Propositions relating to diseases of the stomach

Mathematics to the Scicmce of 3ledici~e. 237

be reached either by tlle experiments of the physiologist, or tile research of the pathologist, when, in lhet, it has baffled the inqui- ring physician for ages, he should be content to direct his attention to the laws which diseased action observes, both under tlle influence of remedies, and when allowed to run its course uninter- rt,ptedly. These laws are always discoverable by the numerical method, when systematically adopted, and if tile knowledge ac- quired is not all that could be desired, the inferences it leads to, are at all events as practical, and founded as strictly in truth, as if the intimate nature of disease was more fiflly understood.

ART. VIII.--Propositions relating to Diseases of the Stomach. By JONATIIAN OSBORNE, M.O., Queen's Professor of Materia Medica, Clinical Physician to Sir P. Dan's and Mercer's Hospitals, IIonorary Fellow of" tile King and Queen's Col- lege of Physicians, &c.

TORPID DmESTtO.~. tIAVING already communicated in this Journal my proposition, on irritation of the gastric glands, and oll irritation of" tile mucous membrane, I now proceed, in pursuance of my origitlal intention, to those relating to torpidity of action in tlle stomach, and I beg the reader to bear ill mind, that my object in those communications has been to diagnose distinct affections of the stomach, which have hitherto been confounded, and to describe an appropriate mode of treatment for each. If I have succeeded even imperfectly in a class of diseases in which so much ]dt or miss practice commonly prevails, I shall hope fbr some indul- gence and forbearance from hasty condemnation on the part of my readers, seeing that tile value of such propositions is not to be tested by their apparent probability, but by that patient observation of various cases which must be the work of time.

FIRST PROPOSITION.--Torpidity of digestion is denoted by the following symptoms: 1st, a feelbzg of distention in the hypochondrium, with an elastic f , lness somewhat relieced by

VOL. xx. NO. 59. 2 I

:238 Dr. Osborne's Propositions relating to

expulsions of gas from the stomach, which are either insipid or sour and sulphureous ; 2nd, palpitations, with slowness or irregularity of the pulse; 3rd, occasional oppression of breathing; 4th, dull pain, or rather weight in the head ; 5th, vision affected with motes, and involuntary action of the eyelids; 6th, more or less deafness; 7th, peculiar lowness of spirits, and disposition to exaggerate and brood over the internal sensation produced by the disease.

A Feeling of Distention in the Itypochondrium.--This is frequently the only cause of complaint, but one, the pertinacity of which is a cause of great distress. It arises from distention either of the stomach, or, of the arch of the colon by gas ; and the tumour being thus elastic keeps up a constant pressure, affecting more particularly the diaphragm. The necessity of holding up the ribs by means of the intercostal muscles, during the impediment offered to the descent of the diaphragm in each inspiration, causes a weariness of the left side, which, although not amounting to pain, is almost worse. Often have I known practitioners (urged, I suppose by the importunities of patients), after an unavailing employment of purgatives, proceed to leech and blister the hypochondrium ; but I need scarcely add with very indifferent effect. The most appreciable benefit is obtained by the expulsion of gas in either direction, and this almost equally whether the seat of the distention be in the colon or in the stomach ; as in either ease the dimunition ofthe tension is the same. When the stomach expels the gas, it is either nearly insipid or has the taste of a gun barrel, and consists of carbonic acid and sulphuretted hydrogen. This last gas, I have observed, is not produced in the stomach for any considerable time without the symptoms of gastric irritation commencing, while the insipid gas is not necessarily followed by any other symptoms except those of torpidity.

The formation of su]phuretted hydrogen in the stomach, when it does not occur in health, may be explained by the con-

Diseases of the Stomach. 259

tinuance in that organ of the aliment in an undigested state, and by its passing into putrefaction under the combined influence of heat and moisture. One instance ofthis production of gas from chemical agencies is seen in the extrication of sulphuretted hydrogen, which takes place when any preparation of iron is taken into the stomach, containing a portion, however small, of iron in the metallic state, from which it appears, that when hydrogen is formed by the action of the free muriatic acid of the stomach on the iron, the sulphur must be there present to com- bine with it, and the greater number of substances which are usually taken into the stomach, have been ascertained to contain more or less sulphur in their composition.

