill rectum. When the inflammation is vio. twenty-four- hottrs. In slight cases, it lent, coagulable lymph, instead of mucus, will be sufficient to administer tt at nigh is thrown ont; sometimes collected in and sometimes in flat masses, like only. Opium lessens the irritability of the eanal, diminishes the peristaltic mo- the lining membrane of the intestine tion, and also the secretion: so that it off, which they h me been supposed does good in various ways, and is by far to be, but improperly. Sometimes the the most powerful remedy we can em. discharge is parulent, and sometimes with blood, or blood may be ploy; but it should not be given too early in the disease, for the reasons stated. copiously discharged ; Mhence the term As the disease is attended with a de- bloody flux, often applied to it. termination of blood towards the intesBile is seldom found in the evactiations, tines, the circulation should be directed The disease is generally attended with or febrile symptoms. to the sqtrface, by diaphoretics; and for this purpose stimulants may be combined Theory.—Dysentery is an inflammation the mucous membrane of the large inwith the opium ; as camphor, or sonietimes even ammonia. i testines, as diarrhœa is of the small. It Astringents are seldom proper at first; is properly enough placed t’y Dr. Cullen as, by stopping the secretion, the inflam- in the same order of diseases as catarrh; mation is apt to increase, and even to af- bnt not for the reason stated, namely,as fect the substance of the intestine, pro- being attended with an increased disducing acute inflammation, which has charge merely, but as being an affection sometimes proved fatal. After a time, ot the same structure, the mucous memastringents, as well as opiates, may Le brane. Upon this gronnd, diarrhœa ought properly employed; and the vegetable to be classed with the others, and not ones are generally to be preferred, such among the order of spasms, with which it no real affinity; for the occurrence as red rose leaves, catechu, kino, logwood, or others. These are commonly of spasm, whether in diarrhœa or in dymore effectual, whes: given in combina- sentery, is altogether accidental. tion with stimulants and opiates, and Dysentery often succeeds both to choand diarrhœa, the inflammation leavlikewise wich chalk. If the purging, after the canal, passes being suppressed by thee means for a ing the upper partof and concentrates downwards, time, continues to recnr, and that rethe colon and rectum. The lower peatedly, there is then reason to snspect itselfofonthe diurn has been found also to the existence of organic lesion, which It often ends in manner already partake of the disease. must be treated in with thickening and contrac explained. Attention should he paid to tion of the gut. From the extremity of the diet of the patient. Food should be taken sparingly, because the stomach in the rectum being inflamed, tenesmus and aptto take place, and general h4is its action impaired in these prolapsus ani aredistress to the patient. There is, however, a great deal cases. g2eat of urrnecessary refinement practised in The neck of the bladder likewise otten the-e casps, in regard both to food and snffers, and strangury is the consequence. At the same time that the action of the drinks. The appetite may in genera! be andrectum is violent, the peristalsafely trusted to, provided there is a limi- colon tation in regard to quantity. The im- tic motion of the parts al)ove is dunimishpregnating the snbstances taken as drinks ed ; as is the secretion both from the muwith viscid and mucilaginous substances, cons membrane and the liver; whenceit does not at all answer the purpose of is, that the faeces are retained, often for sheathing the bowels, which is an absurd two or three days, and become indurated in consequence ; and thus hard masses of and mechanical notion. Warm feculent matter (called scybala) are dis. lone is far preterable. charged from time to time, and give rise an
chrefly
lumps,
peeled
streaked
( pyrexia, of
has
lera
I gradnally part
the
ulceration, occasion
water
Dysentery. Definition.-° Freqnent mucous or bloody stools, the fasces being at the same time retained, or passed at inter3.
vals
only, and
with
tormina,
then in an indurated and tenesmus."
state;
to
sevete
griping pains (tormina) ;so
that in reality one might say, there was both costiveness and purging at the same
time.
and
duration.-In violent
Progress cases, dysentery weeks,
may terminate
two or three
fatally in
but sometimes is pro.
357 one of the best, It given daily, in dose’’ of from five to fifteen grains. If there be much pain and restlessness, a small dose of opium may be given at night. Castor oil is also a good medicine, and relieves the tormina, or gripings, as all purgatives do. Frequent glysters to relieve the tendesmus, are necessary. They should be muclaginous, and exhibited in synall qu antities only, as from four to six ounces ; starch or thick gruel, with opium, is usually
racted to as many yeara, and often ends this purpose, rhubarb i. should be
in dropsy. It may terminate in ulceration, or contraction of the gut; but rarely in gangrane. Causes.-Exposure to cold and moiq tnre, and probably marsh miasmata, appear to be the wost common causes o dysentery. The disease prevails most in hot climates, and in antumn, and in marshy situations. Now when fever arises these places, there being a predisposition to dysentery, this become. combined with the fever, and so thedisease altogether has been slipposed infectious ;
preferred.
