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arises also from internal causes not so well under. stood. It may arise from inflammations of the neighbouring parts communicated to the stomach, and is then to be considered as a symptomatic affection only. It may arise also from various acri. monies generated within the body, either in the stomach itself, or in other parts, and poured into the cavity of the stomach. These are causes more directly applied to the stomach ; but there are per. haps others originating elsewhere, and affecting the stomach only sympathetically. Such may be supposed to have acted in the case of putrid fevers and exanthematic pyrexiæ; in which, upon dissection, it has been discovered that the stomach had been affected with inflammation.
388. From the sensibility of the stomach, and its communication with the rest of the system, it will be obvious, that the inflammation of this organ, by whatever causes produced, may be attended with fatal consequences. In particular, by the great debility which such an inflammation suddenly produces, it may quickly prove fatal, without running the common course of inflammations.
When it lasts long enough to follow the ordinary course of other inflammations, it may terminate by resolution, gangrene, or suppuration. The schirrosities which are often discovered affecting the stomach, are seldom known to be the consequences of inflammation.
389. The tendency of this disease to admit of resolution, may be known by its having arisent from no violent cause; by the moderate state of the symptoms, and by a gradual remission of these, especially in consequence of remedies employed in the course of the first, or at farthest the second, . week of the disease.
390. The tendency to suppuration may be known by the symptoms continuing, in a mode rate degree, for more than one or two weeks; and likewise by a considerable remission of the pain, while a sense of weight and an anxiety still remain.
When an abscess has been formed, the frequency of the pulse is at first abated; but soon after, it is again increased, with frequent cold shiverings, and with marked exacerbations in the afternoon and evening, followed by night-sweatings, and other symptoms of hectic fever. These at length prove fatal, unless the abscess open into the cavity of the stomach, the pus be evacuated by vomiting, and the ulcer soon heal.
391. The tendency to gangrene may be suspect ed from the violence of the symptoms not yielding to the remedies employed during the first days of the disease : and that a gangrene has already begun, may be known from the sudden remission of the pain, while the frequency of the pulse con
tinues, and at the same time becomes weaker, ác. companied with other marks of an increasing debility in the whole system.
392. From the dissection of dead bodies it appears, that the stomach very often has been affected with inflammation, when the characteristic symptoms of it (386) had not appeared ; and therefore it is very difficult to lay down any general rules for the cure of this disease.
393. It is only in the case of phlegmonic inflammation, as characterized in 386, that we can advise the cure or resolution to be attempted by large and repeated bleedings employed early in the disease : and we are not to be deterred from these by the smallness of the pulse; for, after bleeding, it commonly becomes fuller and softer. After bleeding, a blister ought to be applied to the region of the stomach; and the cure will be assisted by fo. mentations of the whole abdomen, as well as by frequent emollient and laxative glysters.
394. In this disease, the irritability of the sto. mach will not admit of any medicines being thrown into it; and, if any internal medicines can be supposed necessary, they must be exhibited in glysters. The giving of drink may be tried; but it ought to be of the very mildest kind, and in very small quantities at a time.
· 395. Opiates, in whatever manner exhibited, are very hurtful during the first days of the disease; but when its violence shall have abated, and when the violence of the pain and vomiting recur at intervals only; opiates given in glysters may be cautiously tried, and sometimes have been employed with advantage.
396. A tendency to suppuration, in this disa ease, is to be obviated by the means just now proposed. After a certain duration of the disease, it cannot be prevented by any means whatever ; and, . when actually begun, must be left to nature; the business of the physician being only to avoid all irritation.
397. A tendency to gangrene can be obviated in no other way than by the means suggested in 393, employed early in the disease; and, when it does actually supervene, admits of no remedy.
398. Erythematic inflammations of the stomach, are more frequent than those of the phlegmonic kind. It appears, at least, from dissections, that the stomach has often been affected with inflam. mation, when neither pain nor pyrexia had before given any notice of it; and such inflammation I apprehend to have been chiefly of the erythematic kind. This species of inflammation also, is especially to be expected. from acrimony of any kind
thrown into the stomach ; and would certainly occur more frequently from such a cause, were not the interior surface of this organ commonly de. fended by mucus exuding in large quantity from the numerous follicles placed immediately under the villous coat. Upon many occasions, however, the exudation of mucus is prevented, or the liquid poured out is of a less viscid kind, so as to be less fitted to defend the subjacent nerves; and it is in such cases that matters even of moderate acri. mony, may produce an erythematic affection of the stomach.
399. From what has been said, it must appear that an erythematic inflammation of the stomach may frequently occur ; but will not always discover itself, as it sometimes takes place without pyrexia, pain, or vomiting.
400. There are cases, however, in which it may be discovered. The affection of the stomach sometimes spreads into the æsophagus, and appears in the pharynx, as well as on the whole internal sur. face of the mouth. When, therefore, an erythe. matic inflammation affects the mouth and fauces, and when, at the same time, there shall be in the stomach an unusual sensibility to all acrids, with a frequent vomiting, there can be little doubt of the stomach being affected with the same inflammation that has appeared in the fauces. Even when no