Palpitations, with Slowness or Irregularity of the Pulse.-- The connexion between the stomach and the heart has never been adequately described in any of the systems of pathology, neither has its importance been duly estimated in the explana- tions given of the effects of poisons. Yet this connexion can he proved in the simplest manner, by feeling the pulse before and after eating or drinking, when the individual has been reduced by previous exhaustion, and by doing it so soon that it cannot be attributed to absorption. The depressing influence of the heart of even slight degrees of flatulence is seen in the intermittent pulse which so frequently accompanies it, and even the certainty of death from taking the corrosive mineral poison, can only be attributed to the influence of the stomach over the heart, from which it results, that tile surfhce of the one cannot be suddenly irritated or disorganized without the other being excited to preternatural activity, to be succeeded by feebleness, and at length cessation of its movements. Without resorting to their nervous connexion to explain this close sympathy between the two organs, it may be stated as a fact, that disturbance of the stomach produces disturbance of the heart, even to that degree to cause it to cease altogether, and that within this limit it produces in it various abnormal states, as frequency or slowness, intermission, and irregularity. The two latter states are a most frequent

240 Dr. Osborne's Propositions relating to

accompaniment to distention of the stomach by flatulence, and appear to be directly referrible to the narcotic effect of the carbonic acid, and sulphuretted hydrogen, as shall be rendered more probable when we consider the effects produced at the same time on the head.

Oppression of Breathing.--Generally comes on after break- fast, and is accompanied with the feeling of distention. This in ordinary eases arises from tile impediment to the descent of tile diaphragm; but in persons of tendency to spasmodic asthma, it passes into paroxysms of that disease, characterized by a spasmodic action of the larynx. This circumstaaee suggested to Dr. Bree, the importance of considering asthma, with reference to ttle stonmeh; and now that the diagnosis between chronfe bronchitis and spasmodic asthma is more clearly established than when his work was written, a new light is thrown on the eases which he has described. Whenever tile bo~'els are torpid in an asthmatic case, a great aggravation is preserved ; and yet, on tile other hand, the administration of tile ordinary purgatives is often injurious, by the gastric irritation which follows; under those circumstances, the best mode of keeping the bowels free is by enemas or purgatives which act exclusively on the rectum.

Motes in Yision.--Those are usually black spots surromld- ed with luminous rings placed in various irregular forms, but generally holding the same relative position to each other. They all, from the opening to the shutting of the eye, appear as if falling down, although the eye may be intently directed tbrward. They are an inferior degree of amaurosis produced by the presence of the narcotle gases of the stomach.

Involuntary ./lction of the Eyelids.--This consists in a tremulous motion of the upper eyelid, which comes ou and continues at uncertain intervals without the control of the patient. It is to be referred tothe same cause as the last.

More or less Deafness.~Those who labour under an im- perfect state of the organ of hearing, are well acquainted with the fact, thut torpidity of file bowels always produces an asgra-

Diseases oJ' the Stomach. 241

ration of the deafiless. In some cases, various noises in the

ears are the most striking symptom of torpid digestion. All such changes of tile due sensibility may be ascribed either to irregularity of the circulation in the brain, or to direct narco- tism from tile presence of carbonic acid and sulphuretted hydrogen in the stomach and bowels.

lu Lowness of Spirits and Di,sTosition to brood ot, er the Sensations produced by the Disease.--The mind is capable of being aflbcted by external objects in a different way at different times, and the same circumstance which at one time appears grievous or intolerable, at another will seem altogether a trifle

and of no moment. For example, when lying awake in the silent watches of the night, what perplexities we undergo, what

anxieties torture us concerning things which, once daylight has

pierced through the window shutters, give os no further con-

cern. ']'his may be adduced as an illustration of the cheering

influence of tight; but to take an instance in which external

circumstances remain exactly the same, how differently we judge of things, according as we may be situate with respect to the requirements of the digestive organs. When under the in-

fluence of hunger, as of any other irritation of the stomach, it is an old observation, that we are less mild and less accessible to the requests of our fellow-creatures. Hence we are instructed,

when seeking favours, to seize the moUia temporafandi; that is, when the individual is neither hungry nor sleepy. This varied

state of our feelings as to the external world is in direct con-

nexion with the state of sensibility of the surl~aces of our orga-

nization, and especially with those which, as the mucous membranes, are destined to come into contact with external objects.

