The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![much more common in subjects of the strumous constitution, or, in other words, in those where the lymphatic system is predominant. Hence the reason of its greater frequency in children, and, when occurring in the adult, in the scrofulous constitution. Two important facts are stated by the above author in reference to tabes mesenterica; one, that it has been observed to be more frequent during moist seasons; the other, that simple peritonitis will not produce the disease. [The inflammation of the lining membrane of the intestines of the infant, may vary in character, like that of other mucous membranes, and be ery- thematous, pseudo-membranous and ulcerated, or follicular. The inflammation of the patches of Peyer is often identical, except in intensity, with that of the typhoid affection. The appearance is the same; and, according to MM. Barthez & Rilliet, (Traite CUnique et Pratique des Mala- dies des Enfants, i. 482, Paris, ] 843,) if there be a difference between the two diseases, it must be sought for elsewhere than in the lesion of the patches (plaques.) These gentlemen maintain, indeed, that there are many relations between ty- phoid fever and enteritis in the infant. The fol- lowing table is given by them to exhibit the man- ner in which the different intestinal lesions are combined; and to prove from the diversity of the combinations, that it is useless to endeavour to esta- blish the symptomatology of each anatomical form: Enteritis (erythematous, pseudo-niemhranous ulcera- ted or pustular, 45 Colitis, (of the same nature), 113 Follicular enteritis, 90 Follicular colitis, 04 Softening of the small intestine, 28 Softening of the large intestine, 35 These lesions were associated in the same indi- vidual, so as to form the following combinations ; 185 being the number of necroscopies : Enteritis alone, 2 Colitis alone, 32 Entero-colitis alone 11 Follicular enteritis alone, 12 Follicular colitis alone, 3 Follicular entero-colitis alone, 10 Enteritis and follicular enteritis, 8 Colitis and follicular colitis, 12 Enteritis and follicular entero-colitis, 2 Colitis and follicular enteritis, 17 Colitis and follicular entero-colitis, 11 Entero-colitis and follicular enteritis, 7 Entero-colitis and follicular colitis, 9 Entero-colitis and follicular entero-colitis, 7 Softening of the great intestine, 8 Softening of the small and great intestine, 10 Enteritis and softening of the great intestine, 1 Colitis and softening of the ^nuill intestine, 2 Colitis and softening of th.; great intestine, ] Enteritis, colitis and softening of the great intestine, 2 Softeningof the small intestine and follicular enteritis, 1 Softening of the great intestine and follicular colitis, 1 Softening of the small intestine and follicular colitis, 1 Softening of the small intestine and follicular entero- colitis, ] Softening of the great intestine and follicular enteritis, 3 Softeningof the large intestine and follicular entero- colitis 1 boftening of the small and large intestine and follicu- lar enteritis, 2 Softeningof the sma'i and large intestine and follicu- lar colitis, 2 t<oftening of the small and large intestine and follicu- lar entero-colitis 3 l.olitis, softening of the small intestine and follicular enteritis, 1 Colitis, softening of the small intestine and follicular colitis, 3 Colitis, softeningof the small intestine and follicular eptero-colitis, 3 d s'ofteningof the great intestine, and Entero-colitis an follicular enteritis ' E-VTERiTis IK THE APULT.—In describing this form of the disease we find the same difficulty in separating its symptoms from those of gastritis, on account of the frequent combination of the two affections. We still want a scries of cases, observed with a view to this particular point, which, however, is not of very great practical importance; for the existence of inflammation being recognized in the digestive tube at any point of its extent, the general principles of treatment are essentially the same. We have already stated that the symptoms are found to vary with the portion of the tube affected ; thus in the following affection the phenomena are often peculiar. Duodenitis*—This may be an acute or chro- nic disease, and rarely occurs without more or less of inflammation of the stomach. Hence the term gastro-duodenitis. It is now pretty generally admitted that irritations of the stomach and duo- denum have a powerful effect in inducing either functional or organic disease of the liver. Indeed, in the opinion of some pathologists, hepatic disease is almost always secondary to this state, a doctrine however which is too sweeping. But it appears certain, that in the notions hitherto received of affections of the liver, the influence of gastro-duo- denitis in their production has been greatly over- looked : thus, when jaundice supervenes in the course of a gastro-enteriris, we may diagnosticate inflammation of the duodenum in most cases, and we shall find that to this lesion are to be attributed a great number of examples of icterus. This duodenitis is quite sufficient to produce the jaun- dice, independent of any mechanical obstruction to the flow of the bile, or the occurrence of an acute inflammation of the liver; and the yellowness appears to arise either from the direct transmission of inflammation along the ducts, or, according to Ribes, by the branches of the porta, or what is more probable, from the sympathetic irritation of the liver, an irritation which will produce a com- plete jaundice, without arising to the degree of actual inflammation of the organ. This is the doctrine of Broussais; but the fact that many cases of the most acute hepatitis will occur with- out jaundice, renders it probable that we must seek some other cause than the mere degree of irritation, to explain the phenomenon. In the third volume of the Dublin Hospital Reports, Dr. Marsh details several cases of this form of jaundice, and insists on the importance of the state of the intestinal mucous membrane. In his cases, the usual cause of the affection was the drinking of cold fluids when the body was much heated, or the sudden and repeated exposure of the surface to cold after a similar slate,—causes, among the most powerful in inducing gastro-intes- tinal inflammation. He there instances, also, the patients were generally aihng for some days before the jaundice occurred, and the symptoms were those of a disordered state of the 'mucous mem- brane. The first case detailed presented the dis- ease completely predominant in the digestive tube. This state was pointed out by the symptoms, which were a deeply florid tongue, unquenchable thirst, epigastric tenderness, anorexia, or at other](https://iiif.wellcomecollection.org/image/b21116817_0052.jp2/full/800%2C/0/default.jpg)