When the disease is olistinate, diaphoretics must be assiduously used. Small doses of ipecacuanha and opium, or the Dover’s powder, are well adapted to the of fever in these cases is known by the purpose. Keeping the patient in bed for usnal symptoms, namely, the affection ot a few days, is of great advantage. Fothehearl, brown tonsne, and prostration menting the bowels will also be useful, of strength. Attimes the fever i, elridemic, and If there is much soreness, a btister and occasionally assnmes an intermitting may be usefully applied. A combination of form, The disease at such titles often calomel, antimony, and opium, given so as eiidsfatally in a few days, and carries off to affret the month, is sometimes advantagreat nnmbers in camps and armies, who geous. Astringents are never useful while are all equally exposed to the canses of the the tormina continue violent ; for they disease. Sometimes it becomes chronic, may increase the inflammation. But a’ter and lasts for months, or even years a time they may be given, in the interShould intermittent continue with the vals of employing purgatives. of dysentery, when simdysentrry,it commonly assumes the quar- The treatment be summed up in a few words. tan form as usnal. Dysentery differs a good tleal in temperate climates, in an- You are to remember that it is inflammatumn and in spring ; hence two varietit-s of I tion you are treating, which requires the it have been laid down, the autumnal and common antiphlogistic means, accommothe vernal. The vernal is more inflam- dated to the strength and other cirenm’ matory, the pulse being strong and full, stances of the patient. The chief peculas well as hard ; the tongue white; and arity is, the absohtte necessity there is the frequent use of purgatives of a the heat of the body gr eater. Treutment.-In vernal dysentery or mild desct ipioa. When dysentery is combined with inwhenever the inflammatory symptoms before mentioned are present, bloodletting termitting tever, the management of the toamodeiate extent is generally proper case is difficult. The cinchona will hardly at first. The stomach should he cleared influence the intermittent in such a state the bowels, while it is rather calculated by an emetic ;which is best eiven in the I of the dysenteric symptoms. It to increase often becanse sweating follows, evening, which is very serviceable. Purgatives is better, in these cases, to endeavour to are always necessary in dysenteiy, in ali relieve the dysentery in the usual way ; tio bad effect npon the its forms, because the fæces by being re- ’or this will have tained, become dry and hard, and thus fever, which, on the contrary, will often irritate the intestines, so as to keep up autside nnder the treatment. The remothe disease. Some have given calomel in val of the patient to a pure air, and an preference ; but this is nota good purga- elevated situation, is a point of the greattive for the purpose, as it i, very uncer- ) est moment. tain in this respect ; in addition to which Colic. ititself capable of inducing dysentery. fluctuating pain Violent In old cases, however, calomel may be Definition. ‘ with constipation and the abdomen ; as in some other chronic inserviceable, the signs of flammations, by inducing mercurial action sometimes vomiting, without inHammation." in the system. Some prefer the saline purgatives ; but these often produce inHistory—Besides inflammation and it! creased secretion, without discharging consequences, as already described, the the more solid contents of the intestines. intestinal canal is liahle to spasm, which The object is, to keep up the pei-istaltic in this part is called colic. motion, and thus prevent accnmn- The symptoms are, very acute pain, lation of fæces in the bowels ; and for chiefly about the navel; the patient bends
but is probably the fever, rather, that is so; for, it is not at all certain that simple dysentery is infectious. The combination
ple, may
for
I in
358
body forward
in these cases, to prevent of inflammation, wbenevef the disease does not readily give way, disturbed ; the muscular strength is tem- bleeding has the further advantage, of porarily impaired It is of yeat impor- being itself a most powerful antispasmodic tance to distinguish between colic or mere for it’ taintness should ensue from it, all spasm of the intestines, and aotual in- spasmodic contraction will ceae, at least flammatiun. Now in inflammation the for the time. The colic produced by the poison of pulse is qnick, the tongue is dry and foul, and there i- y eat soreness of the abdo- lead, (the col ca pictonum) is to be treated men, with heat, and the pain is constant ; in the same way. The recurrence of this spewhereas in spasm, the pain fluctuates, cies of colic may he sometimes prevented and is relieved by pressure. bv the use of’ mercury, employed so as to The causes of colic are, cold, indigesti- aifect the general systpm. This remedy ble food, acid or other irritating mst- appearsin some degree to counteract the ters in the intestines; accnmulation of poison of lead ; for I have observed it in faeces. There is a variety of colic, which many cases relieve, to all appearance,the is of a specific nature,I mean, that pro- colic and tlre paradysis. duced by the application of the poison of Flatulency of Bowels. lead, either internally or externally. This, Air in large quantities is often collected besides constipation, is attended with pain, about the shoulders and arms, and in the large intestines ; but it does not is followed at length by paralysis, chiefly produce pain until spasmodic contraction So that the pin in this rase of the mnscles on the tore-arms. There takes place are often cramps of the legs, and some- i.s not simply from the distension, but from i tite re-action, on effort to contract. Some. times epilepsy. Treatment.—The object of treatment is times the intestine contracting upon the to take off the spasm, upon which both air, forces it through the spasmodicallythe pain and the constipation depend. For contracted part,into the adjoining portion; this purpose heat may be applied, in the and this hack again ; and so stic(,e4,sively way of fomentation or otherwise, to the for a long time, accompanied with arnmabdomen, or, what is still better, by the bling noise, termed borborygmi. This hot bath. Internally, stimulants of all state returns at intervals, daily or oftener, kinds are useful, especially alchohol, and is a very painful and distressing dis. æther, ammonia, and the essential oils, ease. It arises from indigestion, which and, as still more powerful, opium. Or is the remote canse; and it occurs printhese may be variously combined. An dpally in females ; being often in thema emetic will often, upon the principle of hysterical symptom. Treatment.— This affection is often difficounter-irritation, take off the spasm ; this is morep’pecially proper, where the cult of rentoval. The food should be of a disease is occasioned by improper things stimulant qnality, and chiefly animal, Sti. taken into the stomach. Purgatives also mulants of all kinrls give relief. Purgaare donhly proper ; first, by removing all tives are generally required ; but they irritating matters from the intestines ,and ought to be of a stimulant kind, and not next, by exciting the other parts of the of violent operation. The turpentines are canal, they tend to pllt a stop to the SpdS- probably among the best. Tonics arealto modic contraction ot the part itsetf; as useful, combined with purgatives as; our principal object in the treatment of ruubarb with infusion of gentian. this affection is to produce stools by reHœmorrhoidal affections. laxing the spasm of the intestine. Castor oil, sulphate of magnesia, and extract of Definition.—The best, perhaps, that colocynth are the best for this purpose ; can be given, is this " Pain at the ex. as, however, they are often rejected by tremity of the rectum ; one or morelivid vomiting, the intestines should be stimn. tubercles at the verge of the anus, from lated from helow, by injections. Other which there is freqnently a discharge of means failing, the tobacco injection sholild blood from time to time." Sometimes the tumours are situated be made trial of; half a drachm, or at within the anns, and are forced down on most drachm to a pint. Spasm is sometimes followed by inflam- every attempt to evacuate, with much mation ; which you must be watchful of. suffering to the patient. This state may When the abdomen becomes ht aud ten- be ascertained by examination with the der to the touch, and tebrile symptoms finger. Sometimes the blood flows in conarise, you may be sure inflammation siderable quantity without pain, and then taking place. In this case, bloodletting generally proceeds from a greater dis becomes necessary. Indeed it should be tance above the anus, and without in. the
for ease; there is
con-
stipation, and sometimes vomiting;the pulse is not, iu general, much, if at all
is
often the
employed
coming
on
359 mours. Other signs of hœmorrhoids have been mentioned, such as pain and weight in the head, and pain in the loins, but thm are not constant. Theory or explanation of thesymptoms. -The extremity of the rectum, from itc depending position, from its being snh
If the geueral health appears to
done.