To prove how the sensibility of a part may alter from changes within itself, we may take as an example the peritoneum. This in health is so insensible, that we are not aware of its existence except by the evidence of anatomy. In no other way does any man know that he has a peritoneum. Never having felt it, he has no cognizance of it whatever ; but let it be once inflamed,


then it at once informs us of its presence and position by tile pain which it imparts when pressed or even touched in the

slightest manner. This alteration of sensibility produced by disease, now so well known to physicians with respect to different parts of the body, was a subject of anxious observation to Aristotle ; and the careful investigation of it, with the assistance of tlle light afforded by our perfect state of pathological knowledge, will be found to lead to some illustrations of that state of mind which is called temper. This, although it influences the opinions and actions of the great bulk of mankind much more than reason, has, nevertheless, been much neglected by the authors who have professed to treat on tile science of" mind.

Temper, or the state of sensibility belonging to each individual, is quite distinct from his intellectual endowments. In the most highly gifted it is often most remarkable from tile splen- dour which accompanies its aberrations, and which often leads inferior mortals to follow with eager curiosity as the production of a master-mind what has been only the result of disease. Who can calmly reflect on the recorded conversations of John- son, or Swift, or Byron, without being convinced that much of what the world admires has been the product of hypocondria- cism ; and that some of the most brilliant effusions, and those which mark the closest observation of human nature, have been suggested by irritations belonging to the physical organization of those celebrated individuals. This is a department of in- quiry distinct from that of insanity, although often leading thereto ; peculiarity of temper being to be considered a peculiarity of body rather than of mind.

Some organic diseases become established and progress to an incurable extent without affecting the feelings, even no pain is felt, the patient remains quite unconscious of any ailment, and maintains not only his usual tranquillity, but may be said to en- joy life as much as in his perfect health. Of the diseases so ci,'cumstanced, one of the best suited for an example is contraction of the aortic valves; tubercular phthisis is even a still more

Diseases ~.] the Stomach. 2.t3

remarkable instance, from the extent of destruction compared with the stale of the feelings. Without relating eases of private individuals who have passed through all tile stages, fi'om the first short cough, to the extreme of emaciation, and, at length, dissolution, without manifesting either ill temper or despondency, we may at once refer to the eases of two eminent physicians of our own time, who, no doubt, had often in their lec- tures, as iu their writings, informed their pupils of the peculiar infatuation which accompanies this disease, and who yet, when they themselves were the victims of it, fell into the same mis- take; thus showing how in sickness science avails not to its possessor, but that the wise man dieth even as the fool. Laennee, in the last pages of his immortal work, refers to the palpitation evidently belonging to the tubercular deposition, whleh was then taking place, as a mere transient occurrence, and endeavours to convince his readers, as lie had no doubt convinced himself, that it was produced by a flatulence, little imagining how soon his brilliant career was to close ; and the late Dr. Armstrong, who attained to the most extensive practice in London, could hardly be forced away from his patients, to the country, even when his medical friends were convinced that he was far advanced in con- sumption. He died in December, with an unusually large cavity in one of his lungs, and on tile 30th of July, when visited by Sir James Clarke and Dr. Davis, after they left him, tie said he was quite satisfied that they considered his case hopeless, because lie ~w through their evasions of his questions on this point, but that such a conclusion was by no means warranted by the symptoms and circumstances of it. And Dr. Booth adds in his letler, " In short, he seems determined to recover, in order to confute you both." On the 12th of August, he wrote to Dr. Davies, " I shall give both you arid Clarke a lecture for your want of tact." He never resigned expectations of recovery, until a complete prostration of strength had convinced him that the gloomy prognostics of his medical friends were but too well founded.

