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Pathological and Practical Researches onDiseases of the Stomaclt, and IntestinalCanal, the Liver, aoed other Viscera ofthe Abdomen. By JOHN ABERCROMBIE,M. D., Edinburgh. Waugh and Innes,1828. 8vo. pp. 396..

THE influence which the inductive philo-sophy exercises in the science of medicine,is becoming as perceptible, as it is in almostevery other branch of human learning, andthat art which has hitherto been considered

nearly the exclusive region of hypothesis,may yet be ranked with the exact sciences,and present results analogous, in their mag-nitude and importance, to those which are ob-tainable in other departments of natural history. The most splendid of theories, or themost imposing of systems, will obtain a lessbrilliant fame for its inventor, and be far lessesteemed in the present day, than the disco-

very of a single important fact; and the ri-gid interpretation of nature is found to be theonly means of eliciting truths, of command-ing success in medicine, and of ensuringpermanent honour to its author.

In the able work before us, Dr. Aber-crombie attributes the hitherto slow progressof medical science to two causes; the

assumption of principles altogether gratui-tous and imaginary, and the deduction ofgeneral principles, or conclusions, from a li-mited number of facts. The theories of theformer may be considered to be almost in-

dependent of all observation, and the doc-trines of the latter, though they have anapparent foundation in facts, are framedwithout due inquiry whether those facts areuniversal. The best means of eschewingthese errors is, to bear in mind the importantprinciple, that the object of physical scienceis "to ascertain the universality of facts."To every doctrine we ought to apply this !test, "Is it built upon facts, and are thosefacts universal?" The fugitive nature ofthe truths which constitute the basis of the,healing art, renders a sober and patient iexercise of attention peculiarly necessary;the pathologist has oftentimes a tedioustask to perform, in establishing the univer-sahty of a fact; he is often tempted to quit ,the rugged road of induction, for the Bowery !path of fanciful analogy. To this tempta-tion we may fairly ascribe the various ab-

surdities into which alchymical and meeba-nical physicians, the humoralista and the

solidists, are perpetually falling.! Dr. Abercrombie has already furnishedthe public with an excellent work on thepathology of the brain. In the present pro-duction, he has made known the result ofhis practical and pathological researches indiseases of the chylopoietic, and assistant

chylopoietic viscera. He professes to furnishfacts in a concise and accessible form, andto advance to conclusions by " the first stepof the most cautious induction." In op-posing his opinions to the opinions of others,he submits both, to the rigid test of observa.tion. His work is divided into five parts,in reference to the five organs to which it

relates; the stomach, the intestinal canal,the liver, the spleen, and the pancreas. The

two former are treated at some length, andwith an eye both to the pathology and prac-tice of the subjects; the three latter areconsidered with a more immediate referenceto the changes which they undergo in

disease..In a preliminary section, 1e makes a

brief exposition of the alterations to whichthe serous, muscular, and mucous tissuesare liable. Serous membranes are subjectto simple thickening, which is seen most

strikingly in the peritoneum, and is theresult of chronic inflammation; to tuberculardisease, the entire surface of the membranebeing studded with numberless tubercles,generally very small, and of firm consistence,appearing to be invested with cysts, and

presenting the general characters of thismorbid growth; and to another affection,often met with in the peritoneum, appearingin its nature to be quite distinct from tuber-cular disease, and consisting in the surfacaof the membrane being covered by nodulesof various shapes and sizes, of a semi-pel-lucid character, and smooth, rounded, sur-face. This is the disease described by Dr.Baron, and supposed by him to be of thenature of hydatids. On first inspection ithas a resemblance to this animalcule, but itis of an entirely different nature. The

noduies are of a uniformly fine and gelati-nous consistence ; they do not appear to becovered by any cyst, and are entirely solublein boiling water.The muscular tunic of these organs is lia-

b’e to a morbidly increased, but uniform andhannonious, action, which appears to proceed

