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of the chronic diseases of the heart originate in this way, namely, in diseased lungs.

General anasarca, first noticed about the ankles, is also frequently induced by the same cause,inflammation of the parts within the chest, impeding, by pressure, or by the extension of inflammation to the great trunks of the absorbing sys

vitiated quality; thus occasion ing a continued difficulty of breathing, with constant cough, vulgarly termed asthma, and that fluctuates in point of severity with season and weather. The affection of the pleura, in its turn, gives rise to adhesion and serous accumulation in the cavity of the chest. While the continued or frequentlyrepeated attacks tem, the free discharge of of inflammation, however lymph into the veins. Many slight, in the lungs themselves, of these cases of dropsy, if gradually, induce an alteration early attended to, and treated of structure in these parts, by moderate and repeated which, by slow degrees, degenerates into pulmonary consumption, a disease which we shall soon have to notice.

Nor is this the whole of the mischief that results from slight and neglected inflammation in the pulmonary organs. The resistance the heart encounters in its endeavors to

propel the blood through the lungs in the diseased state of these organs, becomes a source of irritation to the heart, that at length terminates in actual disease, such as morbid enlargement or other change of structure, either in the heart itself or the large vessels connected with it, attended of necessity with disordered action, discoverable in the pulse, and which is productive of the greatest possible distress to the patient, and not unfre quently a sudden and fatal termination. A great proportion

bloodletting, and other antiphlogistic measures, admit of cure, by the removal of the cause; whereas, if treated in a different way, by stimulants and the like, they soon terminate fatally.

From this case of disease, and many like it, the reflecting reader will

perceive the propriety of sending early for medical aid. In many dis

eases, whether acute or insidious, cessful, must be done early. Success whatever is attempted, to be sucwill also often depend on the tranquillity of the patient, and his strict compliance with the means devised, and directions given, for his relief. This, too, is one of the multitude of diseases which so frequently arise from inattention to the common causes of catarrh, as too light clothing in damp, chilly and cold weather,

wet feet, and various habits more or less repugnant to health, consisting a good deal in a neglect of those expedients which invigorate the sys

tem, and which would enable it to surmount the common influences of atmospheric changes.

all desire to eat was removed, but a degree of disgust was excited by seeing others eat. He, however, was prevailed on to take a little bread

We shall have occasion to return and milk, which in a very short time to this subject hereafter.

RELATIONS OF THE DIGESTIVE FUNCTIONS

WITH OUR SENSATIONS.

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Hunger. When the stomach is in a healthy condition, and has remained for some time empty, the wellknown sensation of hunger is produced; to account for which, various hypotheses have been devised. Some have attributed its origin to the friction of the sides of the stomach on each other, or to the dragging of the liver on the diaphragm; others to the action of bile or acid vapors on the stomach; to the compression of the nerves, or to the fatigue of the contracted fibres of the stomach: but such theories are subverted by the fact, that the stomach may remain empty for a long interval, during disease, without any sensation of hunger; and that when present, it may cease or be allayed by various causes, though food should not have been taken; as often happens after the accustomed period of repast is over, or from the sudden communication of news that overwhelms us with grief or disappointment. The physiologists of the present day attribute the phenomenon to the stimulant action of the gastric juice on the nerves of the stomach; and to support this opinion, Dr Wilson Philip relates the following experiment. A person in good health was prevailed on to abstain from eating for more than twentyfour hours, and during this interval to increase the appetite by more than ordinary exercise. At the end of this time he was extremely hungry; but, instead of eating, he excited vomiting by drinking warm water, and irritating the fauces. The water returned mixed only with a ropy fluid, such as the gastric juice is described to be. After this operation, not only

ran into the acetous fermentation, as indicated by flatulence and acid eructation. I do not mean to deny that the presence of a portion of gastric juice may not contribute to the sensation of hunger; but I feel more disposed to refer the phenomenon to an energetic state of the gastric nerves, occasioned by an interval of inactivity, during which their vital powers may be supposed to accumulate. With respect to the actual quantity of gastric fluid in an empty stomach, we know little or nothing. It seems probable that it is supplied during digestion, and that its secretion corresponds with the nature and quantity of the ingesta. If a narcotic be applied to the nerves, their pow er is paralyzed, and the sensation of hunger ceases; such an effect is produced by the juice of tobacco, though by long habit the stomach may become indifferent to its operation. Whenever the Indians of Asia and America undertake a long journey, and are likely to be destitute of provisions, they mix the juice of tobacco with powdered shells, in the form of small balls, which they retain in their mouths, the gradual solution of which serves to counteract the uneasy craving of the stomach. In like manner we may explain the operation of spirit in taking away the appetite of those who are not accustomed to it; while those who indulge the habit receive its stimulant without its narcotic impression.

Natural appetite, which is only the first degree of hunger, never appears to recur till the aliment previously introduced has been duly as similated. It cannot, therefore, strictly speaking, be said to have an immediate reference to the state of the stomach; for though all the chyme may long since have passed out of this organ, if any delay occurs in its

2. Difficult Respiration of a quence unable to receive the continued kind.-The breath- venous blood coming from difing is short and laborious, often ferent parts of the system; and with wheezing. This symp- thus a general stagnation of tom is occasioned by the pres- circulation takes place in a sure made by the swelled por- greater or less degree, and action of lung on the aircells counts for the tumid and bloatand minute ramifications of the ed state of the face and extrebronchia, impeding thus the mities. The brain, from its admission of air into the lungs. proximity to the heart, is like3. A livid hue of the skin in ly to suffer most from the imvarious parts, especially of the pediment to the return of blood cheeks, lips, and nails. This to the heart; and hence stuarises from the blood not hav- por, and not unfrequently deing undergone the necessary firium, ensue. Something may changes in the lungs, owing to doubtless be astributed here the imperfect admission of the to the dark or venous characair in breathing. And as ani- ter of the blood itself, by which mal heat depends in a great it is less fitted to excite the measure on respiration, this brain, and other organs of the being imperfectly performed, body, whence the general torcoldness of the extremities like- por and inaction observed. wise takes place.