or is in danger of doing so, by the ceasing of the accustomed hæmor-
have
suffered,
rhage, endeavours should be made prudocf this, by sitting over the
to resteam
of hot water, by the application or leeches from time to time, and by the frequent to freqnent pressure, and other use of aloetic purgatives, which stimulate jected causes, is prone both to inflammation and the rectum in a specific way. The further hæmorrhage. These affections take the treatment of these disorders is chiefly name o1 hcemorrhnids, trom the tendenoy local, and falls within the province ot to bleed, and that of piles, from the swell- surgery. inws or protuberance that take place ; Worms in the Intestines. and sometimes the compound term, bleedWorms in the intestines are far from an ing-piles,is used. The immediate canse is, impeded cir- uncommon occurrence. There are qeveral culation, which is brought abont in diffe- kinds of them met with in the hxmaa rent ways. The depending posture of the body ; ag the tœnia, or tape-worm ; the part, and still more the frequent pressure C?,Icurbitina, resembling the seeds of the to which the part is exposed almost hahi- gonxi ; the lumbricus teres, or common tnally, as already mentioned, may be con- round worm ; and the ascaris, or thread sidered a, the morremote causes. En- worm ; besides others ofrarer occurrence. A variety of symptoms are pointed ont largement of any of the abdominal viscera, especially of the liver, will have the as indicating the pre-ence of worms in the samf effect in interrupting the return ot alimentary c.mal; as irregular and often venous blood from the neighbourhood voracious appetive ; grinding of the teeth of the anus ; as will also an accumulation rlaring sleep ; picking ot the nostril. ; diof hardened fæces in the rectum. The lated pupils ; griping pains about the arteries of the part are thus prevented navel ; itching of the anus, and slimy fro,1I empt)ing themselves with freedom stoots. Epilepsy, or other convulsive into the veins, and are there by irritated affections, are supposed to be produced into increased and inflammatory action, hy the presence of the tape-worm more All of these signs, howso as to produce the states mt-ntioned, particularly. with tumefaction and hæmorrhage. The ever, are equivocal ; there is not one of too freqnent use of purgatives, especially them that may not arise independent of aloetic purgatives, tend also strongly to worms, so as to take pl.ice in other di.eases. Many of them are common signs produce these affections. Hæmorrhoidal affections often become of brain-uffection, which i the case with periodical ; and when attended with a voracious appetite, grinding of the tedh, considerable loss of blood at tolerahiy dilated pupils, and convulsive disorders, regular periods, acquire importance, iuas- all of which verB freqnently arise from much as they cannot always s be interrnpt- this source, and where no worms exist. ed or suppressed without inconvenience, It is true tliit worms are sometimes disor pven without danger to the general charged, where such symptoms areprehealh. isent; but they are more probably the than the cause of the disease; they In the treatment of hæmorrhoidal affections, we are to consider, therefore, are expel led in consequence of the gr eater how tar they may have become habitnat, heat of the body, which is usually present and thereby necessary in some degree to in these cases ; and accordingly a febrile the general health. When there seems atate ot the body, from whatever cause, Is reason to believe such to be the case, freqnently followed by the discharge of they should not be too hastily suppressed ; worms. What reuders it still more prowhile, in endeavonring to relieve them, bable that worms are not the cause of such attention should be paid to the habit of symptoms as have beeu described, is, that are very often observed to be preliving, for the purpose chiefly of inculcating temperance, where a want of this is s nt, and the tape worm, as well as the observed ; and substituting other dis- others, without being attended with disorder of any kind. Admitting, however, cliargrs of blood from time to time. The remote cause should be careftilly that they do really at times give rise to inquired into, in order, if possible, to its the symptoms mentioned, we ought at reinoval, Thus, unnecessary pressure least to have ocnlar demonstration of should be avoided, and especially that their presence, before we have recourse produced by the lodgement of accumu- to active means for their expulsion ; belated fæces in the rectum, Visceral dis cause many of the remedies resorted to eases should be relieved, as far as can be ! on such occasions, are in themselves highly
effect
they
’
360
objectionable, and capable of doing much mtscliief, especially in infants ;such are the more drastic purgatives, and calomel
REVIEW.
among the rest. It’ worms are actually discharged, and A Practical Dissertation on the means of we have sufficient evidence to believe that they are the occasion of the disorder obviating and trealing the varieties of be proper to attempt their removal. This is accomplished In two ways ; first, by administering medicin s which, as is sopposed, will destroy the worms, and which are called anthelmin-
present, it
tics;
secondly, by forcibly dislodging
Costiveness, which
periods of life,
different cases of predispo-
occur
and in
ut
sitions to various Constitutional Muladies, in peculiar temperaments of body, in disorders of the lungs, stomach, liver,
a violent action of tile intestinal canal by purgatives. rectum, &c., and during Pregnancy, by The efficacy of many or most of the anMedicine, Diet, &c. By RICHARD REECE, thelmintics that have been proposed, is M. D. Member of the Roy,tl College of vory questionable. This is shown by the fact, that none of them retain long their Surgeons. 8vo. pp.351. Longman reputation; wnich they might be expected and Co. 1826. to do, if they wete really as efficacions as alleged. I may nrentiun the powder of’ Dr. Reece is pretty generally knownto tin, the fern-root, the anthelmia, or Indian pink root. and the cow-itch: these, the public as the author of’ " The Mediwith many others, are liable to the obser- cal Gtude for the use of the heads of vation I have just made. Purgatives, aud and as Edi. those of the most active kind, are in Famines, the Clergy, &c.," reality the only unequivocal means we tor of a periodical work, called " The possess for removing worms from the in- Uazetteof Health," both of them devoted teslines. The oil of turpentine deserves to what to be distinguished hel e, tor its superior may be called popular or domesser viceit is efficacy ; and particularly tic medicine. We look upon the present able in removing the tape-worm), which it commonly does entire, while other pur- volume as a continuation of the series, gatives bring the worm away piece.meal. but are by no means prepared to assert It requires to be exhibited it) a large do.e, rnat, as well as its prodecessors it does as all ounce, or an ounce and a half; in which quantity it operates much more not contain many things to interest the promildly than could have been expected. fession. Costiveness, one of the most It commonly purges very quickly and accommon " ills that Hesh is heir to," the tive.y, but still without violence. Sometimes it occasions vomiting, and a kind ertile, and probably the most ancient,* of intoxication, which lasts a few hours, rarent of disease, has perhaps added but is of no importance. It is remarkable, that although in small doses the oil nore thin any thing else to the vocabu, of medicine. Barely to enumerate of turpentine is apt to irritate considerably the urinary organs, it seldom has he various orders of catharties which this effect when largely administered, probably, because its quick operation as have swelled the materia medicasofevery a purgative, leaves no time for its being and conntry, would be no easy task; absorbed Im the lacteals. Where ascarides are lodged in great or is it less (Jifficult to explain all the numbers in the rectum, as is often the causes of costiveness, or why it assumes case, they may be removed by an injec- - nch a variety of forms. Cullen has no. tion of the oil ot tnrpentine. iced three It is not to be forgotten, that worms species of costiveness,—1.Obare rarely fonud, where the natural functions of the stomach and bowels are * The Ibis is said to have tanght the well performed. Hencf it is an object of the first importance to restore the healthy Egyptians to obviate costiveness bv the action ot’ these parts by bitters and other nse of ciysters ; and according to Hero. tonics, and by attention to the patient’s dotus and Pausanias, Melampus learned diet. Now it is evident, that the frequent the use of hellebore by observiug that employment of drastic purgatives would his goats were purged after browsing counteract this object. upon it.
