570 PRACTICE OF PHYSIC. 



can therefore avoid the ambiguity of the distention being only 

 flatulent, in which case it is not so painful, this tension gives a 

 suspicion of an inflammatory affection in particular parts, and 

 this will be still more clear if there are fixed pains in any particular 

 part of the abdomen. We may join to the symptoms of an in- 

 flammatory determination to the abdomen, a decubitus difficilis 

 occurring without any affection of the thorax. We have explained 

 how this symptom may arise from affections of the thoracic vis- 

 cera. Now, where the peculiar symptoms of these are absent, and 

 the uneasy lying is considerable, this may, along with the other 

 symptoms, be taken as a mark of the determination to the abdomi- 

 nal viscera. Where there is an anxiety without any affection of 

 the thorax, we are in some measure conscious of a difficult 

 transmission of the blood through the system of the vena por- 

 tarum, from which the anxiety arises ; and wherever it takes 

 place without our suspecting nausea, or other particular affections 

 of the stomach, we may consider it as a mark of the inflamma- 

 tory determination to the viscera of the abdomen. 



" The stomach is an organ which is liable to a very great 

 variety of states, and that from a great variety of causes, and 

 the symptoms of it afford us only a very doubtful conclusion. 

 Thus vomiting is very often no other than a symptom of a con- 

 siderable state of debility ; sometimes it is to be considered no 

 otherwise than as a mark of considerable constriction affecting 

 the state of other parts, as of the extreme vessels on the surface 

 of the body, which may be considered as the chief of the causes 

 of vomiting. But if the vomiting and nausea arise from the 

 constriction upon the surface, they will very often yield more or 

 less to the restoration of the determination to the surface, and 

 to the use of medicines which have that effect, such as the saline 

 draughts ; or, when they are owing to irritation, they will yield 

 to the use of opiates. But when a vomiting continues frequent, 

 and does not yield to any of these remedies, it may be consider- 

 ed as a mark of some inflammatory affection in the abdominal 

 viscera. 



" To these marks we may add, that the determination to the 

 abdomen is especially to be suspected to have occurred, when- 

 ever more or less of the nature of intermittent fever inter- 

 venes. In delivering the history of fever (LI.), I have 



