of the treatment; and frequently promoted the operation of these remedies, by directing the injection of a purgative enema a short time after the exhibition of the opening draught. This plan has been generally continued daily until the stools assume a natural appearance, and been varied according as the character of the motions procured by the medicines improved. After three, four, or five days, the stools generally became less morbid; when, instead of the large doses of calomel, alterative doses only were prescribed, generally in combination with aloes, or the aloes and myrrh pill; and the bitter aperient mixture, so as to preserve a free action of the bowels, until the disorder was removed, and the alimentary canal assumed its natural functions.

When this affection is complicated with worms in the alimentary canal, smart cathartics, followed by cathartic enemas, are at first requisite, until the viscid and tenacious sordes in which the worms are usually lodged are removed; after which the treatment recom. mended for worms should be pursued steadily until the functions of the digestive organs are restored, and the countenance and habit of body assume a more healthy appearance. But our attention should not terminate with the attainment of this end. It must be recollected, that the disorder of the alimentary canal, from which the affection under consideration proceeds, is very apt to return, if the actions of this part of the economy be not promoted, from time to time, by the employment of suitable medicines. For this purpose, tonics in combination with aperients should be perscribed, and the regular functions of the bowels attended to on the part of the patient as well as on that of his medical adviser. In this particular description of cases, rhubarb in conjunction with the sulphate of iron and a little powdered ginger, as a corrigent, is extremely beneficial, and, when taken to a sufficient extent to act gently upon the bowels, tends most essentially to prevent the accumulation of morbid secretions and the generation of worms, and to restore the strength of the patient.

I have often resorted to the application of blisters behind the ears and on the temples in this affection; but although benefit has occasionally resulted from the practice, it is to be viewed rather as an auxiliary than as a principal means of cure. If the patient complain of headach, or if there be symptoms of congestion of blood in the head, as indicated by fulness of the countenance, injection of the conjunctiva, weight of the head, or heaviness, &c., leeches should be applied, and efficient purgatives administered.

On Accumulation of Morbid Matters in the Bowels, as a

cause of Nervous and other Ailments.-In the preliminary observations on the subject of fæcal accumulation in the large bowels, I have already pointed out the general outline of the relations which a morbidly distended colon has with the other abdominal viscera ; and I shall now proceed to offer some remarks upon the disturbance which results to the economy in consequence of this state of the large bowels, particularly when it is accompanied with collections of excrementitious matters in its cavity.

When the cæcum and colon are loaded, the functions of adjoining viscera are more or less disturbed, in consequence of the pressure to which they are thereby subjected. The loaded and distended cæcum presses upon the right iliac vessels and nerves; and hence supervene pains of the right limb, and, in the more severe cases, a degree of partial paralysis is superinduced. When the accumulations take place in the sigmoid flexure of the colon, similar phenomena supervene in the left inferior extremity; and if the cæcum and sigmoid flexure of the colon are both loaded, as is not unfrequently the case, the disorder is extended accordingly to the right and left extremities. In addition to these symptoms, patients thus circumstanced frequently complain of pains in the loins, with occasional disorder of the urinary secretion, which is generally of a deeper colour than natural, and either depositing a very thick sediment, or exhibiting a very thick, mucous-like cloud, or both. When the fæcal accumulations are carried to the greatest height, then, in addition to the above ailments, or even independently of them in some cases, an oedematous state of the lower extremities supervenes, with an inability to use them, or at least a difficulty in subjecting them to the least voluntary exertion.

These symptoms are often viewed either as constituting of them. selves the disorder complained of, or as resulting from some other pathological condition than that now assigned. Nor do I deny that they are occasionally dependent upon other causes. I merely wish to point out the causes now under discussion to the practitioner, in order that he may investigate more closely the state and functions of the large bowels, in those cases wherein the above symptoms are present. If he examine carefully the state of the tongue, the appearance of the alvine evacuations, and the size, sensibility, and condition of the abdomen, he will generally be able to form an opinion as to the existence of that pathological state of the large bowels, for the presence of which, in ailments of the above description, I have contended.

To collections of morbid matters, and the consequently loaded

and distended states of the large bowels, attacks of rheumatism and gout are, I believe, often induced, particularly in those who are liable to these diseases, either from hereditary predisposition, previous attacks, or exposure to one or more of the concomitant and exciting causes whence they often spring. That the views thus entertained are correct in respect of these complaints, seems to be proved by the treatment which is found most successful in removing them; for, in the large majority of cases of this nature, it is uniformly found, that they soon yield after the morbid accumulation in the prima via has been carried off by a proper employment of purgative remedies.