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from causes of irritation, applied to the in-ternal surface of these cavities; to a mor-bidly increased, but partial and irregular,action, arising, chiefly, from morbid irritabi-lity of small portions of the internal surface;to diminution, or loss of muscular power,resulting from two causes, over-distensionand inflammation ; and to thickening of themuscular coat, which has been described byLouis, and other French writers, under thename of hypertrophia ventriculi; as parti-cularly occurring in the stomach.The mucous membrane is obnoxious to

inflammation and its consequences. This

appears in various degrees, of which the

causes are unknown. The effect of the low-est degree of inflammation of this coat is,simply, an increase of its proper secretions,more or less changed in its qualities. Inanother stage of inflammation, aphthouscrusts are formed, and a third deposition offalse membrane takes place. In a highergrade, inflammation of the mucous tunic ter-minates by remollisement, or a degenerationof portions of the membrane ; these fall outand leave spaces, which are apt to ulcerate.A uniform, dark softening, resembling gan-grene, occasionally happens, as well as adhe-sion of the opposite surfaces of this mem-

brane, producing obliteration of the intesti-nal channel. A chronic form of inflammationnow and then exists, and is distinguishedby increased and morbid secretion, whichinduces a thickened and indurated state of

parts, and consequently a diminution of ca-vity. Fungous growths not unfrequentlyspring from the diseased mucous surface.The lining of the chylopoietic viscera is alsosubject to diseases of the follicles ; to dis-ease of a tubercular character; and to dis- 1eases of the part concerned in the absorptionof the alimentary matter, which, thoughelaborated in the usual manner, passes offwithout entering into the circulation.

It There are few points in medical science,"observes Dr. Abercrombie, *’ which have un-dergone more discussion than affections ofthe stomach : and yet, it must be confessed,that when we come to investigate the sub-ject, according to the rules of pathologicalinduction, we find little that is satisfactory.This has, in part, arisen from numerous diffi--culties which attend the investigation. Ma,

ny of the aftèctions of the stomach, tho!!,g!1productive of much and protracted discom-fort, are not apt to be fatal ; and thus fewopportunities occur of investigating their;

pathology, except when the patient dies ofr. another disease. The great proportion of

these seem also to be entirely of a functionalnature, leaving no morbid appearance thatcan be discovered after the death of the pa.; tient; and, in others, the appearances are

of so doubtful a kind, that they do not afn ford sufficient ground for any precise prin.e ciple in pathology. In a practical point of

view, also, this is perhaps more encumberedY vvith uncertainty than almost any other de.epartment of medical practice ; for the dis.eases are so much under the influence ofmoral and other adventitious causes, that the

action of remedies is aided, modified, or

counteracted, in a manner which entire1yeludes our observation, and is often altoge-tller beyond our control. From these vari.ous causes, diseases of the stomach have, presented a wide field for speculation, con.jecture, and empiricism ; a vague and inde.

finite phraseology has often been allowed totake the place of principles ; and the whole

*. subject is removed, in some measure, outof the usual limits of pathological inquiry,’ Amid this uncertainty, we must endeavour

to discover what is the pathological truth;and, should this prove to be more limitedthan a slight view of the subject might lead

us to expect, something will at least be doneby ascertaining its extent, and tracing thecourse by which it may be enlarged." I shall consider affections of the stomach

under three classes :-I. Affections of an in.flammatory kind, including ulceration and itsconsequences.—II. Affections which moreproperly come under the class of organic.-III. Functional affections,—embracing aslight outline of the subject of dyspepsia.-In an appendix, I shall briefly allude to theaffections of the œsophagus—and the duo.denum-and to derangement of the functionsof the stomach by tumours attached to it

externally—p. 10.

We could now quote from our author mostfreely and most advantageously; but thework is of so entire a nature,that it is difficult,without devoting to it a space which wecannot afford, to limit the extracts we shouldbe tempted to make. The forte of Dr.Abercrombie consists in luminous arrange-ment, and as we recommend this volume

most heartily to our readers, we shall ratherseek for those portions of it which may bemost appropriately isolated.

An interesting account of the pathologyof dyspepsia, occurs at page 68.

« For the healthy condition of the processof digestion, in all its stages, the followingcircumstances appear to be necessary:-" 1. A healthy state of the muscular ac

tion of the stomach.

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11 2. A healthy, consecutive, and har-monious action of the muscular coat of theintestinal canal.

" S. A healthy state of the fluids of thestomach, both as to quality and quantity.1 4. A healthy state as to quality and

quantity of the other fluids, derived fromthe liver, pancreas, and intestinal mem.brane.

h 5. A healthy state of the mucous mem-brane itself, both in .the stomach and in-testines." The dependence of the function of di-

gestion upon the influence of the eighth pairoi nerves, is among the most beautiful dis-coveries of modern physiology ; but nothingof a practical nature has hitherto been de-duced from it."

