III. PATHOLOGY.
17. Dothinenteria. Pustules of the small Intestines.—From δοθη, a pustule, and εντερον, an intestine. This name is given to a disease which has been described by M. Bretonneau, of Tours, and, after him, by Serres, Broussais, Andral, and several others, and consists in pustules, generally situated at the lower end of the ileum.
We are constantly lamenting to ourselves the contracted bounds allotted to our Quarterly Summary. Indeed, were it not for other objects, it might occupy, with advantage, half of the number, and most of the time employed in the preparation of the work. Every thing must be curtailed, though cut off at the most interesting and valuable point; and the painful exertion of the attention, necessary to condense information for our readers' use, of the amount of which they cannot possibly be aware, can only be equalled by the constant feeling of disappointment at rejecting so much important matter.
We are told that this pustular disease is as common and as destructive as the small pox, (indeed!) the measles or the scarlatina; that few persons spend the whole of their lives without having, at some period, suffered by it; that it never affects individuals but once; and that it is suspected of being contagious.
M. Bretonneau has prepared a set of specimens, taken from the bodies of those who have died in various stages of this complaint. He traces the malady day by day, with a precision which we will not copy here. The seat of this affection is the glands of Peyer and Brunner. The former are found in groups, throughout the lower half of the jejunum and the whole of the ileum, gradually increasing in the size and number of their clusters, till they reach the valve of the colon, where they cease. They have been mistaken by some dissectors of the modern school for the effects of inflammation. They are found in honey-combed patches; which are agglomerations of mucous glands. The glands of Brunner are thinly dispersed mucous follicles which are scattered singly throughout the whole length of the small intestines, with nearly equal frequency. These organs are well described by Haller in the great Physiology. They are not seen well, unless in a young subject, and by cutting into the intestine very close to the mesentery.
When inflamed, they swell and thicken, and, after some days, the membrane around them assumes a reddish tint. The mesenteric glands are enlarged. M. Bretonneau has seen one as large as a hen's egg: they generally equal in size that of a pigeon. The disease spreads and affects an additional number of glands. It reaches its acme generally on the 9th day; after which sometimes all, and always a part of the affected glands return to their natural condition, by resolution of the inflammation. Those which are to run the full course of the disease continue to augment in size and projection into the intestine. On the 13th and 14th days they are discovered tinged with bile, which penetrates their substance, and thus proves the occurrence of disorganization. On the 15th and 16th, the sloughs separate, and leave from one to six ulcers. These penetrate the gland, and with it the mucous membrane, of which it forms a part, and next, the cellular tissue of the intestine. In numerous instances they perforate the muscular coat, leaving nothing but peritoneum at the bottom; and frequently, passing this, they induce inflammation of the cavity of the belly, and death.
The cases of simple resolution terminate in three weeks: those in which sloughs are formed, in from 30 to 40 days, if not fatal. If death be from peritonitis, it is of course soon after the 15th and 16th days; if from exhaustion, at periods varying according to the strength of the sufferer. Dothinenteria occurs in many of the cases commonly called typhus fever, gastro enteritis, &c. It is proper to remark that both the author and the journal are in opposition to Dr. Broussais.—Archives.
18. Dr. Broussais.—While the opinions of this celebrated reformer have been gradually becoming more extensively known among our countrymen, the war has prevailed with increased heat in his native land. The most vehement attacks are made, from various quarters, upon his system of medicine physiologique. No one appears to deny that he has clearly proved the existence of mucous gastritis and enteritis in many or most fevers, or the propriety of directing a part of the remedies to them. Criticisms and invectives are freely emitted: but they are only levelled against the too extensive application of this doctrine, and the inconsistencies, unquestionably often real, of the system of which he has made it the foundation. Indeed, if the quotations given are correct, we think no one who has not assumed a party, can refrain from concurring in their condemnation.
"Those who understand our doctrine never attack it; they speak of it only to express their admiration: above all, they never think of wishing to modify it, because they know that its fundamental dogmas are unshakeable." "Surtout ils ne s'avisent jamais de vouloir la modifier," &c. A man who assumes such ground as this, had need be very careful in assuming his positions, indeed; and should particularly avoid any thing like self-contradiction.