But the functions of the lower extremities are not the only functions which are disturbed by collections in the large bowels, and distensions of these viscera. The actions of the liver are generally deranged at the same time with those of the large bowel. Indeed, in many cases the operations of this organ are the first disordered, the biliary secretion being either deficient in quantity, or in its stimulating properties on the bowels; and hence supervenes the torpid and relaxed state of the colon, favouring the formation of accumulations in its cavity. When, however, these accumulations are formed, and more particularly when they occasion any pressure upon the gallbladder, the liver, or their ducts, and especially if they press at the same time upon the duodenum and stomach, or impede the functions of these viscera, the disturbance of the economy becomes more marked, and assumes the form of serious disease. In this manner, various dyspeptic disorders arise, and put on an acute character, not unfrequently being accompanied with slight jaundice, or terminating in this state, owing to the obstruction placed in the way of the flow of bile into the duodenum, as well as to the absorption of the biliary and other secretions during the retention of them in the bowels.

The distensions of the cæcum and colon, whether resulting from the generation of flatus, or from fæcal collections, or, as is most usually the case, from both, when carried to a great height, not only impede the functions of the organs with which these viscera are generally in contact; but also, by displacing, to a certain extent, adjoining organs, disturb their operations, and occasion disorder even of more remote parts. When the abdomen is distended by inflation or fæcal accumulations in the colon, particularly if the transverse arch and superior flexures of the viscus are the seat of disorder, the stomach and liver are pushed against the diaphragm, the descent of this organ is impeded, the liver and stomach are

thereby deranged in their operations, the cavity of the thorax is diminished in capacity, and hence proceed difficult circulation through the lungs, a quickened respiration and circulation, and not unusually a retardation of the return of blood from the head. In this manner various disorders, depending upon the condition of the heart's functions, are either originally produced or subsequently perpetuated; and the return of these ailments is very frequently promoted by the morbid condition of the bowels, now under consideration, acting most probably in the way pointed out. Various functional disturbances of the heart are occasioned in this manner, and the operations of the lungs themselves become also disordered, in those who are disposed, either from hereditary conformation or previous disorder, to derangements of these organs.

The same observations may also be extended to the functions of the brain. It is obvious, if it be admitted that the return of blood from the head may be retarded in the way pointed out, or the circulation in this situation in any other way deranged, that disorder of the functions of the brain and nervous system will supervene, to an extent depending upon the degree to which the original cause is carried, and upon the peculiar constitution and predisposition of the patient. The irritation, also, which accumulations of morbid matters occasion in the prima via is sympathetically propagated to the brain, and hence the more frequent dependence of disorders of the nervous system upon the condition of the alimentary canal. In this manner, attacks of melancholia and hypochondriasis, and even mental alienation, supervene in many instances; and the more usual forms of hysteria, epilepsy, chorea, paralysis, and even apoplexy, seem to be connected with, if not altogether dependant upon, the conditions of the large bowels which I have endeavoured to illustrate in the present chapter. The treatment of these diseases proves the accuracy of those views, inasmuch as it is notorious to every experienced observer, that a regular course of purgative medicines is indispensably necessary for their cure, that the alvine evacuations are generally morbid, and that recovery is seldom complete until they are restored to their healthy condition, whatever means may have been resorted to besides.

CHAPTER IV.

ON DYSENTERY.

In the observations which I shall have to make on this very im. portant and prevaling disease, I shall, first, consider it in its simpler and less complicated forms; next treat of that variety which is characterised by attendant disorder of the liver; and afterwards offer some remarks on the chronic forms of the disease, and on the scorbutic dysentery which is occasionally met with in intertropical practice. I shall then inquire into the organic lesions or consequences which sometimes supervene to repeated attacks of the disease, or to neglected or injudiciously treated cases. In the remarks and illustrations to be offered under each of these heads, the advantage of having an early recourse to active treatment will be most apparent. The practitioner must not be led astray by imaginary distinctions of subordinate varieties of dysentery, or by opinions respecting the non-inflammatory character of one form, or the highly inflammatory condition of another. The mildest and least inflammatory to appearance may rapidly terminate in extensive ulceration, before the practitioner becomes aware of any danger, if the mere acuteness or activity of the symptoms be solely relied upon. In all cases, he should endeavour to ascertain the probable predisposing and exciting causes of the disease, and the particular habits of, and circumstances connected with the patient, as they will serve to throw considerable light upon the pathological condition of the disorder, the kind of means which should be resorted to, and the extent to which they should be carried.

SECT. I.-On Acute Dysentery.

The view I have endeavoured to exhibit of the functional disorders of the large bowels, which depend upon accumulations of morbid secretions and fæcal matters in their cavity, shows in a very remarkable manner one of the very earliest pathological states which gives rise to the form of disease we are now to consider. Collections of excrementitious matters tend very directly to irritate