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analogy to those curious fæcal excretions from the roots of various plants, poisonous more or less to the vegetable life by which they are produced.*
The treatment of the cases mentioned above is not without many difficulties, and we have reason to believe that mischief is often done by a mistaken practice. To deal with these instances as with common diarrhoea, by opiates and astringents, may injuriously interfere with actions beneficial or needful in their result. On the other hand, irritation, by medicine or otherwise, to the vascular surface which is the source of these peculiar excretions, may inflict mischief of another kind, and equally prevent a salutary issue.
These difficulties, in truth, are common to cases of diarrhoea of more ordinary kind, arising out of the complication of the causes concerned; the various ingesta received into the stomach; the different secretions poured into the alimentary canal, as well from the large glandular apparatus of the liver and pancreas, as from the innumerable mucous follicles in every part of the canal; and further, the great extent of vascular surface from which fluids may be separated by exudation or otherwise. In effect of this, a great variety of division and nomenclature has arisen as to these disorders; adding much to the embarrassment of the student, and increasing the chances of error in practice. It will probably
*The observations of Macaire on these remarkable excretions from the roots of plants are valuable to agriculture, as well as interesting in the analogies they afford to animal life. On the latter point I have notes of several instances, showing the noxiously sedative influence of some of these matters generated within the body, and thus separated from it. One case is now before me, where, in a vigorous young man of two and twenty, the pulse, habitually about seventy, was brought down below forty, and rendered very irregular, by the passage through the intestine of a large quantity of that peculiar secretion resembling black oil; the pulse rising again immediately after it was removed from the body.
be admitted by all who give honest expression to their experience, that even in these very familiar complaints the rule of treatment is less certain and consistent than in most other disorders, fluctuating perpetually between the doubt whether the diarrhoea present is to be checked by direct means, or allowed to proceed on its course; whether medicines should be given with intent gradually to alter the secretions ; or, with a bolder hand, to remove at once such as may be disordered or hurtful. This uncertainty of practice in bowel complaints, as they are termed, can only be obviated by experience, and the careful observation of what is mere mechanical irritation - what vitiated secretion from other topical causes-what the separation of noxious matters from the blood through the liver or intestinal membranes. Technical rules here may be too minute, as well as too general and vague, to be useful in practice. At all events, they can never supersede individual discrimination.*
Some of the remarks just made relate to disorders of the
* In all general reasoning on the disorders of the abdominal viscera, it is needful to estimate fairly what is still wanting to an adequate knowledge of the healthy functions of these organs. The stomach is now perhaps best known; but chiefly through researches of recent date. progress in the minute anatomy of the liver, for which we are chiefly indebted to Mr. Kiernan ; and even the valuable experiments of Tiedemann, Majendie, and others, expressly applied to its physiology, have left us yet in doubt as to the uses of the bile in the animal economy; --whether specific for certain purposes in digestion ;-or as an agent in the separation of carbon or other elements from the blood; or for both these objects in conjunction. The functions of the spleen are still matter of vague conjecture. Numerous questions remain to be solved as to the especial functions of the several parts of the alimentary canal. And though much more has been done towards the history of the kidneys both in sound and diseased state, yet the relations of the urine, in its quantity and properties, to the various changes occurring in other parts of the body, still offer singular difficulties to the physiologist.
small intestines as well as to those of the colon; but the cases are so numerous in which this bowel is especially affected, and to which these questions of treatment directly apply, that it is impossible not to notice them as an essential part of the subject.
The disturbances produced in the body by what may be called the mechanical conditions of the colon are deserving of notice, particularly as they are sometimes mistaken for more serious disorders of other organs. The whole subject, indeed, of the sympathetic and reflex actions produced by unequal distension and change of place in the parts of the intestinal canal, is curious and instructive in various points of pathology. Their influence upon the nervous system, even as connected with the common processes of digestion, is familiar to us in every moment of life. It is more strikingly shown in different states of disease, especially in the female habit; as well as during the period of infancy, when the nerves are more sensitive to all automatic impressions, and less under the control of those functions of the brain which afterwards govern so large a part of the muscular system.
As respects the colon, these effects manifestly depend in part on the contiguity or attachments of the intestine to other organs, making the latter liable to be affected by the distension which so often occurs in the whole or parts of this bowel from temporary causes. Its peculiar course through the body renders some of these connexions very important in pathology; since not only the stomach and other parts of the alimentary canal, but also the action of the heart and the respiration, are liable to great disturbance from this cause. The latter effects are more especially produced when the transverse arch, as so often happens, is distended throughout its length; forming a tight girth across the body, and pressing
directly or indirectly upon the diaphragm, stomach, duodenum, and even the large vessels underneath. Though there is often ambiguity from the distension of the stomach itself, yet in many cases it is obvious that the colon is solely concerned; either through air confined in the bowel, or from more solid matters compacted in some part of it; and it forms one of the various circumstances in digestion by which the heart's action is disturbed, frequently so much as to alarm the most experienced practitioner.
Irritation to the stomach is often produced by distension of the transverse arch of the colon; and many states of disorder supposed to belong to the former organ are really due to this cause. The distress so common to dyspeptic patients in the course of the night, and obviously connected with the state of the bowels, seems frequently to belong to this part of them especially; the recumbent posture giving more effect to all irritations which depend on its distension and pressure on the adjoining parts.
The close attachment of this portion of the colon to the stomach and duodenum may be looked to as explaining many other symptoms of disordered digestion, and the morbid sensations or actions suddenly spreading between distant parts of the alimentary canal. A distended state of the colon may disturb an earlier stage of digestion, either mechanically by pressure on parts nearer the stomach, or indirectly through the system of nerves, by which these various organs are associated in one common function. Both these causes must be held in view in treating the disorders to which they are subject; the actual complexity of which may well embarrass the young practitioner, seeking to unravel, by technical names and descriptions, symptoms which no nomenclature can reach.
Disturbances in the colon are not unfrequently mistaken
for complaints of the kidneys; and there is the greater liability to this mistake from the influence they really have (either mechanically, or by some cause of sympathetic irritation, or by changes in the circulation), in disordering the state and secretion of the urinary organs. Whencesoever it arise, so close and frequent is this connexion, that we may always expediently begin the treatment of apparent disorder of the kidneys by full evacuation of the larger intestines; secure that we shall obtain alleviation in this way, if not entire relief. Few of the means especially directed to the urinary organs are so effectual as those which operate upon them through this part of the intestinal canal.
Many pains in the back and loins, which pass vaguely under the names of lumbago and rheumatism, are distinctly to be referred to the same cause. The effect of treatment here is usually the most certain proof; purgatives and injections relieving these symptoms speedily and effectually in some cases, failing in others. The very peculiar pains in the same parts, which attend the whole course of acute dysentery (and which are by no means sufficiently indicated in the common descriptions of this disorder), give further evidence how remarkably the morbid state of these bowels affects the adjoining textures.*
Cramps, and other spasmodic and painful affections of the lower limbs, are a frequent effect of the mechanical distension of different portions of this bowel; perhaps, also, of disordered secretions lodged within or passing through it. Of the latter we obtain proof in the very common concurrence of
* Those physicians who consider that dysentery expresses not so much a state of the intestinal membranes, as a more general disorder of the chylopoietic viscera and of the portal and mesenteric circulation, may find somewhat different explanation of these pains. It is probable, indeed, that they are derived from different sources.