The Lettres a un medecin de province, in a style of lively criticism, labour to show a great variety of inconsistencies in this immoveable doctrine. The review of this publication in the Revue Medicale, including copious extracts, coincides with, and evidently wishes to aid, the author's satire. In the same journal are a series of criticisms on some of the elementary propositions of Dr. Broussais, published in a late edition of his Examen; (nearly the same which were published here, some time since, in the American Medical Recorder, having been translated by Dr. Atkins.) In these critiques, great severity is shown, in dealing with the new dogmas, and the doctrine is treated as one of dangerous tendency; while, at the same time, high praise is awarded to their author, for his discoveries in the diseases of the alimentary mucous membranes.
In the other journals, there is a division; some favouring the new opinions, while others oppose them with more or less of vehemence.
That the doctrine of gastritis has made a great impression at Paris, that almost every one believes in it, to a greater or less extent, appears undeniable; but there, as well as here, most of the more rational, and moderate minded men are evidently of the only school a physician ought to belong to, the eclectic. Borrowing largely from Broussais, and having had their minds powerfully stimulated by the succession of striking and novel ideas which he has introduced, they think it unmanly to "bind themselves to his chariot-wheel," but form conclusions for themselves from every resource within their power. If the great French reformer really wishes to establish as absolute a power over the minds of his followers, as Mahomet or Pythagoras did, and as the above-quoted extract seems pretty fairly to indicate, he must certainly undergo many mortifications. Notwithstanding the "inebranlable" nature of his dogmas, M. Miquel has furnished us with several variations from them, in the writings of Messrs. Boisseau, Roche, Sanson, Remusat, Richond, and Begin; and the last-named individual has had a public dispute with his preceptor.
M. Begin has produced his promised work on surgery, according to the principles of the new school. We have not seen the volume, but have read a review of it in the Revue Medicale, by M. Bellanger. The latter describes it as a cursory work, having for its object the adaptation of surgery to a set of general principles, rather than a detailed system of instructions how to proceed in each individual case. It contains only what is easy to be remembered, and omits those matters for which it is usual to refer to books. Thus two pages only are appropriated to fractures of the body and neck of the femur! and twenty-six for the whole subject of fractures, wounds, and six or eight of the most important diseases, of bones! Yet all this criticism is not without a compliment, well-merited at least by the former productions of the same author, to his talents and ingenuity.
19. Whooping-cough.—"There is no disease of children, in which the resources of medicine are more manifestly serviceable than in an obstinate whooping-cough." Such, in amount, was the opinion of Dr. Underwood, and Dr. Watt uses language almost equally strong. Certainly, we are not at all times equally successful or equally sanguine in America.
Dr. A. Cavenne considers whooping-cough a true bronchitis, a pulmonary catarrh; accompanied with greatly heightened nervous symptoms, owing to the irritable period of life at which it occurs, and particularly to its frequent existence in nervous constitutions. Professor Tourtelle calls it a pneumo-gastric, pituitous catarrh; and certainly, the pupils of a modern school will find no difficulty in recognizing symptoms of gastritis in its severer forms. The further inferences drawn by Dr. Cavenne, are as follows:
1. That the whooping-cough, in an individual of a sanguine temperament, requires, in general, the use of bleeding, and a debilitating regimen.
2. That bleeding and a debilitating treatment are equally necessary, whatever be the temperament, in whooping-cough of the chronic form.
3. The antispasmodics are necessary in nervous constitutions.
4. That blood-letting and the debilitating treatment should be rejected, when the subject is endowed with a lymphatic temperament. This observation, says our author, is equally applicable to early infancy, in which lymph predominates over the red blood, and the fluids are more diluted.
Finally, if the disease be obstinate and there be disturbance in several functions, there is certainly reason to believe that a lung, a viscus of the abdomen, or the brain, is in an unfavourable condition; (the author means of the inflammatory kind;) and this is ground for the moderate abstraction of blood.—Journ. Univ. Feb.