,

A deficiency of one or more of these con.ditions constitutes dyspepsia.In the regulation of the diet for all

affections of the stomach, strict attentionmust always be paid to the nature andsource of the disease. Animal food is, in

general, the most digestible, but there are

many cases which depend upon an irritablestate of the mucous membrane, in which thediet found to be beneficial or even necessary,is one restricted to farinaceous articles andmilk. The higher degrees of this affection,in which the disease amounts’ to inflamma-tion of the mucous membrane, have alreadybeen referred to ; but there appear to bemodifications of it, which, without assumingthis formidable character, have a similareffect on the functions of the stomach, andrequire similar treatment, especially in re-gard to diet. The subject is one of greatinterest, and opens a most important field ofobservation to him who, renouncing a mereempirical treatment of dyspeptic affections,shall direct his attention to the importantvarieties in the nature and source of the dis-ease. Such a person %%ill be astonished tofind the improvement which is made in cer-tain cases, under a diet restricted entirely torice, arrow-root, or bread and milk, withtotal abstinence from all stimulating liquors,after the patient had spent years of wretch-edness upon animal diet, with wine, or

brandy and water, and the usual round ofstomachic remedies. Other cases, again,agree better with animal diet in very smallquantity, and the moderate use of stimu-lating liquors. The diagnosis is often diffi-cult, and must be guided more by the judg-ment and attention of the practitioner, thanby any general rule."

The author then treats successively ofgastrodynia, chronic vomiting, pyrosis, hæ-matemesis, acd sympathetic affections of thestomach.

r- " Sympathetic affections of the heart," hete observes, "are often among the most trou-

blesome symptoms that accompany affec-tions of the stomach, and are always themost alarming to the patient. They appearunder various forms, and frequently assume,

m in a very great degree, all the characters oft- fixed disease of the heart or large vessels.

The slightest, and perhaps the most common,t- form, consists of a momentary feeling of at- rolling or tumbling motion of the heart, like

that which is produced by a sudden surprisei- or fright, and it is accompanied by an in-ir termission of the pulse. This feehng may;-1 be repeated only once or twice at a time, anda occur at long intervals ; or it may return in!. rapid succession for half an hour, or an hourtogether ; or it may be felt occasionally, at

irregular intervals, for several days or weeks,or for a still longer period. It is sometimes

accompanied by a feeling as if the heartwere violently grasped. In other cases, theaffection assumes the form of continued fits

of palpitation, or strong and irregular actionof the heart, which continue without anyremission for an hour or more at a time, and

recur in this manner daily, or several timesin a day, for a length of time; or recur at’ uncertain intervals. In other cases, again,’these fits of palpitation continue for severaldays together. They are of course accom-panied by irregularity of the pulse, when theaction of the heart is itself irregular; but

frequently there is no irregularity in theaction-the affection merely consisting of astrong pulsation, which the patient feels orhears throbbing in his ear, and can count

distinctly by the sound, especially when helies in bed. In other cases, again, there isonly an increased frequency of the action of

the heart, showing itself by paroxysms ofquick pulse, accompanied with a feeling ofanxiety, continuing for an hour or two at atime, without any irregularity. I shallmention in the sequel a remarkable case, inwhich an affection of this kind continuedwith little remission for a year. Betwixtthe various forms of this affection and dis-ease of the heart, the principal diagnosisconsists in the pulse being regular, and theaction of the heart natural, during the inter-vals between the attacks,—in an obviousconnexion with disorders of the stomach,and relief by treatment directed to that or-gan,—and particularly by the symptomsbeing most apt to occur while the patient isat rest, especially after meals,-not beingincreased by bodily exercise, but ratherrelieved by it,-and not being excited bysuch bodily exertion as we should natu-

rally expect immediately to influence a

disease of the heart. The affection is atall times very alarming to a patient, and issometimes perplexing to the practitioner;for, from the permanency of the symptoms,,

