PATHOLOG Y. 
258 
complaining that the internal heat which devours them 
is ten times more infupportable when the cheSl is covered. 
They try all kinds of pofitions in bed 5 ligh deeply ; and 
Show in their countenances the expreffion of intenfe 
agony. If they are queftior.ed refpe&ing the nature and 
feat of their pains, they apply the hand to the epigaftric 
region, but cannot clearly defcribe their Sufferings ; the 
fenfe of internal burning is the only one which is distinct 
to them. We muft therefore ground our diagnolis on 
the tout enfemble of the fymptoms, and efpecially on 
the instantaneous relief produced by cooling drink. 
In refpeCt to the refpiratory fyftem, we obfer/e fome- 
times a cough, with teazing pain ; a glairy or mucous 
expectoration Streaked with blood, or white, like that of 
peripneumony, at the period of refolution ; a general 
pain in the cheft 5 a laborious refpiration in fanguineous 
fubjeCts. 1 The voice is often loft from a fympathetic pa- 
ralyfis of the laryngeal muffles. During the firft days of 
acute gaftritis, the pulfe is full, hard, and often as ftrong 
as in pneumonia, particularly if the peCtoral fymptoms 
above mentioned are prefent; a proof of fanguineous 
plethora in the pulmonary parenchyma. In lighter 
ihades of gaftritis, and when the vital powers have been 
reduced by pain, the pulfe is Sharp, irregular, or even 
intermittent; towards the clofe of life, imperceptible. 
Heat of lkin is confiderable, during the violence of the 
acute ftage. M. Brouffais has always found it dry and harfti. 
The lkin is cold when the difeafe is on the decline, and 
cannot be brought to a natural warmth when the difeafe 
is verging to a chronic Hate. The cutaneous fecretions 
are fuppreffed ; and the breath is fetid in a few days 
after the circulation becomes much increafed. 
Chronic Gaftritis cry thematica .—This may be a primi¬ 
tive affeCtion, or the lequela of an acute attack. It is 
produced by the fame caufes as the above-mentioned form 
of the difeafe; but, from peculiarity of constitution, or 
force of caufe, it is unaccompanied by thofe violent com¬ 
motions in the fyftem which arrelfc the attention of the 
other kind. The patient complains of pain acrofs the 
bafe of the cheft, deep-feated in the epigaftric and hypo¬ 
chondriac regions ; generally more confiderable in the 
right fide, and fometimes fo high up as to be thought in 
the cheft. This pain is conftant and very troublefome; 
fometimes burning, lancinating, pricking, and confined 
to a very circumfcribed fpot, efpecially when the ftomach 
contains any acrid or irritating fubftances. It is very 
frequently accompanied by a fenfe of conltriCtion. Some 
patients complain of feeling as though a ball of large fize 
were prefling againft the diaphragm ; others as if a bar 
were fixed acrofs the ftomach, preventing their fwallow- 
ing food or drink. Gf all thefe fenfations, the lancina¬ 
ting and Hinging pains are thofe which acquire the great- 
eft degree of iutenfity. The others are fo faint, that the 
patient feldom demands relief from them till the ftrength 
becomes conliderably reduced. 
The appetite always fails; and, when the difeafe exifts 
in its greateft degree, there is a general abhorrence of 
food. When there is any remains of appetite, the digef- 
tion is quite imperfeCt. Aliments are ufually thrown up 
foon after eating ; efpecially if too much food, or food of 
a ftimulating nature, have been fvvallowed. Thofe who, 
from a milder degree of the difeafe, or idiofyncrafy of 
ftomach, do not vomit, are opprefied, during the gaftric 
digeftion, with a fenfe of load at the ftomach, naufea, 
acid, corrolive, or fetid, eruCtations, rumination, and 
exafperation of the ufual pain. There are fome patients 
who only experience eruCtations, inquietude, and mental 
perturbation. The pulfe rifes a little, and the fkin warms, 
during gaftric digeftion ; but fink to their ufual level 
when the digeftive procefs is finished. For a confidera¬ 
ble time the bowels are as coftive as though a fcirrhus of 
the pylorus exifted; but ultimately, in the majority &f 
cafes, there is diarrheea, with colic, tenefmus, and ftools 
mixed with blood--a proof of the extenfion of the diff 
eafe. Then the breath, and even the perfpiration, exhale 
an odour manifeftly fteroraceous. 