In severe cases of peripneumony, the tongue assumes a brown hue, similar to what is observed in low fever; and this probably from the same cause, the oppressed condition of the brain. The thicker and darker the crust on the tongue is in these cases, the greater in general is the danger of the disease.

4. The same pressure which acts on the airvessels, influences also the bloodvessels of the lungs, namely, the minute branches of the pulmonary artery and veins. The blood in consequence is impeded in its passage from the right to the left side of the heart, which is thus deprived of its due and There is often no cough, regular supply of blood. The because the mucous membrane pulse in consequence is gene- is not always or generally afrally small, soft, and feeble, fected, When cough does ocand sometimes irregular.

5. The obstructed state of the pulmonary artery leads to a gorged state of the right side of the heart, which cannot sufficiently empty itself of its blood. It becomes in conse

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cur, however, there is not much expectoration at first, and the expectoration is often of a brown or sanious appearance; sometimes it is bloody, but the blood is rather of a dark than a florid hue.

mica. The approach of this may be suspected from the continuance of the oppressed state of breathing, after the pain and febrile symptoms

The history I have now given, you are to consider as an extreme case of the disease, and as it appears in its most simple and uncombined form. In most cases, it is a have declined. Occasional much milder disease than I shivering fits, also, indicate ap have now stated, and is most proaching suppuration. The frequently accompanied with abscess commonly bursts into more or less of inflammation the bronchia, when the matter of both the investing mem- is brought up by coughing. brane, the pleura, and of the Sometimes, though rarely, it mucous membrane, or that penetrates through the pleuwhich lines the bronchia. ra, into the cavity of the chest, Hence the pain, and cough, and then constitutes what is and expectoration, that so com- called empyema, that is, a colmonly are found in combina- lection of purulent fluid in the tion with the other symptoms. thorax. In many instances,

Progress and Terminations. the lungs adhering to the ribs, -The progress of inflamma- the matter makes its way betion of the lungs is according tween these, and is discharged to the violence of the disease at the skin, often very remote and the age of the patient. In from the opening into the infants, it often runs its course, chest. Patients occasionally and proves fatal in little more recover under all these cirthan eight and forty hours; cumstances, though slowly, and and the same is the case in after a long period. very old subjects.

Peripneumony terminates in various ways; as, 1st, by reso lution, as it is called; that is, by simply subsiding, without even expectoration or other obvious change: 2d, More frequently it terminates in coughing and expectoration. The more early this takes place, and the more copious and easy the discharge of mucus becomes, the more likely is the disease to terminate favorably.

4th, by hemoptysis.-This occurring early in the disease, tends powerfully to take off the inflammation, though, in itself, it is not unattended with danger.

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5th, by deposition of blood or serum, or both, into the cellular texture of the lungs, and that to such a degree as to occasion suffocation. When the disease proves fatal in this way, the lungs, on being cut into after death, resemble the liver in color; and hence have

3d, by abscess, commonly though needlessly termed vo- been said to be hepatized. This

BOSTON MEDICAL INTELLIGENCER.

is a very unwarrantable use of language, as it tends to excite ideas that are without foundation. Modern writers have a great deal of this sort to answer for.

6th, by apoplexy.-The im pediment given to the return of blood from the head, and which is evident in the bloated state of the face, the red, and starting, and suffused appearance of the eyes, and the turgid state of the jugular veins, not only induces stupor, the effect of mere stagnation, but becomes also, in some cases, a cause of irritation to the arteries of the brain, urging them to an increase of propulsive action, and consequent rupture and extravasation of blood.

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Prognosis. The chief danger in peripneumony, arises from the impeded respiration, and the interruption given to the passage of the blood through the lungs. The unfavorable symptoms are, the livid hue of the skin, with coldness of the extreme parts; a feeble and irregular pulse; and the occurrence of stupor or delirium. A thickly coated brown and dry tongue, also indicates danger.

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and this often to a great ex tent, the patient in many cases requiring to be bled, once, or oftener, daily, according to the severity of the symptoms, for many days in succession, till either the disease gives way, or the strength will no longer allow of this evacuation. Of this, you are to judge chiefly by the pulse. In proportion as this declines in strength and fulness, you are to be cautious in abstracting blood. You must be aware, however, that the pulse in this disease is not wholly or exclusively to be trusted to; for, owing to the blood retaining its venous character, and thereby not stimulating the heart and arteries sufficiently; and partly, also, to the imperfect transmission of the blood through the pulmonary artery; the pulse at the wrist may be weak and small, though the general strength be still unimpaired. In such cases, you must judge of the general strength from other circumstances; such as the duration of the disease, the quan tity of blood already lost, and the state of the patient immediately previous to the attack.

In the advanced stage of the disease, when the skin is livid, the extremities cold, pulse feeble and irregular, and the tongue of a dark brown color,

Treatment. The common remedies for inflammation are all that are required in this case. Bloodletting, commenced bloodletting is hardly admissi at an early stage of the disease, is particularly necessary,

ble, though we may be convinced the inflammation is still

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