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they certainly often assume, in a great de-gree, the character of disease of the heart,and may even exhibit some of the stetho-scopiesigns, particularly the bruit de soufflet.There is also, in many cases, a considerabledegree of dyspnoea, and sometimes there areparoxysms of it of considerable urgency.’ " A gentleman, aged 48, in November,1325, began to be affected with paroxysmsof palpitation of the heart, and intermissionof the pulse. They attacked him daily,sometimes twice or three times a day, andgenerally continued about an hour at eachtime, and they were occasionally accompa-nied with a considerable degree of dyspnoea.During the intervals, the pulse was calm andregular, and the action of the heart quitenatural. The period of the attack was gene-rally soon after meals; but it likewise oc-curred at various other times; sometimeson first getting up in the morning, andsometimes during the night. During theparoxysm, he could take walking exercisewithout increasing the symptoms. His

digestion was imperfect, and his stomach

easily disordered ; his bowels were ratherslow, and the motions were dark and unliealtliy. A great variety of treatment, andevery possible variety of diet, were em-ployed with very little benefit. He went toLondon, and then to Cheltenham, wheremuch treatment was again had recourse towith little effect. He sometimes lost great,ly in flesh and strength, and sometimes im-proved again ; his digestion was sometimesbetter and sometimes worse; but, amid allthese changes, the affection of the heart con-tinued in the same form, namely, paroxysmsof violent palpitation of about an hour’s du-ration, occurring once or twice every day,and at no stated hours. After the affectionhad continued in this manner for two yearsand a half, it at last subsided under the useof the colchicum wine, in very moderatedoses. I do not attempt to account for theaction of the remedy in this singular case ;it acted at first strongly as a purgative, sothat he was only able to take ten drops olthe wine twice a day. The patient’s ownaccount of the effect of it is in these words :" At the time of commencing the use of thecolchicum, I had once, at least, every day,a severe fit of palpitation of all hour’s dura-tion ; often two, and sometimes three fits iua day. So immediate was the effect of thecolchicum, that, with the exception of thefirst and third days after beginning its use, Ihave not had a single paroxysm of the palpi.tation." He adds, that he continued theuse of it for a month, and then left it oil

entirely ; and that the quantity did not ingeneral exceed from fifteen to twenty dropsin a day."

Dr. Abercrombie thus treats of the patho-logy of the intestinal canal :-

" In attempting to trace the pathology ofthe intestinal canal, we have to keep in mindthe three distinct structures cf which it is

composed, namely, the peritoneal, the mus-cular, and the mucous coats. These struc-turps perform separate functions, and f!iable to be the distinct seats of disease. Oraof the most interesting points in this inres.tigation, is to trace the different classes of

symptoms which arise from, or are connect.ed with, these varieties of structure. This,I think, we are enabled to do with somedegree of accuracy, by tracing, in other partsof the body, in which the three structuresare more distinct from one another, theleading phenomena connected with the dis.eases of each. Thus, from ample observa.tion, we have reason to believe, that themost frequent result of inflammation in aserous membrane, is deposition of falsemembrane,-in a mucous membrane, ulce.ration, and in a muscular part, gangrene,rhere are various modifications of these ter.minations, but these now mentioned are themost prominent, and the most peculiar tothe different structures. When, therefore,in a fatal disease of the intestinal canal, wefind ulceration of the internal surface, wehave reason to conclude that the disease hasbeen seated chiefly in the mucous mem-

brane; when we find only false membrane,that it has been in the peritoneum; whenwe find gangrene, that the muscular coat

had been affected ; and when we find both

gangrene and false membrane, that both themuscular and peritoneal coats were involvedin the disease.

« In tracing the symptoms connected withinflammatory affections of the abdomen, wewe find them resolvingthemsetves into threemost important modifications. Thus we meetwith inflammation existing in the intestinalcanal, with a perfectly natural state of thebowels, with a loose state of them, and witha state of insuperable obstruction. In the

progress of this investigation, we shall seereason to believe, that these three states ofdisease, so different from each other, areconnected with three distinct varieties inthe seat of the inflammation ; that when it

is seated in the mucous membrane, there isan irritable state of the bowets, assumin;the characters of untractable diarrhcea cr

dysentery ; that, when the muscular coat rs

affected, there is obstruction of the bowels;and that inflammation may exist in the pen-toneal coat alone, and go on to a fatal terrai-nation, while the functions of the bowelscontinue in a perfectly natural state, throughthe whole course of the disease. It is neces-

sary to anticipate these results, in counte-

tion with the arrangement of this extensivesubject. But, besides the various forms ofinflammatory affections of the intestinalcanal, there is a class of diseases entirely

