A very observant physician.!
ON THE CŒLIAC AFFECTION.
THE stomach being the digestive organ, labours in digestion, when diarrhœa seizes the patient. Diarrhœa consists in the discharge of undigested food in a fluid state; and if this does not proceed from a slight cause of only one or two days' duration; and if, in addition, the patient's general system be debilitated by atrophy of the body, the Cœliac disease of a chronic nature is formed, from atony of the heat which digests, and refrigeration of the stomach, when the food, indeed, is dissolved in the heat, but the heat does not digest it, nor convert it into its proper chyme, but leaves its work half finished, from inability to complete it; the food then being deprived of this operation, is changed to a state which is bad in colour, smell, and consistence. For its colour is white and without bile; it has an offensive smell, and is flatulent; it is liquid, and wants consistence from not being completely elaborated, and from no part of the digestive process having been
properly done except the commencement.
Wherefore they have flatulence of the stomach, continued eructations, of a bad smell; but if these pass downwards, the bowels rumble, evacuations are flatulent, thick, fluid, or clayey, along with the phantasy, as if a fluid were passing through them; heavy pain of the stomach now and then, as if from a puncture; the patient emaciated and atrophied, pale, feeble, incapable of performing any of his accustomed works. But if he attempt to walk, the limbs fail; the veins in the temples are prominent, for owing to wasting, the temples are hollow; but also over all the body the veins are enlarged, for not only does the disease not digest properly, but it does not even distribute that portion in which the digestion had commenced for the support of the body; it appears to me, therefore, to be an affection, not only of the digestion, but also of the distribution.
But if the disease be on the increase, it carries back the matters from the general system to the belly, when there is wasting of the constitution; the patients are parched in the mouth, surface dry and devoid of sweat, stomach sometimes as if burnt up with a coal, and sometimes as if congealed with ice. Sometimes also, along with the last scybala, there flows bright, pure, unmixed blood, so as to make it appear that the mouth of a vein has been opened; for the acrid discharge corrodes the veins. It is a very protracted and intractable illness; for, even when it would seem to have ceased, it relapses again without any obvious cause, and comes back upon even a slight mistake. Now, therefore, it returns periodically.
This illness is familiar to old persons, and to women rather than to men. Children are subject to continued diarrhœa, from an ephemeral intemperance of food; but in their case the disease is not seated in the cavity of the stomach. Summer engenders the disease more than any other of the seasons; autumn next; and the coldest season, winter, also, if the heat be almost extinguished. This affection, dysentery and lientery, sometimes are engendered by a chronic disease. But, likewise, a copious draught of cold water has sometimes given rise to this disease.