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irritation of the stomach, the intestines, and the liver, and to distinguish the cases, few in number, in which recourse must be had to evacuants, is the fundamental principle which should, at the present day, guide the practitioner in the treatment of gastric affection. If, instead of employing himself in invectives, against the partisans of antimony, Gui Paten had collected, with care, conclusive facts, the cause he advocated would have triumphed, and humanity have been spared many a groan. It is not, says the inimitable Molieres, who was unspairing in his appropriate philippics against the profession, and the public of his day, it is not, after all, that your daughter may not die; but at all events you will have the consolation that she died according to form.
Ce n'est pas, qu'avec tout cela votre fille ne puisse mourir mais au moins vous aurez fait quelque chose, et vous aurez la consolation qu'elle sera morte dans la forme. L'amour Medecin, Act I., Scene 5.
We do not say (says De Ticknor) that cathartic remedies always produce injurious results; but as there are many of the diseases of the digestive organs that are aggravated by irritating their lining membrane, it follows, therefore, that purgatives being irritants, are, in all such cases, decidedly improper. This is more particularly the case with regard to those chronic, troublesome affections, known by the name of dyspepsy, indigestion, bilious complaints, and other terms equally vague and unmeaning. Maladies of this class are characterized by an almost
numberless train of distressing symptoms; and so unhappy and perfectly wretched do they render their victims, that they eagerly seize upon any means that afford the most distant prospect of relief, and that without calculating the chances, or ever dreaming of a possibility of being made
In a large proportion, if not in a majority of the dis eases to which the digestive organs are subject, the mucous lining membrane will be found to be the seat of the malady; and the disease itself is found, by examinations after death, to consist in a greater or less degree of inflammation.
Inflammation of the mucous membrane of the stomach is characterized, in most cases, by tenderness directly at the bottom of the breast bone, extending over the space about equal the size of a dollar. The degree of pain caused by pressure in this region, is in proportion to the degree of inflammation. Sometimes an individual thus affected is compelled to wear the dress inordinately loose; and when gentle pressure is made with the points of the fingers, he experiences the most acute pain. Whoever is thus afflicted may rest assured that his disease will be aggravated by a frequent repetition of active purgatives. It is an unquestionable fact, that cathartic remedies produce their effect in two ways only. First, by an increase of the secretions, or the natural fluids that are found in the cavity of the alimentaary canal. These secretions, like those of all other organs, are supplied by the blood;
and whenever they are increased in quantity, the supply of blood to the part is increased in an equal ratio. Thus the supply is constantly proportioned to the demand occasioned by an active irritating purgative. If, then, the mucous membrane be inflamed, purgatives add only to the flame already existing. The lining of the stomach and bowels in this case, is in a state resembling, exactly, an inflamad eye, where there is more or less pain and an increased secretion of tears. Any person of the least observation would perceive at once the injury likely to result from the application of an acrid, irritating substance, for the sake of increasing still farther the secretion of tears; and so any man, who knows the effect of remodies, would see in prospect the mischief likely to result from repeated purging. The bad effects of active cathartics do not end here; nor do the ill effects of improper remedies to an inflamed eye cease with the flow of tears. In the latter case the eye is not unfrequently disorganized, and the sight lost forever. In the former, change of structure is also the result, with sometimes ulceration, that ends in a perforation of the intestines, causing immediate death, There is one important fact that should be borne in mind by the lovers of "powerful physic!" and that is, that oftentimes each successive dose must be greator than the one preceding; so that after a long course of purging, five or ten times as much medicine is required as was necessary at first. It is unnecessary to explain why there shall, from too frequent repetition of the physic in one
case, follow obstinate constipation, in another, diarrhoea chronica, asthma, etc. It is sufficient for our present purpose, to know, that these results, and many others, do ensue.
Purging is many times continued till a sub-acute enteritis is induced or aggravated, and the abdomen becomes painful and distended, under an erroneous impression that a new disease had occurred to remove the very symptoms it has caused. Thus the patient is finally purged out of existence, without the doctor once suspecting a possibility that he may be wrong, or that something else, or some other treatment would be advisable.
No article can produce vomiting but such as causes an irritation of the stomach; and most substances that do so, like the active cathartics, possess acrid and stimulating properties. In gastric affections, where digestion is deranged, there is often experienced a sensation of distension, or of a load at the pit of the stomach; and most substances that do so, like the active cathartics, possess acrid stimulating properties. In gastric affection, where digestion is deranged, there is often experienced a sensation of distension, or of a load at the pit of the stomach; and an attempt is made to remove this load, as it is called, by an emetic. To the surprise, however, of the suffering party, nothing is vomited but a small quantity of mucous, watery fluid, quite inadequate to account for the previous
symptoms, and accordingly another emetic is administered, but with no better effect. The relief afforded in such cases, if there be any, is merely temporary; and there is soon the same necessity for a repetiton of the medicine as there was at first.
The sensation of a load in the stomach at such times is not caused by any quantity of matter, but is the sole result of the diseased membrane lining its internal cavity, giving a sensation which is purely deceptive: and when relief is afforded by an emetic, it is because the diseased action is temporarily changed or superseded. But even a temporary remission is not always procured, the disease being immediately, and permanently, and often incurably aggravated.
An individual, after unusual fatigue, or exposure to wet or cold, night air, or any other cause sufficient to derange the health, complains of lassitude, more or less headache and chilliness, loss of appetite, tenderness at the pit of the stomach on pressure, pain in the back and loins, and other symptoms that generally usher in a febrile attack: an emetic is now administered, without affording the anticipated relief, but is followed by an obvious aggravation of all the preceding symptoms; the remedy is perhaps repeated, with a still more decidedly, bad, and unhappy result. The ultimate effect in this case is inflamation of the stomach.
When bile is vomited with violent retching towards the last part of the operation of an emetic, it is consideren