Thefe fufferings, even when not very fevere, are badly 
borne by the fick, who become dejeCted, impatient, taci¬ 
turn, difcontented, and not difpofed to enter into the 
details of their feelings. They have an air of fuffering 
in their countenance ; the conjunctiva, lips, and cheeks, 
being of a deep red colour, verging towards that of tinc¬ 
ture of logwood ; as are alfo the tongue and whole inte¬ 
rior of the mouth, excepting along the centre of the 
former, where a thin mucous lift may be feen. In a few 
fubjeCts the tongue is very much loaded, the breath of¬ 
fensive, and a bitter tafte is experienced in the mouth; 
but thefe are exceptions, and the diagnofis muft be drawn 
from the whole of the fymptoms, not from any one ex- 
clufively. 
As foon as this difeafe is completely eftabliftted, the 
cellular and adipofe membrane becomes nearly abforbed, 
with but little diminution of the muffles; when thefe 
laft are much extenuated, the difeafe is without hope. 
At all times, however, the fkin is drawn tight over the 
muffles, finking in in their interftices, fo that it cannot 
be pinched up but with difficulty, even in thofe places 
where it is ufually very relaxed. In no other fpecies of 
maraffnus has M. Brouflais feen this degree of adhefion 
fo ftrongly marked. This character of the lkin, toge¬ 
ther with its colour, being a brown, inclining to yellow, 
offer two of the moll conftant diagnoftic Signs of chronic 
gaftritis. 
The pulmonary fyftem fuffers very little in this fpecies 
of the difeafe, with the exception of a flight ftomach- 
cough occafionally. Nor is the circulation fo much in¬ 
fluenced, at the beginning, as to evince any appreciable 
febrile movement. When the difeafe has made progrefs, 
then the pulfe becomes hard and frequent ; the lkin, at 
the fame time, being hot, and dry to the touch. There 
is always an evening exacerbation, with agitation and 
reftleffnefs. If this train continues unchecked, proftra- 
tion of ftrength foon enfues, and the gaftritis, in fa£t, 
paffes info the acute form. If, however, the febrile 
movement is only marked by frequency of pulfe, with¬ 
out heat of fkin ; or if the patient only experiences a few 
hours of heat towards the evening, or during digeftion ; 
the malady may continue chronic. In all cafes, if long 
protraCted, the febrile fymptoms fubfide, and the evening 
exacerbation ceafes to be fenuble. Then the fkin becomes 
cold, and of the colour before deffribed, with percepti¬ 
ble wafting of the body. When diarrhoea is added, the 
ceflation of pyrexial phenomena is ftill more fudden and 
complete. 
The treatment of the acute form of this variety is fimi- 
lar to that of Gaftritis adhasfiva, except that cold lotions 
at firft, and afterwards warm fomentations, are to be ap¬ 
plied to the epigaftrium inftead of blitters; and local is 
to fuperfede in a great meafure the general bleeding. 
Cooling acidulated drinks and efferveffing draughts af¬ 
ford much gratification to the patient. Strong purges, 
even when naufea is not prefent, are extremely hurtful; 
and, upon the whole, the practitioner is to be careful 
not to give too much medicine. 
As to the treatment of chronic gaftritis of the mucous 
membrane, this mult be regulated by fomewhat fimilar 
indications. The patient muft abftain from all animal 
food and all indigestible vegetable fubftances ; thin gruel 
and cold drinks, as weak folutions of nitre, the occa- 
fional application of leeches and warm fomentation, with 
laxative clyfters, forming the molt approved remedies. 
This applies to chronic gaftritis when itaffumes the cha¬ 
racter of local pain and irritaffon, manifesting generally 
a fenfe of burning at the pit 0/ the ftomach, redntfs of the 
fauces, and factor of the breath. Another form of chronic 
gaftritis, which Supervenes to long-continued nervous 
irritation, has been mentioned under Dyfpepfia, where 
it is deffribed as constituting the fecond ftage of that 
4 complaint. 
