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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    next by the sympathetic relations of other parts, by the sympathies of the respiratory system, of the circulation of the skin, and of the nervous system. I shall enumerate the local phenomena and func- tional lesions; vomiting, anorexia, thirst, jaundice, pain, tenderness on pressure, tympanitis, changes in the character and quality of the discharges, constipation. Here are a set of functional lesions and local phenomena; let us now consider the sympathetic relations; these are fever, heat of skin, suppression of the cutaneous secretion, suppression of the secretion of urine, morbid states of the tongue and pulse, pains in the chest and cough, hurried breathing, and palpita- tions of the heart. In the next place, we may have prostration of strength, delirium, coma, convulsions, tetanic spasms, and other symptoms of functional disease of the brain; these are all sympa- thies of relation. Now, in the first place, I have to remark, that there is a great deal of variety in the combination of these symptoms. On what does this depend? on a variety of circumstances ; some- times on the intensity or extent of the inflammation : sometimes on the situation of the disease : sometimes on the complication of the affection ; sometimes on the various modes and degrees of suscepti- bility of the individual. All these causes tend to produce a great variety in the disease, and an extensive modification of the sympa- thetic relations. For instance, in some cases inflammation of the stomach and intestines is so slight that the patient is not prevented from going about and pursuing his ordinary avocations; in others, on the contrary, the patients are struck down at once by the violence of the disease, and are carried off by the fever which accompanies it before the inflammation is completely developed. It varies also according to situation; there is a difference between gastritis and dysentery : in the former we have an inactive state of the great in- testine, and consequent constipation ; in the latter, the colon is thrown into violent action, and there are frequent dejections. Disease of the duodenum is attended with a very remarkable peculiarity, being very frequently complicated with jaundice ; here is a modification produced by situation. Again, inflammation of the ileum is attended with a very curious peculiarity, namely, the absence of pain. The patient states, that he feels unwell, he has obscure symptoms of in- testinal disease, but it is neither dysentery nor gastritis ; you investi- gate it with care, and find that the ileum is in a state of inflamma- tion. Yet the patient does not complain of any pain; and this is another peculiarity depending on situation.* But in considering the differences which depend upon intensity, extent, and situation of disease of the intestinal canal, we must not omit those which depend upon tissue. If disease be confined to the mucous membrane of the intestines alone, we may have an ex- tremely diffused and extensive inflammation, sufficient to destroy * [The physiological explanation consists in the fact, of the ner- vous supply to the ileum corning from the sympathetic; a fact of some importance in making our prognosis of typhoid fever. The absence of pain might induce belief that there was no organic lesion. — B.]