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distinct, namely, that which affects it simplyas a muscular organ. This includes the va-rious modifications of ileus, which, though itvery often terminates by inflammation andits consequences, is, in its early stages, tobe considered as a disease of the canal,affecting chiefly its muscular action. The

investigation of the pathology of the intesti.nal canal might, therefore, divide itself intodiseases affecting it as a muscular organ,including the varieties of ileus, and the in-

flammatory diseases under three classes ;namety, lst. simple peritonitis, without anyderangement of the muscular action of thebowels; 2d. Peritonitis, combined with ob-struction of the bowels, constituting the dis-ease commonly called enteritis; 3d. Inflam-mation of the mucous membrane. This is,perhaps, the correct pathological division ofthe subject, but I think it answers the pur-poses of practical utility, to consider peri-tonitis and enteritis together, and the dis-eases of the mucous membrane separately.On this plan, an actual division of the sub-ject may be made into, 1. Ileus ; 2. The

inflammatory affections of the more externalparts, including peritonis and enteritis;3. The diseases of the mucous membrane.The principal organic affections, and thevarious forms of chronic disease of the in-testinal canal, are intimately connected withone or other of these classes."-p. 101.

Ileus, with all its variations, peritonitis,enteritis, erysipelatous peritonitis, are, in

succession, perspicuously treated.The inflammatory affections of the mucous

membrane of the intestinal canal form a nu-merous class of diseases which are of dailyoccurrence, and require the most carefulattention of the student. The portion of thevolume devoted to them is very valuable. ;

Dr. Abercrombie considers in succession,active inflummation of the mucous mem-

brane ; chronic diseases of this membrane ;ulcers of the same membrane without pro-minent symptoms, and the treatment of

these affections. He thus introduces the

subject of treatment of the acute cases :-" If to the class of diseases now described,

we simply apply the term intianimntion ofthe mucous membrane of the intestine, wecan be at little loss iu fixiug upon the fiistand great principle to be followed in thetreatment ; while, if we use the term dy-aelltery, we in vain endeavour to find ourway amid the various courses that havebeen proposed for the treatment of the dis-ease. But upon a fair and candid review ofall the facts which are now before us on thisimportant subject, I think we are fully war.ranted in assuming the principle, that dy-sentery is primarily an inflammation of the

mucous membrane of the intestine ; and thatthe first principle in the treatment is pre-cisely the same as that which applies to otherinflammations. There is, however, a cir-

, cumstance to be kept in mind, which perhapsmay be considered as the source of some ofthe diversity of opinion in regard to thenature and treatment of dysentery ; namely,that inflammations of all mucous membranesexist in a state in which they admit of aspontaneous cure,-certain changes takingplace in the discharge from the morbid sur-face, in the course of which the parts gra-dually recover their healthy condition. Ofremedies which are given while this pro-cess is going forward, some may assist it,some may be totally inert, and some mayperhaps even have a tendency to retard it,and the process may notwithstanding go onto a resolution of the disease. The mostobvious illustration of these facts is from the

inflammatory affections of the bronchialmembrane. In a certain form, even of con.siderable extent, they get well under theuse of trivial remedies, or without anytreatment at all ; and at a certain period ofthis progress, active treatment is not onlyuseless, but hurtful. But these facts do notaffect our opinion in regard to the pathologyof the disease ; fur we know it to exist inanother degree, in which, it’ not acdvelytreated in its early stage, it is speedily fatal.On the same principle, we cannot doubtthat dysentery, in all its forms and all its

degrees, is an inflammatory affection of theintestinal membrane ; that it exists in a

degree in which it admits of a spontaneouscure, and that this may perhaps be assistedby various remedies of no very active kind ;but that it exists in another degree, which,if not treated with the utmost activity, it

may be speedily fatal, or may terminate byincurable ulceration.

