257 
P A T H O L O G Y. 
cafes, a previous adhefion of'the ftomach with the perito¬ 
neum had taken place by means of the inflammatory 
procefs.- 
We are not acquainted with any particular predifpofi- 
tion to gaftritis in the firft inftance ; but, when the dii- 
eafe lias once occurred, like mod: other inflammations, it 
leaves a tendency in the part affedled to be more eafily 
excited to inflammation again ; and therefore, fora long 
time fubfequent to recovery, the utmoft caution, in re¬ 
gard to the ufe of irritating food and drink, is required. 
The exciting caufes are, inch matters applied to the fto- 
mach, as, from their fenfible, chemical, or mechanical, 
properties, occafion violent irritation to the ftomach, or 
injure its texture 5 or the inflammation is produced by 
the extenfion of the difeafe from the neighbouring organs, 
or from diftant parts; or frequently it follows luddenly 
on the fecond variety. 
When inflammation of the ftomach induces death, in¬ 
dependently of fuppuration or gangrene (which are not 
the moll frequent terminations of the difeafe), lometimes 
the inflammation is found, upon diffcclion , to havelpread 
over a confiderable part, or perhaps the whole, of the in¬ 
ner membrane ; but moll commonly it occupies a fmaller 
portion. The ftomach upon theoutfide, at the inflamed 
part, ftiows a greater number of fmall veflels than ufu-al, 
but is commonly not much crowded with them. On 
opening the ftomach, it is found to be a little thicker at 
the inflamed part, the inner membrane is very red from 
the number of fmall florid veflels, and there are frequently 
f'pots of extravafated blood. Portions of the inner mem¬ 
brane are fometimes deftroyed ; and fometimes a thin 
layer of coagulable lymph is found thrown out upon a 
portion of the inner furface of the ftomach. See Baillie’s 
Morbid Anat. p. 138. 
The treatment of acute gaftritis will neceffarily vary, 
according to the nature of the exciting cauff, and to the 
degree and duration of the difeafe, and to the circum- 
. fiance of its being Ample or complicated. The leading 
indication however, and the general plan, muft be the 
fame as in all phlegmonic inflammations in their com¬ 
mencement; namely, to attempt the refolution of the 
difeafe by depletion, together with the ftrift obfervance 
of the antiphlogiftic regimen. Large bleedings inuft be 
fpeedily employed, and repeated, if the urgency of the 
fymptoms continue to require it, notwithftanding the 
fmallnefs of the pulfe, the general debility, and even 
difpofition to fainting. For, after bleeding, it is ob- 
ferved that the pulfe commonly becomes fuller, and the 
tendency to fyncope is diminiflied. In an inftance re¬ 
corded in the Edinburgh Medical Effays, the patient was 
bled five times within feven hours, and was each 'time 
fuddenly relieved from the acute pain ; the pulfe, before 
irregular, became regular; and the cold extremities be¬ 
came warm. In delicate conftitutions, when the violence 
of the inflammation has been reduced, but not altoge¬ 
ther removed, by bleeding, the application of leeches, 
or of cupping-glafles, after ffarification, to the region of 
the ftomach, may be occaflonally reforted to with advan¬ 
tage. A large blifter, applied to the pit of the ftomach, 
after venefedtion, is likewile advantageous. In cafes 
where a confiderable irritability of the ftomach, with 
little or no adlual inflammation, exifts, and gives rife to 
naufea and vomiting, the external agency of a blifter is 
often the moll effectual remedy. It is perhaps advifable 
to abltain altogether from taking any thing whatever 
into the ftomach, Whether by way of medicine or ali¬ 
ment, until the violence of the inflammation be fome- 
what fubdued, Ance thefe matters at flrft will produce vo¬ 
miting. In other cafes, where any thing can be borne 
by the ftomach, liquids of the very mildelt kind, fuch as 
milk arid water, thin gruel, See. muft be given, and in 
very fmall quantities at a time. 
