Hepatitis.-Inflammation of the covering of the liver, or peri-hepatitis, must be distinguished from that of the parenchyma. In the former, the serous membrane is attacked, and the same treatment is demanded as in peritonitis. (Vide the latter.)

In inflammation of the parenchyma there is cholæmia, the bile elements being retained in the blood. Thence, a feeling of malaise, pungent heat of the skin, keen thirst, sometimes vomitings, and all the signs of a decomposition of the blood, the bile acting like a real poison, on account of its alkaline nature. It results from the above pathological condition that, independently of general antiphlogistics, baths, cataplasms, leeches, etc., recourse must be had to evacuants and antispasmodics, notably hyosciamine and arseniate of cafeine, in order to re-establish the flow of the bile :

A granule of each, together, every hour.

The Seidlitz salt must be given to refresh the intestinal tract. Hepatitis, in hot countries, often terminates in abscess of the liver, with bilious-purulent reabsorption. Recourse must therefore be had to pneumatic aspiration, as soon as fluctuation appears. The English in India are more liable to attacks of hepatitis than the natives, on account of their heating diet and burning medicaments. It would be desirable that dosimetry should penetrate into that country; unhappily the tenacity of the English to preserve established usages is well known.* In South America, where the miasmatic bilious fevers prevail, dosimetry has been welcomed with great favour, because its advantages have been understood, and it has been seen to be more rational, especially in comparison with the intricacies of the old pharmacy.

Splenitis. In splenitis, as in hepatitis, the state of the blood must be especially considered. The red globules of the

* Dr. Vurdapah Naidu, of the Madras General Hospital, has recently advised all native practitioners to employ the dosimetric medicaments in the treatment of the fevers peculiar to India.-H.A.A.

ceous.

blood accumulating in the spleen, render it friable and pultaThence, therefore, arise venous congestions of the side of the stomach, causing hæmatemesis. (Vide this latter.) In this inflammation the spleen must be emptied by arseniate of strychnine, which will also have the effect of preventing alteration of the blood :

A granule every hour.

Splenitis, like hepatitis, may terminate in apostemation. In this case it is necessary to perform pneumatic aspiration, in order to prevent disorganization of the spleen. Generally, the physician may be reproached with want of boldness; it is true that he is held back by professional responsibility. However, the autopsy ought to prompt to more than useless regrets.

Gastro-enteritis. It is known that Broussais wished to make gastro-enteritis, and its extension to the other abdominal viscera, as well as to the brain and the meninges (gastro-enterohepato- meningo-encephalitis), the foundation of medicine. Thus he confounded the cause and the effect, by placing in the same class the ataxic adynamic fevers and the visceral inflammations which are the consequence of them. I have previously discussed those fevers, and the treatment which they require. I shall therefore only occupy myself here with the idiopathic inflammations, due to local causes.

Thus,

Gastritis. It is necessary here to distinguish the different membranes which may be the seat of inflammation. when the pain is violent, increasing at the least touch, with pinched face, hiccough and greenish vomitings, it is a localized peritonitis which has to be dealt with, and it must be treated in the same manner as general peritonitis.

When it is the mucous membrane which is inflamed, there is the burning sensation which extends to the throat. The tongue is small and red at the edges. The stomach should be kept at rest, and if the pain, or rather the epigastric sensibility persists, it must be relieved by leeches.-Liquid diet (milk with lime-water, weak mutton or chicken-broth, etc.), emollient drinks.

Cramp-like pains point to the sub-mucous layer as the part attacked; it is properly called gastrodynia, and should be treated as such.

As to gastritis of typhoid character, it is known that to the illustrious author of "Physiological Medicine," adynamia and ataxia were signs of local inflammation. What is certain, is that with his burning medicaments, Brown did but increase the irritation of the stomach. Having at his disposal only fixed or diffusible stimulants, such as cinchona and Virginian serpentaria, the typhoid state, characterised by fuliginosities of the tongue and lips, sub-delirium or coma-vigil, carphology, etc., was only exasperated, and excessive azotization of the humours or the ataxic state due to the production of carbonate of ammonia, was seen to arise. (Vide Typhus.)