In direct contrast with lifts, is the stale of general feeling in

244 Dr, Osborne's Propositions relati~g to

affections of tile intestinal tube, and of tile organs immediately connected with them. It was an observation amongst the Greeks, that lowness of spirits was connected with the formation of black bile; hence the derivation of the word melancholy. We see the truth of this observation confirmed in all tile forms of jaundice, and in all diseases in which there is a retention of the biliary secretion. How the presence ot' this fluid can produce a feeling of sadness and despondency, rendering lit~ miserable, is a question, towards the solution of which we dare not make an attempt. The immediate cause of pleasure or pain is far beyond our ken; even the connexion between those internal feelings, and the manifestation of them by external actions, have never been explained. No one has ventured upon a conjecture to explain, why in grief the lachrymal gland pours forth tears, and the inspiratory muscles engage in short inspirations, called

sobbing, or why, under cheerful emotions, the mouth is expanded in a lateral direction, and long inspirations take place, followed by short inspirations, called laughing ; or why certain emotions contract certain muscles of the face, and relax others. The fact, that jaundiee is connected with sadness and lowness of spirits, is so generally known, that a smile on a jaundiced countenaiice appears almost an impossibility, and if represented in a painting, the utmost skill of the artist would scarcely succeed in prevent- ing the observer fi'om interpreting it as the expression of despair.

I f unable to account for this effect produced by the retention of bile, we are not so with regard to irritations of the mucous membrane of the stomach, or intestinal canal. The sadness belonging to jaundice is very different from the temper produced by the irritation now mentioned. In the latter there are both sadness and peevishness combined. It often happens, that the temper of an individual is observed to be changed for the worse, that he becomes querulous and snappish without any evident cause, but that this state is sooner or later succeeded by the breaking out of a gastric fever, at the termination of which his wonted placidity returns. In children this moroseness is

Diseases of t/be Stomach. 245

easy to be observed, being denoted by gestures showing disin- clination to be amused ; while in their seniors it occasionally bursts forth in explosions of temper, without any adequate external cause. An instance of gastric moroseness once occurred within tile walls of our College of Physicians, which is so illustrative, that I cannot refrain from mentioning it. A certain physician, member of the Board (since dead), at one of tile meetings deli- berately applied language so unjustifiable and offensive to ano- tiler member, from whom he had not received the slightest pro- vocation, that the interposition of the President alone prevented a hostile meeting. The College having taken up Ihe matter, were on the point of proceeding to extreme measures, when the offender was visited by one of the body to remonstrate with him upon his unjustifiable conduct. He found him in the state best suited for obtaining the forgiveness and commiseration of his professional brethren. He acknowledged his fault in the fullest manner, but pleaded in extenuation the state of his stomach. To this (or rather to the liver, according to the pathology of that time*) he ascribed the doleful truth, that tie had become a misanthrope of the worst description, being as m'mh an enemy to himself as to others. He stated, in an affecth~g manner, that on going out in the morning, lie often felt tempted to commit suicide, were it not that it wouhl afford a gratification to certain individuals, with which lie was unwilling to indulge them. For- tunately this statement was made to a medical tribunal, who, by their professional experience, were convinced of its truth, and lie obtained a remission of their original decision. Many labour under irritations of the stomach, without being aware of it, and ascribe their misery to extrinsic causes ; often to l~aults or fhilings on the part of their family, or household, without any truth or justice ; others vent their ill-humour on their neighbours, or on those set in authority. When ocurring in advanced life, it often suggests a proneness to make disadvantageous comparisons

" N o u s avons ehang~ tout c e l a . "

VOL. XX. NO. 59. ~ ~<


between former times and the present ; thus realizing the lau- dator temporis se ],lvene exacti. It would far exceed our bounds to trace out all the forms which this temper assumes, but in all it is to be explained on the one principle, viz., a feeling of misery from an internal cause, of tile nature, or even existence of which, we are not aware, and a consequent persuasion that it is occasioned from something without. When we reflect that the mucous membrane has not the sense of touch, and that when irritated or inflamed, it is not so much by a sensation in the part, as by dull headach, moroseness, feelings of distention, and general uneasiness diffused over the whole frame that it manifests itself, it is not surprising that such general misconception should prevail with regard to it.