Opiates, in whatever manner exhibited, are very hurt¬ 
ful during the flrft days of inflammation of the ftomach ; 
but, when its violence has greatly abated, or the pain 
and Acknefsrecur at intervals only, opiates may be cau- 
tioufly adminiftered in clyfters. It is remarkable, that, 
notwithftanding the ufually naufearing effedt of antimony, 
this fubftance may be given with advantage in gaftritis, 
when combined with enough opium to reftrain its ac¬ 
tion. Adtive purges fnould be exhibited in clyfters till 
the bowels are fully opened. 
We are particularly cautioned in this complaint to 
avoid a fudden return to full living, on account ot the 
tendency of the difeafe to relapfe. 
The fecond variety differs in its fymptoms, as it is 
chronic or acute. Its acute form is ufually connected 
with general inflammation of all the coats of the ftomach, 
and hence its fymptoms are often the fame; yet it un¬ 
doubtedly may exift feparately, Ance fuppuration and 
gangrene of the ftomach, leftons not very uncommon in 
the flrft variety, are fcarcely ever met with in the acute 
gaftric inflammations which are found in exanthems. 
Its caufes are nearly flmilar to thofe of the other variety. 
The firft fymptoin of Gaftritis erythematica is fome¬ 
times a violent vomiting refembling cholera morbus. 
The patient throws up every thing that he fwallows ; 
then bilious, mucous, or even fanguineous-looking, mat¬ 
ters; going very frequently to (tool at the fame time. 
Fever is a neceflary accompaniment of this form of the 
difeafe. Sometimes gaftritis declares itfelf without vomit¬ 
ing ; but always with violent pyrexia, often unpreceded 
by a cold ftage or (hivering. The patient complains of a 
burning internal heat, and generally of a forenefs in the 
pharynx. The tongue appears red and clean, and the 
thirft is confiderable ; the defire for cold acidulated drink 
is as great as the averficn for every other kind of liquid. 
If the phlogofis does not extend to the inteftinal tube, 
there is conllipation. If it reach the colon, there is di¬ 
arrhoea with tenefmus. There is deep-feated pain in the 
epigaftric, and efpecially in the right hypochondriac, re¬ 
gion, but not exafperated without a certain degree of 
preffure. This pain isfometimes lancinating, and accom¬ 
panied by a fenfe of conllridtion. It manifeftly dimi- 
nifties after the patient has fwallowed cold aqueous drink, 
efpecially if acidulated. Very often the vomiting ceafes 
in a few days, although the other fymptoms perfift. At 
other times it continues, o^ fupervenes in the courfe of 
the difeafe; and the patietit is haraffed with conftant 
naufea, which appears to him to be occafioned by fome 
globular body rifing upwards, aiul painfully com'prefting 
the lower part of the cheft. Each fit of vomiting is fol¬ 
lowed by a temporary eafe of very ftiort duration, the 
patient inceffantly demanding emetics ; a fymptom ftiH 
more common in peritoneal inflammation than in acute 
gaftritis. The abfolute impoflibility, which the patient 
l'uppofes, of ('wallowing any thing, appears referrible to 
the contradled and highly-irritabJe ftate of the upper 
orifice of the ftomach. Such are the principal fymp¬ 
toms of uculq gajlrilis; but feveral of them may beabfent; 
even pain itfelf does not exift, in fome cafes, where 
the inflammation is molt intenfe. Our diagnofis muff 
therefore be aflifted by a rigid obfervance of the fympri- 
thetic troubles produced by this phlogofed ftateof the 
mucous membranes of the digeftive organs. The Jir/i 
clafs of thefe appertains to the head, affedling the func¬ 
tions of the fenfes, and the movements of the voluntary 
muffles. Head-ache may or may not exift. Aberrations 
of the intellect, correfponding with the moments of 
greateft buffering, are more Heady in their appearance. 
“ I have feen,” fays Brouffais, “ men as completely 
delirious as in fevers the moft malignant, or phrenitis it¬ 
felf.” In fuch cafes too, we often fee the conjundtiva 
red, the eye inflamed, and the features altered. In pro¬ 
portion as the difeafe advances, and the bufferings in- 
creafe, the attention becomes eftranged, till coma en- 
fues. In the mean time we obferve irregular con tradf ions 
of the facial muffles, grinding of the teeth, fubfultus 
tendinum, and variousconvullive movements. The pa¬ 
tients throw off the bed-clothes when they are fenfible, 
complaining 