them, by exciting
LECTURES
account the two circumstances
now men-
tioned, viz. the increased peristalticmotion,
ON THE
and the increasrd secretion from the mucous membrane, both of which take place when this membrane is in a htate of inflammation. BY DR. CLUTTERBUCK. Diarrhœa, or purging, however, may take place without any inflammation of Theatre, General Dispensary, Aldersgate- the mucous membrane, and, in fact, withstreet. out any actual disease of the intestines Their natural action may be simply increased from a variety of LECTURE XXIX. causes, in which they tlremselves have no direct concern. Thus purgative medias well as various other drugs, cines, tl e Mucous Membrane of Inflammation of have this effect; but in this case, in geof the Intestine. neral, the purging continues no longer Gentlemen, than till the irritating substance is disINFLAMMATION of the mucous mem- charged So, if the functions of the brane of the intestines is attended, after stomach are imperfectly performed, there a time, with increased sec’etion and con- may be acid or putrescent matter geneseqiient discharge ; and the affection is rated there ; and this passing into the termed diarrhœa, or purging. Now it is intestines may irritate them, and produce neces,ary that yon shonld know how increased evacuations. Again, a larger purgingis effected ; for some of the terms quantity of bile may be secreted by the in general use convey a very false idea liver, or bile of a more acrid quality; or of the thing. Puring is frequently said the bile may be pent up for a time by to be owing to relaxation, or weakness of gall-stones, and then snddenly poured the bowels ; implying, that they are pas- ont : either of these may produce temAn abscess of the sive on the occasion ; which is qnite con - porary diarrhoea. trary to the truth, and leads to improper liver, or of any other part within the abtreatment. The immediate catse of the domen, bursting into the intestine, may discharge of the contents of the intestines produce the same effect. All these may is the muscular action of the canal, ex- take place without any disease of the erted in an undulatory or worm-like man- intestines themselves; and the effect will ner, and callt-d accordingly the vermicu- be ereater or less, according to the states lar, or peristaltic motion. This action is of in itability of the canal. But often the mucous membrane begreater or less at different times, and the evacuation is in proportion. All purging, comes actually inflamed from these or therefore, implies greater action on the other causes ; and, as in other parts of part of the intestines; and consequently similar structure, increased secretion folthe terms rrlnxation and -weakness are im lows ; the muscular fillies of the intesproper. The system in such cases may tine become at the same time more irribe altogether weak, but the intestines table and active, and thus increased disthemsehes are always in a state of in- charges, or purging, takes place. This creased action in diarrhœa. The dis- inflammation may be excited by any of charge, again, is facilitated by the con- the causes above enumerated, when aptents being rendered more tiqnid ; and plied with more than the usual intensity; this effectproduced hy a more copious and then the purging will continue alsecretion taking place from the mucous though the cause has been removed, or THEORY AND PRACTICE OF
PHYSIC,
themselves.
[No.146.
[June 17, 1826.]
354 ceases to
duce it,
act,
Cold, likewise,
especially
tremities, and in
if
applied
some
persons
continue may course.
may pro. to the exmore
and go
This disease
than
through the usual
has sometimes
proved
in others, owing to predisposition. This fatal in twelve hours ; but vhen about to sweats come predisposition may be constitutional ;for terminate favourably,andwarm other symptoms in some the intestirres are at all times so on, and the pain
irritable, that the slightest irregularity cease. will produce purging. This irritability of Causes.—Cholera morbus rarely appears the intestines i, in general, greater in except towards the end of summer, and the morning than at the latter part of it is observed to confine itself chiefly to the day. A predisposition to such dis- the month of August ; it prevails with eases exists remarkahly in hot climates ; greater frequency and violence the longer but in what way the effect is produced it and itotter the summer proves; this, is difficult to understand. A similar pre- therefore, may be considered as tlie pre. disposition to such affections is observed disposing cause. The immediate, or ex. also towards the end of summer in tem- citinr causes are exposure to cold, indi. perate climates, and has been ascribed
to gestible matter of any kind taken into this the stomach, but especially pntrescent mo- substances. Crabs and other shell fish derate use of fruit rather tends to lessen readily produce it in certain individnals, the predisposition, by lessening the irri- Inhaling putrid vapours will likewise octability of the system altogether. casionally produce it. Arsenic (and proNow the inflammation of the mucous bably other mineral poison’-) give rise to membrane may be in different degrees, symptoms that are not distinguishable and more or less extensive ; and the dis- trom cholera produced by other canses. ease has received different names accordTheory of Cholera Morbus.—There is ingly. When, for example, the whole great reason to believe that this disease tract of the alimentary canal is thus consists in an inflammation of the mucous as well as affected, (stomach intestines) the disease has been called cholera mor- membrane of the whole tract of the alibus; when it affects pretty generally the mentary canal (including the stomach) increased secretion of bile being only small intestines, we call it diarrhœa ; and when the larg-e intestines principally, it secondary, and the result of irritation, as These three are in other cases of violent vomitiug and is termed dysentery. therefore essentially the same, and differ purging. The pain that precedes as well chiefly i’ extent, and the particular seat as accompanies the disorder, and which which they occupy. As, however, there often remains, with heat an(] tenderness is some differellce in regard to the treat- to the touch, after the evacuations have ment, it will be necessary to speak of ceased ; the furred tongne, and other febrile symptoms that succeed the coldthem separately. ness, are all signs of abdominal inflamma. tion. Besides that the disease is brought 1. Cholera Morbus. on by many causes that act immediately the mucous membrane, and which can Definition.—" Vomitingand purging of on bilious matters, tormina, with cramps of have no direct influence on the iiver,the the legs." supposed seat of the disease. This view of the nature of cholera, yon will find useHistory.-The symptoms of this disease in practice ; for the disease is most - are, violent pain in the stomach and successfully treated by means that art bowels, quickly followed by enormous adapted to the cure of inflammation o vomiting and purging of bilious matters, the mucous membrane in general. whence the name cholera, bile or choler The treatment of cholera is very simple, being supposed to be the actual cause ot and has not been materially improved the disease. There is great depression since the time of Sydenham. In most of strength ; the pulse is small, frequent,cases, it may be said to cure itself*; tire and often very irregular. Other symp vomiting and purging cea’sittg ’spontatoms often present are, hiccup, cramps neousiy, after a short time. It is btst at of the tegs, and coldness of the extremi- 1 first to encourage the disreharges, 6y
eating fruit;but though excess in may excite immediate purging, the
the
ful
ties. Cholera is often
I giving warm water freely, or, if you choose, with’idio., mucilaginous drinks, though these are of accompanied no moment. ’By proceeding in this way, pathic fever, which may co ntinae after) two ends are answered-every thing: that the cholera has subsided. T here is then be present of an irritating quality headache, brown tongue, p ostration the muscular strength, wit the other is got rid of; while the increased secretion from the mucous membrane, tends to symptom-, of ordinary fever, and
ofmay
which
,
!