20. Antiperistaltic globus. Globus hystericus.—Dr. Trolliet, of Lyons, observes that hysteria cannot, with propriety, be said to exist in the male sex; that it arises, as its name imports, from derangement of the uterus, and that Cullen and Sydenham have done wrong, and stand alone, in teaching the contrary. When there exists a real hysteria, the contractions are not confined to the intestinal regions, but invade the neighbouring parts; (quere, which of them contract?) they are always accompanied, when existing in a high degree, with convulsions and loss of the mental powers. In the intervals, the patients affected can satisfy their appetite.
Antiperistaltic globus may occur from various causes; and either in the intestines or the œsophagus.
That of the intestines is met with chiefly in advancing age; and is generally produced by daily and often-repeated pressure on the abdomen, as practised in various professions. Hard labour and bad diet also greatly aggravate it. At first pain in the intestines occurs, aggravated by labour; together with derangement of digestion.
The sensation of a globe then appears on the lower and left side of the abdomen; and, after performing various circuits, finally reaches the stomach; from which is soon after discharged, with great relief, a quantity of gas, issuing from the mouth. Vomiting of an acid and burning fluid, as also of the food, is not uncommon as an accompaniment. This ball is about the size of a man's fist, and is sensible to the external touch, and even to the sight. The patients possess the power, to a certain extent, of controlling its motions, and relieving the pain, which is often extremely violent, by pressure.
Indigestible food always aggravated the disease. Some could only tolerate milk, broth, and other fluids. A weaver was obliged to quit his profession, from the pressure on the abdomen which it required, occasioning the paroxysms.
The treatment consisted in
1. Avoiding the original causes.
2. The use of a species of corslet, (plastron,) to prevent future pressure on the abdomen.
3. A rigid diet. We do not understand why, firstly, articles containing a great deal of fecula, and, as it is said, "requiring a great action of the intestines," are forbidden, while, in the second place, rice is recommended. "Bouillon aux herbes," (a laxative decoction,) rice-cream, and milk, were found the best. Wine was injurious. Assafœtida and camphor were useful, and were administered in boluses. Purgatives were injurious. Emolient enemas were useful.
Of antiperistaltic globus in the œsophagus our author saw only two cases, which were not complicated with hysteria. The patients had both been subject to rheumatism; and, in one of them, this had been supplanted by an eruption Of tetter: on the disappearance of which last the globus appeared. These cases were cured, the latter by a severe, light diet, and some antispasmodics, the names of which are not mentioned; the other by curing the rheumatism.
Dissections are somewhat difficult to obtain; unless where some other more mortal disease exists. In one, scirrhus of the pylorus was found; the stomach greatly enlarged; the small intestines contracted, red outside and gray within. (Where was the redness situated; in the peritoneal or the muscular coat? We must guess the latter.) The stomach was pale gray, and thickened. The large intestines were dilated, and gray.—Journ. Univ.
21. Non-contagion of Yellow Fever.—Dr. Valentine, of Nancy, has printed a pamphlet of a single sheet, in which he finds himself involved in all the turmoil, through which American physicians passed during the period which intervened between 1793 and 1805. Dr. V. gives his authority decidedly in favour of the non-existence of a contagion in this disease; and grounds his opinion upon the innumerable cases of patients affected with the disease and otherwise, who have escaped from infected districts, without communicating the malady in any instance, to the persons with whom they lived; upon the healthiness of ports, from which it has been said to have been introduced, &c. Dr. V. is not, as some of his countrymen have been, unwilling, from some unimaginable cause, to make use of the immense mass of American evidence; though he observes, and with justice, that experiments should be repeated in France, in order to set the public mind at rest in that kingdom. He proposes the employment of criminals for this purpose; and recommends every mode of the most close contact which his imagination could suggest. He mentions experiments of this kind having been made in the United States; and by M. Guyon, of Martinique, on his own person.
He quotes Dr. Chervin's labours, with great and just applause. This indefatigable and daring physician has now spent upwards of ten years in accumulating proofs upon this single question.
At the commencement of the pamphlet, the arrangement of which does not seem to us to be quite clear and easy, Dr. V. gives a sketch of the situation and localities of Leghorn. He traces the fevers of that place to putrid matters, perceptible by the sense of smell; and principally to obstructed drains. He does not give the exact degree of heat, but merely states that it was excessive, and followed by heavy rains.