Torpidity of digestion is however a still more remarkable instance of misconception and exaggeration of grievances on the part of the patient. In this the distention of the stomach or of the cells of the colon, although of" small moment in the eyes of

the physician, not only acts specifically on the temper, but perpetually reminds the patient of its presence, and in some instances has actually led to aberrations of intellect. In such

cases an elastic tumour is felt, vague in its seat, sometimes moveable, sometimes fixed, increasing and diminishing at different times during the day, but never entirely absent, and usually accompanied by either the symptoms of irritation of tile gastric glands or of the mucous membrane already described. Here the attention is constantly directed inwards, and generally a firm conviction takes place, that there is an organic disease either of the liver or of the heart. The moroseness and depres- sion of spirits here take a new direction. Having an actual subject of complaint the patient fixes on it as the cause of all that he feels, and thus arises the disease termed hypochondri- asis. The unhappy individual kept perpetually thinking of his ailment by this peculiar feeling of elastic distention, is constantly urged to seek relief wherever he imagines it can be obtained, and seldom possesses sufficient energy or patience to put

Diseases of the Stomach. 2t~7

in practice those measures which are necessary to accomplish a cure. He, more than any other description of patient, is likely to apply for assistance from quacks. Medical science, with the doubts and hesitations which true knowledge always inspires, appears to him quite inadequate to remove the mighty burden of his disease; and thus, sooner or later, he falls into the toils of some impostor, or at least bestows his confidene% not acecord- ing to the real benefit received from his medical adviser, but rather in proportion to tile absurdity of his pretensions, and the zeal with which his adherents trumpet forth his praises. He generally wearies his friends with details of his sensations, and watches them with such anxiety, that he appears often to neglect every thing else. The minutest trifles appertaining to diet become matters of the gravest consideration, and we often see realized the picture drawn by the French comedian of Monsieur Argan, who was in a state of the most painful uncertainty, as to whether he should take his walking exercise along or across his room, and also as to the number of grains of salt he should put into his egg.

I had a patient once of this description, who imagined himself the subject of several complaints, but whose mind chiefly ran on the belief that he had an internal visceral disease, combined with rheumatism of the head. The sequel of his case t)ruved how groundless those notions were, and I subjoin a short extract of his letters as a specimen of the style of a hypo- chondriac.

" Impossible, doctor, would it be for me to tell, or any mind to conceive my extraordinary and critical state. My whole body has appeared filled with water bursting out of every part of my head, my chest also felt as if greatly swelled, very sore all over the surface, and like a mass of ice and snow. My clothes felt as if quite wet every day ; my back appeared to have a wet op- pressive load pressing upon it, and my shoulders felt as if there were weights st, spended from them dragging me down to the ground." " When I was three weeks under your care I coutiHued


to improve, and I am sure the bile would have been all removed;

but the day after you told me you would soon have me able to go

back to - - (it was cheering news)--you ordered me a draught (of oil and turpentine) which, though an excellent medicine, dis- agreed so far with my peculiar ease, as to throw me back and

leave me worse than ever I was. Oh pardon me for saying it, it locked up the bile tighter, it left a pain in tile left side of my

breast and in my left side, which I have yet; and a few days

after you ordered me a draught of the black bottle which left me in an indescribable pitiable state, and operated so inju-

riously on my urinary organs.as to leave me ever since scarcely able to pass any water, and then a draught of the comfrey root

knoeked me down entirely, and left me unable to leave the bed lbr weeks past."

Let it not, however, be supposed, that the sufferings of those individuals are not real. They have as much reality to them as if p'rodueed by organic disease of the most evident and tangible character; and while we should be strenuous in our exertions

to persuade them to abandon the inactivity which is always their

principal aggravation, and often their only cause, we must re-

collect, that this morbid state is one to which all persons of

merely intellectual oeeupations are more or less liable, and that we may at some time or other have to claim for ourselves the

same sympathy whieh we are now called on to bestow.

SECOND PaoPosxTIO~r.--To the above ore added, in individuals disposed thereto, the. symptoms of irritation of the gas. tric glands, (vlz., sour eructations, and vomiting of sourjguid, with a sense of distention of the stomach,felt within about four hours after eating) or those of irritatidn of the mucous membrane of the stomach, (viz., morbid secretions on the tongue, bad taste and odour of the mouth,frontal headach, sometimes hiccup, and, in the greater degrees, thirst, loss of appetite, heat of the hands and feet.