355
ake 8ff the inflammation, a8 in the case the feet. Irritating matters of all kinds, of oidinary Catarrh. You may then give introduced into the stomach, or generated be ranked among the occaopium, combined with stimulants of ony there, ateto ot kind, such as spirits, the essential oils, siollal causes the disease. You must bra) in mind what I said, cumphor, &c. The opium may be either whrn in at or small treating of chronic inflammation of dose in a full onre, given and repeated doses; it is difficult to say the intestinal canal, namely, that diarwhich isthe better mndf. Warm fomen- rhœa, or purging, is not always primarily tations should he applied to the abdomen an affection of the mucous membrane, but and the lower extremities ; and if prac- may be a symptom ot a disorgan zed state ticable, the watm bath. Anodyne clysters 0/ the intestine. It is also frequently the conse quence of disease in the mesenteric may also he exhibited with advantage. If, when the vomiting and purging glands, tendering the intestinal canal bave ceased, there remains pain of a more irritable than usual. Treatment. With respect to the treatcontunued kind in the abdomen, with ten deraess to the t, uch, a blister should be ment of diarrhœa, it i,; sufficiently simple, applied; and even blood etting practised, attention always being paid to the probaIn most cases, the disease is if tile pulse or general stren!!;th will allow ble cause left tu itself, when, after a short of it. After an interval of 24 hours or litile more, a mild purgative should be time, as a day or two, it generally ceases given, in order to guard against accumu- spontaneously ; whereas the hasty snplation of matters iu the intestines, which presaion of tt by opiates andastringents, IS often follwved by a relapse, or even a might reproduce the disease. When cholera prevails epidemically, it converaion ot’ it into enteritis, the inflamis observed to occur in various degrees ; mation extending itselt to the general sometimes there is vomiting only, during substance of the intestine. It the disease appear to arise from which bile is thrown up (called then biious vomiting); sometimes there is purg- indigested food in the stomach, a gentle ing, without vomiting ; and sometimes emetic of ipecacuanha, will be proper. It pain, without either vomiting or pur ging is curious to observe how long matters remain undigested in the stomach, (called bilious cholic). Tirtse are all of will the same general natnre, and require the whilst the digested part of the food passes same general treatment to be applied to on. An emetic, tlieiefoi-e, is almost them ; always taking care that sufficient always useful: it may do good, also, upon evecuations are procured before opiates the ptincipte of counter-irritation If the disease arise from fermentation in the ate had recourse to. and consequent acidity, you may give antacids, such as the prepared chalk, 2. Diarrhœa.
l ’
-
hotter
stomach magnesia. or
Acidity
is
a common cause
Definition.—" Frequent evacuation ofof diar thoea in children, and the disease is in general readily cured by the means liquid læces." stated. When diarrhoea arises from cold, inducHistory.—This disease is characterized by a tiequent discharge of thin fæculent ing inflammation of the mucous memmatters, the stools becoming grad nally brane, similar to catarrh, (which is the more watery and less copious, and at most common case) we are not to attempt length slimy, and sometimes bloody ; at- to check it in the first instance, because tended more
or less with griping pains, the evacuation tends to catry off the inthe effect of spasmodic contraction. There flammation ; it is, in fact, the natural is generally also soreness ot the abdomen, cure. If it continue longer, so as to disand often pyrexia, with definient appetite. tress the then remepatient considerably, of The taking food genera.ly produces dies are to be employed. a stool. Sometimes the food passes unNow, if the patient is strong, and there changed, and the disease. is then termed is muth pain or soreness of the abdomen, an unfounded notion that and the febiile lientery, from symptoms run high, even the spleen (lien) was concerned. At other bleeding is proper to a moderate extent, time., the stools are whitish, which was and will greatly facihtate the cure. At to be to ot supposed owing the presence events, mild purgatives should be emch)le, and the affection was then called ployed. The natural purging does not the cœliac passion: probably, however, evacuate the intestines ; for a entirely this appearance arises from an alteration will often bring away feculent in the secretion trom the mucous mem- purgative
all
brane.
