Lectures on the theory and practice of physic (Volume 1).

  • William Stokes
Date:
1845
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Licence: Public Domain Mark

Credit: Lectures on the theory and practice of physic (Volume 1). 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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    You should be careful in the examination of such cases, and should try to ascertain whether these symptoms may not depend upon in- flammation of the stomach ; for as long as the patient is in this state, the less you have recourse to symptomatic or specific treatment the better. It is hard to mention one single medicine, which, in this state, will not prove stimulant, and if the stomach be unfit for stimu- lants, it must be unfit for the generality of medicines. There are numbers of cases of persons labouring under chronic gastritis, which have been cured by strict regulation of diet, and by avoiding every article of food requiring strong digestive powers. We find that arti- cles of diet vary very much in this respect; some are digested with ease, some with pain. We might express this otherwise, by saying, that some require very little excitement of the stomach, and others very great vascular excitement. Patients, in this irritable state of stomach, can scarcely bear any kind of ingesta ; and when you con- sider the great vascularity, thickeuing of themueous membrane, and tendency to organic disease, you will be induced to think that every- thing entering the stomach should be of the mildest kind, and not requiring any powerful determination of blood to that organ.* If you continually prescribe for symptoms, neglecting or over- looking the real nature of the disease, giving arsenic to excite the system, and iron to remove anaemia, and bitter tonics to improve the appetite, and alkaline remedies for acidity, and carminatives to expel flatus, you will do no good; you may chance to give relief to-day, and find your patient worse to-morrow ; and at last he will die, and you may be disgraced. On opening the stomach, after death, yon are astonished to find extensive ulceration, or, perhaps, cancerous disease. Very often, in such cases, practitioners say that it is can- * [This course, so conformable with reason and experience, and so readily understood by the attentive inquirer, is, however, the most difficult to be carried out in practice. Our patients will take every kind of nauseating drug without much grimace : they will consent to be blistered and cauterised and punished, after every medical fashion : but so soon as we wish to substitute a regulated and restricted diet for this polypharmacy, they all at once discover innumerable difficulties in the way. We then become cruel, starv- ing doctors; without good bowels of our own, it is believed, and of course without compassion for the bowels of others. In fact, a physician will be much more likely to preserve his reputation in a family, whilst, bringing on chronic, perhaps incurable, gastritis, by the needless administration daily of arsenic, than whilst he is suc- cessfully attempting the cure of a case of this disease by a very restrict- ed diet. After all, however, it will be found with this, as with many other prejudices of the people, that they are but the reflexion or echo of former opinions and now exploded hypotheses of the profession. If physicians, generally, would cease, indolently perhaps oftener than ignorantly, to administer to the whims of their dyspeptic patients, the latter seeing a general concert of opinion among medi- cal men, would be less reluctant to follow out literally the acfvice of their immediate professional advisers. —B.]