As my chief object has been to establish a diagno,is of those

Diseases o.I" tt, e Stomach. 249

distinct affections which are generally confounded together, under the name dyspepsia, and as nay treatment rests entirely on this diagnosis, I cannot expect the reader of this~ or of any of the previous articles, to appreciate their correctness or practical importance, unless be can recollect the distinctions which have been laid dowu. He will then perceive how I have assigned separate sets of symptoms to each affection, and be prepared to admit, that the simultaneous occurrence of the symptoms of different affections arises from the simultaneous occurrence of the affections themselves. Thus, in infancy and childhood, torpidity of digestion is always attended by gastric irritation ; while in the adult age, it most frequently is accompanied by sourness aud the other symptoms of irritation of the gastric glands; and, again~ there are many cases in which the torpidity of digestion exists by itself, and is then productive of the symptoms described in the present communication, unaccompanied by any other.

Tread PaOPOSITION.--Its presence may be frequently diag- nosed by the appearance of the mzlcous membrane of the mouth, and its presence predicted from a consideration of tl~e general torpidity of the capillary circulation.

One of those appearances is characterized by remarkable paleness of the tongue and interior of the mouth, and has been well depicted in the plates belonging to Dr. M. Hall's work on the diseases of females. Another is more frequently see, in the advanced stages of life, and is remarkable from the deep shade of colour, approaching to lividity. In both there is coldness of the extremities, frequently amennorbcea, and all the other indications of torpor in the capillary circulation, even ahhough there may be preternatural activity in that of the heart. This torpor, as seen in the capillaries belonging to the general circulation, is always accompanied by a still greater degree of torpor in the circulation of the liver, and by a conseque,t de- rangement in the action of the stomach and bowels. From this consideratiou it follows, that in a great majority of cases, no


treatment can be successful which shall not act as an excitant to the liver.

FOURTH PaorOmTmN.--The agencies producing it, and aggravating it when present, are sedentary occupations, con-

.fined air, indigestible diet. The tendency to it is most frequent in the decline of life, but the habits of society have rendered it a common complaint at all ages.

Fn:Tn PaorosmoN.--Although arising from defective action and diminished sensibility in the mucous membrane, yet it leads often to local irritations and inflammation of the same,

from the retention o f f cecal matters which, in process of decom- position, act as chemical irritants, and hence arises much con-

fusion, not only in the judgments formed of the symptoms, but of the adjuvantia and l~dentia and means of cure.

SIXTH PaorosiTiO~.--The treatment to be adopted will be successful in proportion as it restores the mucous surface to the degree of sensibility requb'ed for the timely transmission of the f~ecal masses ; and the success is complete when this is effected permanently, and without other diseases being induced.

Other Diseases being induced.--This in a more special manner refers to the abuse of purgative pills, which have, in Eng- land, become an article of commerce. Besides those well known in the trade, as Hunt's, Cockles', Anderson's, &e., each esta. blishment has now its "antibilious" pills, the sale of which is im- mense. The object in most of those formulm is, to make sure of their operating. If they fail in this point, the purchaser will consider the money laid out as so much thrown away ; and hence almost all contain the most drastic purgatives, combined in a small bulk. By dissolving Molrison's pills in warm water, we may at once render evident the presence of gamboge and aloes ; and although the late proprietor is entitled to respect, if it be true that he sealed his belief in them, by suffering marfyrdom

Diseases of the Stomach. 251

under their use, yet his agents, who have if, so many instances been convicted of manslaughter, can hardly justify themselves by the plea of ignorance as to their probable effects. Used as a purgative, their action is generally satist~aetory, with the ex- ception of a slight frontal headach; but when taken in large doses daily, for a considerable time, as is directed, they prodlme chronic inflammation of the stomach and bo~'els, as is known by cases which have occurred to most practitioners. The effects following their indiscriminate administration are dreadful to reflect on. Ttle continuous use of any combination of drastic purgatives not only creates a necessity of repeating the stimulus, but by the constant action of the same article, either softening or ulceration of the mucous membrane is at length produced ill that portion of it on which the drastic more specially acts.

SEVENTH FROPOSITION.~ Tile remedies which are applicable to fulf i l the required indication are, mercury, purgatir, es, tonics, cantharides, camphor ; the diet that which is least in bulk and easiest of digestion. The other means of cure are cold bath- ing, frictions, early rising, variety of exercises, and the main- tenance of a habit of taking food, and of evacuating the bowels at stated periods.