Causes.-Diarrhœa is most frequently produced by cold, especially by wetting
matter, after the diarrhœa has existed for many days. All purgatives, however, are not equally proper. Rhubarb is one of the best (though it does not operate as
B2’
356
astringmt, as has often been supposed.)’, Symptoms. -The evacuations in this When the action of the rhnbarb is over, form of disease, are frPquFnt, but small the purging generally ceases : if not, in quantity; thpy are, at the same time, opium in small qnantities will be found alimy, and often ftothy, and consist of the mucus of the colon aiid useful ; such as a quarter or half of a grain, administered three or four times ill rectum. When the inflammation is vio. twenty-four- hottrs. In slight cases, it lent, coagulable lymph, instead of mucus, will be sufficient to administer tt at nigh is thrown ont; sometimes collected in and sometimes in flat masses, like only. Opium lessens the irritability of the eanal, diminishes the peristaltic mo- the lining membrane of the intestine tion, and also the secretion: so that it off, which they h me been supposed does good in various ways, and is by far to be, but improperly. Sometimes the the most powerful remedy we can em. discharge is parulent, and sometimes with blood, or blood may be ploy; but it should not be given too early in the disease, for the reasons stated. copiously discharged ; Mhence the term As the disease is attended with a de- bloody flux, often applied to it. termination of blood towards the intesBile is seldom found in the evactiations, tines, the circulation should be directed The disease is generally attended with or febrile symptoms. to the sqtrface, by diaphoretics; and for this purpose stimulants may be combined Theory.—Dysentery is an inflammation the mucous membrane of the large inwith the opium ; as camphor, or sonietimes even ammonia. i testines, as diarrhœa is of the small. It Astringents are seldom proper at first; is properly enough placed t’y Dr. Cullen as, by stopping the secretion, the inflam- in the same order of diseases as catarrh; mation is apt to increase, and even to af- bnt not for the reason stated, namely,as fect the substance of the intestine, pro- being attended with an increased disducing acute inflammation, which has charge merely, but as being an affection sometimes proved fatal. After a time, ot the same structure, the mucous memastringents, as well as opiates, may Le brane. Upon this gronnd, diarrhœa ought properly employed; and the vegetable to be classed with the others, and not ones are generally to be preferred, such among the order of spasms, with which it no real affinity; for the occurrence as red rose leaves, catechu, kino, logwood, or others. These are commonly of spasm, whether in diarrhœa or in dymore effectual, whes: given in combina- sentery, is altogether accidental. tion with stimulants and opiates, and Dysentery often succeeds both to choand diarrhœa, the inflammation leavlikewise wich chalk. If the purging, after the canal, passes being suppressed by thee means for a ing the upper partof and concentrates downwards, time, continues to recnr, and that rethe colon and rectum. The lower peatedly, there is then reason to snspect itselfofonthe diurn has been found also to the existence of organic lesion, which It often ends in manner already partake of the disease. must be treated in with thickening and contrac explained. Attention should he paid to tion of the gut. From the extremity of the diet of the patient. Food should be taken sparingly, because the stomach in the rectum being inflamed, tenesmus and aptto take place, and general h4is its action impaired in these prolapsus ani aredistress to the patient. There is, however, a great deal cases. g2eat of urrnecessary refinement practised in The neck of the bladder likewise otten the-e casps, in regard both to food and snffers, and strangury is the consequence. At the same time that the action of the drinks. The appetite may in genera! be andrectum is violent, the peristalsafely trusted to, provided there is a limi- colon tation in regard to quantity. The im- tic motion of the parts al)ove is dunimishpregnating the snbstances taken as drinks ed ; as is the secretion both from the muwith viscid and mucilaginous substances, cons membrane and the liver; whenceit does not at all answer the purpose of is, that the faeces are retained, often for sheathing the bowels, which is an absurd two or three days, and become indurated in consequence ; and thus hard masses of and mechanical notion. Warm feculent matter (called scybala) are dis. lone is far preterable. charged from time to time, and give rise an
chrefly
lumps,
peeled
streaked
( pyrexia, of
has
lera
I gradnally part
the
ulceration, occasion
water
Dysentery. Definition.-° Freqnent mucous or bloody stools, the fasces being at the same time retained, or passed at inter3.
vals
only, and
with
tormina,
then in an indurated and tenesmus."
state;
to
sevete
griping pains (tormina) ;so
that in reality one might say, there was both costiveness and purging at the same
time.
and
duration.-In violent
Progress cases, dysentery weeks,
may terminate
two or three
fatally in
but sometimes is pro.
357 one of the best, It given daily, in dose’’ of from five to fifteen grains. If there be much pain and restlessness, a small dose of opium may be given at night. Castor oil is also a good medicine, and relieves the tormina, or gripings, as all purgatives do. Frequent glysters to relieve the tendesmus, are necessary. They should be muclaginous, and exhibited in synall qu antities only, as from four to six ounces ; starch or thick gruel, with opium, is usually
racted to as many yeara, and often ends this purpose, rhubarb i. should be
in dropsy. It may terminate in ulceration, or contraction of the gut; but rarely in gangrane. Causes.-Exposure to cold and moiq tnre, and probably marsh miasmata, appear to be the wost common causes o dysentery. The disease prevails most in hot climates, and in antumn, and in marshy situations. Now when fever arises these places, there being a predisposition to dysentery, this become. combined with the fever, and so thedisease altogether has been slipposed infectious ;
preferred.
When the disease is olistinate, diaphoretics must be assiduously used. Small doses of ipecacuanha and opium, or the Dover’s powder, are well adapted to the of fever in these cases is known by the purpose. Keeping the patient in bed for usnal symptoms, namely, the affection ot a few days, is of great advantage. Fothehearl, brown tonsne, and prostration menting the bowels will also be useful, of strength. Attimes the fever i, elridemic, and If there is much soreness, a btister and occasionally assnmes an intermitting may be usefully applied. A combination of form, The disease at such titles often calomel, antimony, and opium, given so as eiidsfatally in a few days, and carries off to affret the month, is sometimes advantagreat nnmbers in camps and armies, who geous. Astringents are never useful while are all equally exposed to the canses of the the tormina continue violent ; for they disease. Sometimes it becomes chronic, may increase the inflammation. But a’ter and lasts for months, or even years a time they may be given, in the interShould intermittent continue with the vals of employing purgatives. of dysentery, when simdysentrry,it commonly assumes the quar- The treatment be summed up in a few words. tan form as usnal. Dysentery differs a good tleal in temperate climates, in an- You are to remember that it is inflammatumn and in spring ; hence two varietit-s of I tion you are treating, which requires the it have been laid down, the autumnal and common antiphlogistic means, accommothe vernal. The vernal is more inflam- dated to the strength and other cirenm’ matory, the pulse being strong and full, stances of the patient. The chief peculas well as hard ; the tongue white; and arity is, the absohtte necessity there is the frequent use of purgatives of a the heat of the body gr eater. Treutment.