Since polypharmacy, or the mania for drugs, has been held less in favour, real or idiopathic gastritis has singularly diminished. No one now cares to risk the conversion of a simple derangement of the stomach into gastritis*, since drastic purgatives are more sparingly used, although pompous advertisements are continually tempting poor dupes to buy them. Physicians ought to warn their patients against this quackery, which assumes all forms, in order to insinuate itself into the confidence of the public.

Enteritis. The distinction between inflammations of different portions of the intestine is based especially upon their functions, their degree of vitality, and their relations to the neighbouring organs.

Duodenitis. Duodenitis is accompanied with bilious symptoms, on account of the hepatic duct. Pancreatitic symptoms are less well marked, unless the fatty or lactescent diarrhoea

* I knew a highly respected and clever medical practitioner who died from acute gastritis, produced by his habit of taking large doses of calomel (10 grains) whenever he got out of order. He believed, according to the erroneous doctrine of his day, that calomel was a remedy for most diseases.-H.A.A.

remarked in this case be included as such. The pain is dull and deep, the descending and transverse portions of the duodenum having only a partial serous covering. This pain is increased by pressure over the liver. The jaundice which declares itself in the course of this inflammation is owing to the extension of the duodenitis to the liver. (Vide Hepatitis.) The treatment consists principally in causing the bile to flow into the intestine by means of quassine, and by washing the intestinal tract by the Seidlitz salt; this is so much the more necessary as the transverse colon is in direct relation with the duodenum. Diet and emollients will do the rest.

Jejunitis.-Ileitis.-The jejunum and ileum having a peritoneal covering, present when inflamed symptoms of partial peritonitis, characterised by pungent pains, irradiating about the umbilicus, but deeper seated than those of parietal peritonitis. The colics also observed in these cases, may assume the character of internal strangulation or miserere. must be combated by hyosciamine with oils:

These

A granule every half-hour, with a dessert-spoonful of olive oil, either pure or mixed into an emulsion with the yolk of egg.

Typhoid fever localizes itself in the jejunum and ileum by hypertrophy and ulceration of the glands of Peyer and Brunner; therefore the cleansing of the intestine by Seidlitz salt must be insisted upon.

cœcum is characterised by Here again it is necessary

Typhlitis. Inflammation of the a deep pain in the right iliac fossa. to distinguish peritoneal typhlitis or perityphlitis, which often extends to the surrounding cellular tissue, and gives rise to an abscess which may extend in a variety of directions, opening either into the bladder, rectum, or the inguinal canal. Typhlitis often declares itself during the course of typhoid fever. Independently of external antiphlogistics, leeches, cataplasms, etc., stagnation of the fecal matters must be prevented by cleansing the intestine with Seidlitz salt.

Colitis. The position of the ascending and descending portions of the colon causes this inflammation to be felt deep in the loins, where it might be confounded with psoitis, more especially, as it is increased by straightening the trunk; however, the abdominal swelling and the rumblings in the bowels indicate functional derangement of the large intestine. In such cases, emollient enemata must be especially insisted upon. If constrictions are present, recourse must be had to hyosciamine and oils, as in enteritis.

The sigmoid flexure of the colon being undulatory and having a peritoneal covering, the pains arising from its inflammation are sometimes very acute. The treatment is similar to that of partial peritonitis.

Rectitis. This inflammation is characterised by a sensation of heat within the pelvis, and tenesmus of the anus. It must be combated by leeches and emollient enemata, but especially by veratrine and hyosciamine :

A granule of each, together, every hour.

Nephritis. Renal inflammation is characterised by pains of a colicky kind, irradiating along the plexuses of the great sympathetic, and causing retraction of the testicle in man, and ovarian pain in the woman. The urine is scanty, red, and sometimes mixed with blood. Here spasm must be combated by hyosciamine, and the urinary secretion re-established by digitaline :

A granule of each, together, every half-hour.

The cleansing of the intestine by Seidlitz salt is so much the more necessary, as the accumulation of fecal matters in the colon augments the renal pain. It may be noted that turpentine vapour baths are sometimes useful, on account of their influence over the urine. When there is abundance of uric acid, recourse must be had to benzoic acid :—

A granule every quarter-of-an-hour.

The fever of nephritis in its continued form should be combated by veratrine :

A granule every half-hour,