The use of mercury is indicated, first, when the appearance of the discharges denotes a deficiency of the secretion of bile ; and secondly, when the state of the capillary circulation, taken in connexion with other circumstances, points to a torpid circulation through the liver. In some of these cases a t~ee use ot" mercury, so as to affect the month, will be required, and the benefit derivable from occasional doses of calomel, taken at night, and followed by aperients in the morning, is generally

manifest even to the feelings of the patient. Purgalives.~'l 'o enter on this part of the subject would

require a large space. The idiosyncracies of patients with regard to this class of medicines are so various, that little benefit can be derived d-ore medical advice by the patient who requires

25"2 Dr. Osborne's Propositions relating to

them, unless the practitioner is in attendance sufficiently long to acquaint himself with his individual peculiarities. In tile case of an old lady, I found the best purgative was Dover's powder, in ten grain doses, while the most approved purgatives had rather an astringent effect. In another, boiled turnips had a powerful effect whenever taken, while it was very diflieult to move her bowels in the usual way. Many are purged by porter, or by bark, and some by coffee. Much may depend orl using a variety of purgatives, so as to act on different portions of the canal. When there are irregular contractions in it, with distentions of flatus in the colon, peculiar benefit is derived from lialf-grain doses of assafcetida combined with soap. The same patient may, at different periods, require such dissimilar articles as tile following : viz., quarter-of-a-drop doses of croton oil, mixed with Venice turpentine. Various aloetic compounds, solutions of the neutral salts in camphor-water, or with sulphurie acid, eonlbinations of tinctures resembling the elixir of Jernitz, compounds of' sulphur and scammony, enemas of solutions of soap, of assafoetida, or of turpentine. Let it be remembered, however, that purgatives are to be given only to redress a temporary evil, the effec- tual repairing of which is to be effeeted by other means.

fonics.--As the treatment mainly rests on the application of tonic agencies, aloes are peculiarly well suited, as combining a bitter, which improves the languid state of the stomach, with the nauseous principle which causes contraction and evacuation of the large intestines. I have often seen great benefit follow the use of the following compound, viz., seven ounces ofcom- potmd decoction of aloes and one of Huxham's tincture, a wine- glass full taken early in the morning, preceded by ml assatbatida pill taken at bed time the previous night.

Camphor-Cantharides.~Camphor assists assafoatida in pro- curing the equal contraction of all parts of the intestinal tube ; but the common practice of sending pills home in boxes, renders the administration of this, as of other volatile substances, very

Dr. Osborne on Diseases of the Stomach. 253

uncertain. To obviate this inconvenience, tile following pills are directed to be kept in well stopped bottles :

I~ Assafoet. gr. vj. Camphorm gr. iv. Carb. Ammon. gr. viij. Aloes Hepat. gr. xxxvj. M. Ft. Pil. xij. St. i. o. n. h. s.

With respect to cantharides, tlteir efli~ct on the neck of the

bladder, and consequent slra'nguary, is only one part of that on

the whole capillary circulation, and especially on the circulation

of the mucous membranes. * Hence, unless forbidden by gastric

irritation, it is of great value in the kind of torpor now before

us, and doubly so in females, when accompanied by ammenor- rhoea. A drachm and half of the tincture may be added to tlle

aloetic mixture above mentioned.

Early Rising, Variety of Exercises, 8fc.--The baneful practice of lying in bed~ is attended by general relaxation and torpidity of the bowels ; while the contrary practice, in delicate individuals, is often followed by a slight diarrhoea. But I find, that to adequately show the mode of action on the stomach, belonging to the agencies enumerated in this proposition, would by far exceed the boundaries assigned to the present communi cation ; and I now close it wilh this observation, that the cure of torpid digestion is easy to conceive in theory, but diiilcu]t to effect in practice, not from the inefficiency of the means to be employed, but from tim discomfort and impatience appertaitling to the disease, which render the patient unwilling to contlnne in the course of exertion and self-denial during the space of time which must be required for its removal.

* Even where the stranguary occurs it is so much under control, generally ceas-

ing immediately after the mediciz~e is discontinued, that it is not productive of

any serious inconvenience.

vOL. XX. NO. 59. 2 L

Propositions relating to diseases of the stomach

Documents

Transcript of Propositions relating to diseases of the stomach