-In vernal dysentery or mild desct ipioa. When dysentery is combined with inwhenever the inflammatory symptoms before mentioned are present, bloodletting termitting tever, the management of the toamodeiate extent is generally proper case is difficult. The cinchona will hardly at first. The stomach should he cleared influence the intermittent in such a state the bowels, while it is rather calculated by an emetic ;which is best eiven in the I of the dysenteric symptoms. It to increase often becanse sweating follows, evening, which is very serviceable. Purgatives is better, in these cases, to endeavour to are always necessary in dysenteiy, in ali relieve the dysentery in the usual way ; tio bad effect npon the its forms, because the fæces by being re- ’or this will have tained, become dry and hard, and thus fever, which, on the contrary, will often irritate the intestines, so as to keep up autside nnder the treatment. The remothe disease. Some have given calomel in val of the patient to a pure air, and an preference ; but this is nota good purga- elevated situation, is a point of the greattive for the purpose, as it i, very uncer- ) est moment. tain in this respect ; in addition to which Colic. ititself capable of inducing dysentery. fluctuating pain Violent In old cases, however, calomel may be Definition. ‘ with constipation and the abdomen ; as in some other chronic inserviceable, the signs of flammations, by inducing mercurial action sometimes vomiting, without inHammation." in the system. Some prefer the saline purgatives ; but these often produce inHistory—Besides inflammation and it! creased secretion, without discharging consequences, as already described, the the more solid contents of the intestines. intestinal canal is liahle to spasm, which The object is, to keep up the pei-istaltic in this part is called colic. motion, and thus prevent accnmn- The symptoms are, very acute pain, lation of fæces in the bowels ; and for chiefly about the navel; the patient bends
but is probably the fever, rather, that is so; for, it is not at all certain that simple dysentery is infectious. The combination
ple, may
for
I in
358
body forward
in these cases, to prevent of inflammation, wbenevef the disease does not readily give way, disturbed ; the muscular strength is tem- bleeding has the further advantage, of porarily impaired It is of yeat impor- being itself a most powerful antispasmodic tance to distinguish between colic or mere for it’ taintness should ensue from it, all spasm of the intestines, and aotual in- spasmodic contraction will ceae, at least flammatiun. Now in inflammation the for the time. The colic produced by the poison of pulse is qnick, the tongue is dry and foul, and there i- y eat soreness of the abdo- lead, (the col ca pictonum) is to be treated men, with heat, and the pain is constant ; in the same way. The recurrence of this spewhereas in spasm, the pain fluctuates, cies of colic may he sometimes prevented and is relieved by pressure. bv the use of’ mercury, employed so as to The causes of colic are, cold, indigesti- aifect the general systpm. This remedy ble food, acid or other irritating mst- appearsin some degree to counteract the ters in the intestines; accnmulation of poison of lead ; for I have observed it in faeces. There is a variety of colic, which many cases relieve, to all appearance,the is of a specific nature,I mean, that pro- colic and tlre paradysis. duced by the application of the poison of Flatulency of Bowels. lead, either internally or externally. This, Air in large quantities is often collected besides constipation, is attended with pain, about the shoulders and arms, and in the large intestines ; but it does not is followed at length by paralysis, chiefly produce pain until spasmodic contraction So that the pin in this rase of the mnscles on the tore-arms. There takes place are often cramps of the legs, and some- i.s not simply from the distension, but from i tite re-action, on effort to contract. Some. times epilepsy. Treatment.—The object of treatment is times the intestine contracting upon the to take off the spasm, upon which both air, forces it through the spasmodicallythe pain and the constipation depend. For contracted part,into the adjoining portion; this purpose heat may be applied, in the and this hack again ; and so stic(,e4,sively way of fomentation or otherwise, to the for a long time, accompanied with arnmabdomen, or, what is still better, by the bling noise, termed borborygmi. This hot bath. Internally, stimulants of all state returns at intervals, daily or oftener, kinds are useful, especially alchohol, and is a very painful and distressing dis. æther, ammonia, and the essential oils, ease. It arises from indigestion, which and, as still more powerful, opium. Or is the remote canse; and it occurs printhese may be variously combined. An dpally in females ; being often in thema emetic will often, upon the principle of hysterical symptom. Treatment.— This affection is often difficounter-irritation, take off the spasm ; this is morep’pecially proper, where the cult of rentoval. The food should be of a disease is occasioned by improper things stimulant qnality, and chiefly animal, Sti. taken into the stomach. Purgatives also mulants of all kinrls give relief. Purgaare donhly proper ; first, by removing all tives are generally required ; but they irritating matters from the intestines ,and ought to be of a stimulant kind, and not next, by exciting the other parts of the of violent operation. The turpentines are canal, they tend to pllt a stop to the SpdS- probably among the best. Tonics arealto modic contraction ot the part itsetf; as useful, combined with purgatives as; our principal object in the treatment of ruubarb with infusion of gentian. this affection is to produce stools by reHœmorrhoidal affections. laxing the spasm of the intestine. Castor oil, sulphate of magnesia, and extract of Definition.—The best, perhaps, that colocynth are the best for this purpose ; can be given, is this " Pain at the ex. as, however, they are often rejected by tremity of the rectum ; one or morelivid vomiting, the intestines should be stimn. tubercles at the verge of the anus, from lated from helow, by injections. Other which there is freqnently a discharge of means failing, the tobacco injection sholild blood from time to time." Sometimes the tumours are situated be made trial of; half a drachm, or at within the anns, and are forced down on most drachm to a pint. Spasm is sometimes followed by inflam- every attempt to evacuate, with much mation ; which you must be watchful of. suffering to the patient. This state may When the abdomen becomes ht aud ten- be ascertained by examination with the der to the touch, and tebrile symptoms finger. Sometimes the blood flows in conarise, you may be sure inflammation siderable quantity without pain, and then taking place. In this case, bloodletting generally proceeds from a greater dis becomes necessary. Indeed it should be tance above the anus, and without in. the
for ease; there is
con-
stipation, and sometimes vomiting;the pulse is not, iu general, much, if at all
is
often the
employed
coming
on
359 mours. Other signs of hœmorrhoids have been mentioned, such as pain and weight in the head, and pain in the loins, but thm are not constant. Theory or explanation of thesymptoms. -The extremity of the rectum, from itc depending position, from its being snh
If the geueral health appears to
done.