" The general principles of treatment ap-pear to be the following : 1. To subdue theinflammation ; 2. To quiet the general irrita.tion of the canal; 3. To correct the morbidsecretions from the diseased surface."—

p. 276.And thus the section on the treatment of

the chronic cases :-" In the chronic form of the disease, the

morbid conditions which we have chietiy tocontend with are, either the chronic fungoidinflammation, or ulceration. The treatmentis extremely precarious, and but few of thecases comparatively do well. The remedieswhich appear to be most generally useful arethe following: lime water; vegetable bit-ters and astriugents, especially the cuspariaand logwood ; preparations of iron ; smallquantities of mercury with opium, especiallycalomel with Dover’s powder, or small doseaof calomel, with opium and ipecacuan.; the

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resins, as turpentine, balsam of copaiva ortolu, with small opiates ; sulphur with

opium ; nitric acid; various combinationsof these remedies with each other, as a

strong decoction of cusparia, with nitric acidand laudanum. Repeated blistering on theabdomen is often very beneficial, also ban-daging with abroad aannel roller, and tepidsalt-water bath. Sulphate of copper has’lately beeu recommended by Dr. Grenvillein various protracted affections of the bowels;and in any trials of it which I have had an

opportunity of making in this class of dis-eases, it appears to be a remedy deservingof much attention. It is given in doses, at

first, of half a grain, combined with an equalquantity of opium, and is gradually increased,if necessary, sometimes to the extent ofthree grains, with half a grain or a grain ofopium, three times a day. In the treatmentof all the affections of this class, much de-pends upon the most rigid attention to diet.Animal food in every form seems in generalto be hurtful ; and the greatest benefit resultsfrom a diet strictly confined to farinaceousarticles and milk."—p. 285.No class of diseases has been more fully

treated of, than those affecting the liver. In

Dr. Abercrombie’s remarks, we recognisehis customary accuracy, but we do not meetwith any great originality of conception.The pathology of the spleen and pancreasfollows. The few pages devoted to these

subjects are very interesting; but we mustrest from further extracts. We think we

have said enough to excite a desire in theminds of our readers, for a further acquaint-ance with this precise and perspicuouswork.

Cerebro-Spinal System in Man, togetherwith the Origin and Primary Divisionsof the Nerves which arise from it. Trans-lated from the French of Dr. Manec. ByLUIS VICENTE D’AFFONSECA. London.Underwood. 1829.

Tms publication is printed in the form of achart, and may be either suspended in the

study, or placed on a roller. It presents a

drawing of the brain and its nerves, exe-

cuted in a very clear and excellent manner,and is accompanied by such a description of’their various pats as must enable the stu-

dent to obtain a knowledge of them readilyand advantageously. The drawing of thebrain and spinal system is of the size of

life, and occupies the centre of the sheet.

The references are printed on each side,under the following heads :—general de.

scription - spinal chord - origin of the

nerves ; first class, cranial nerves ; secons

class, spinal nerves-physiology ; first class,nerves of motion, and general corollaries.The translation appears to be made with

correctness, and we recommend the chartas being well calculated to the purposefor which the ingenious author has pub-lished it.

LONDON MEDICAL SOCIETY,

Mr. CALLAWAY, President.

Monday, Oct. 5, 1829.

PUERPERAL MANIA.

! IN the discussion which followed thereading of Alr. Ashwell’s paper, September28th, the particulars of which were acci.

dentally omitted in our last, the early re.

moval of patients similally affected, withthe patient therein referred to, was point-ed out as beneficial; the use of opium,

as tending- to cerebral excitement, was de-precated (contrary to the opinion of Mr.Ashwell, who considered injurious effects tohave arisen from bleeding and purging);and the propriety of an immediate cessationof suckling, and the exLibtion of camphorand tartrate of potash were suggested. Somecases were alluded to, in which the durationand regularity which marked the presentcase were equalled.The discussion on the present evening,

Oct. 5, was resumed.The propriety of exhibiting large doses of

opium, both after and without bloodletting,was much discussed, as well as the advan-tages and evils of venesection, and the cau.tion which should attend it; camphor wasrecommended; stimuli to be avoided ; quietto be encouraged; and weaning to be ad.vised. The morbid appearances of this dis.ease were considered important. None wasallowed in Alr. Ashwell’s case, and deathsfrom puerperal mania were stated to be Mfew, that it was not easy to obtain post-mortem examinations. Some cases were

mentioned, in which the ovaria were foundin such a state, that they b:oke down by apush of the finger.The President this evening again en-

joined the committal to paper of cases com-municated to the Society.Want of space has compelled us, on the

present occasion, to abridge the romatbthat were made, and postpone one report.