or is in danger of doing so, by the ceasing of the accustomed hæmor-
have
suffered,
rhage, endeavours should be made prudocf this, by sitting over the
to resteam
of hot water, by the application or leeches from time to time, and by the frequent to freqnent pressure, and other use of aloetic purgatives, which stimulate jected causes, is prone both to inflammation and the rectum in a specific way. The further hæmorrhage. These affections take the treatment of these disorders is chiefly name o1 hcemorrhnids, trom the tendenoy local, and falls within the province ot to bleed, and that of piles, from the swell- surgery. inws or protuberance that take place ; Worms in the Intestines. and sometimes the compound term, bleedWorms in the intestines are far from an ing-piles,is used. The immediate canse is, impeded cir- uncommon occurrence. There are qeveral culation, which is brought abont in diffe- kinds of them met with in the hxmaa rent ways. The depending posture of the body ; ag the tœnia, or tape-worm ; the part, and still more the frequent pressure C?,Icurbitina, resembling the seeds of the to which the part is exposed almost hahi- gonxi ; the lumbricus teres, or common tnally, as already mentioned, may be con- round worm ; and the ascaris, or thread sidered a, the morremote causes. En- worm ; besides others ofrarer occurrence. A variety of symptoms are pointed ont largement of any of the abdominal viscera, especially of the liver, will have the as indicating the pre-ence of worms in the samf effect in interrupting the return ot alimentary c.mal; as irregular and often venous blood from the neighbourhood voracious appetive ; grinding of the teeth of the anus ; as will also an accumulation rlaring sleep ; picking ot the nostril. ; diof hardened fæces in the rectum. The lated pupils ; griping pains about the arteries of the part are thus prevented navel ; itching of the anus, and slimy fro,1I empt)ing themselves with freedom stoots. Epilepsy, or other convulsive into the veins, and are there by irritated affections, are supposed to be produced into increased and inflammatory action, hy the presence of the tape-worm more All of these signs, howso as to produce the states mt-ntioned, particularly. with tumefaction and hæmorrhage. The ever, are equivocal ; there is not one of too freqnent use of purgatives, especially them that may not arise independent of aloetic purgatives, tend also strongly to worms, so as to take pl.ice in other di.eases. Many of them are common signs produce these affections. Hæmorrhoidal affections often become of brain-uffection, which i the case with periodical ; and when attended with a voracious appetite, grinding of the tedh, considerable loss of blood at tolerahiy dilated pupils, and convulsive disorders, regular periods, acquire importance, iuas- all of which verB freqnently arise from much as they cannot always s be interrnpt- this source, and where no worms exist. ed or suppressed without inconvenience, It is true tliit worms are sometimes disor pven without danger to the general charged, where such symptoms areprehealh. isent; but they are more probably the than the cause of the disease; they In the treatment of hæmorrhoidal affections, we are to consider, therefore, are expel led in consequence of the gr eater how tar they may have become habitnat, heat of the body, which is usually present and thereby necessary in some degree to in these cases ; and accordingly a febrile the general health. When there seems atate ot the body, from whatever cause, Is reason to believe such to be the case, freqnently followed by the discharge of they should not be too hastily suppressed ; worms. What reuders it still more prowhile, in endeavonring to relieve them, bable that worms are not the cause of such attention should be paid to the habit of symptoms as have beeu described, is, that are very often observed to be preliving, for the purpose chiefly of inculcating temperance, where a want of this is s nt, and the tape worm, as well as the observed ; and substituting other dis- others, without being attended with disorder of any kind. Admitting, however, cliargrs of blood from time to time. The remote cause should be careftilly that they do really at times give rise to inquired into, in order, if possible, to its the symptoms mentioned, we ought at reinoval, Thus, unnecessary pressure least to have ocnlar demonstration of should be avoided, and especially that their presence, before we have recourse produced by the lodgement of accumu- to active means for their expulsion ; belated fæces in the rectum, Visceral dis cause many of the remedies resorted to eases should be relieved, as far as can be ! on such occasions, are in themselves highly
effect
they
’
360
objectionable, and capable of doing much mtscliief, especially in infants ;such are the more drastic purgatives, and calomel
REVIEW.
among the rest. It’ worms are actually discharged, and A Practical Dissertation on the means of we have sufficient evidence to believe that they are the occasion of the disorder obviating and trealing the varieties of be proper to attempt their removal. This is accomplished In two ways ; first, by administering medicin s which, as is sopposed, will destroy the worms, and which are called anthelmin-
present, it
tics;
secondly, by forcibly dislodging
Costiveness, which
periods of life,
different cases of predispo-
occur
and in
ut
sitions to various Constitutional Muladies, in peculiar temperaments of body, in disorders of the lungs, stomach, liver,
a violent action of tile intestinal canal by purgatives. rectum, &c., and during Pregnancy, by The efficacy of many or most of the anMedicine, Diet, &c. By RICHARD REECE, thelmintics that have been proposed, is M. D. Member of the Roy,tl College of vory questionable. This is shown by the fact, that none of them retain long their Surgeons. 8vo. pp.351. Longman reputation; wnich they might be expected and Co. 1826. to do, if they wete really as efficacions as alleged. I may nrentiun the powder of’ Dr. Reece is pretty generally knownto tin, the fern-root, the anthelmia, or Indian pink root. and the cow-itch: these, the public as the author of’ " The Mediwith many others, are liable to the obser- cal Gtude for the use of the heads of vation I have just made. Purgatives, aud and as Edi. those of the most active kind, are in Famines, the Clergy, &c.," reality the only unequivocal means we tor of a periodical work, called " The possess for removing worms from the in- Uazetteof Health," both of them devoted teslines. The oil of turpentine deserves to what to be distinguished hel e, tor its superior may be called popular or domesser viceit is efficacy ; and particularly tic medicine. We look upon the present able in removing the tape-worm), which it commonly does entire, while other pur- volume as a continuation of the series, gatives bring the worm away piece.meal. but are by no means prepared to assert It requires to be exhibited it) a large do.e, rnat, as well as its prodecessors it does as all ounce, or an ounce and a half; in which quantity it operates much more not contain many things to interest the promildly than could have been expected. fession. Costiveness, one of the most It commonly purges very quickly and accommon " ills that Hesh is heir to," the tive.y, but still without violence. Sometimes it occasions vomiting, and a kind ertile, and probably the most ancient,* of intoxication, which lasts a few hours, rarent of disease, has perhaps added but is of no importance. It is remarkable, that although in small doses the oil nore thin any thing else to the vocabu, of medicine. Barely to enumerate of turpentine is apt to irritate considerably the urinary organs, it seldom has he various orders of catharties which this effect when largely administered, probably, because its quick operation as have swelled the materia medicasofevery a purgative, leaves no time for its being and conntry, would be no easy task; absorbed Im the lacteals. Where ascarides are lodged in great or is it less (Jifficult to explain all the numbers in the rectum, as is often the causes of costiveness, or why it assumes case, they may be removed by an injec- - nch a variety of forms. Cullen has no. tion of the oil ot tnrpentine. iced three It is not to be forgotten, that worms species of costiveness,—1.Obare rarely fonud, where the natural functions of the stomach and bowels are * The Ibis is said to have tanght the well performed. Hencf it is an object of the first importance to restore the healthy Egyptians to obviate costiveness bv the action ot’ these parts by bitters and other nse of ciysters ; and according to Hero. tonics, and by attention to the patient’s dotus and Pausanias, Melampus learned diet. Now it is evident, that the frequent the use of hellebore by observiug that employment of drastic purgatives would his goats were purged after browsing counteract this object. upon it.
them, by exciting