sion of inflammatory action is uncommonly rapid; and if it be not arrested at its commencement, the most decided and appropriate means will subsequently fail. A tendency to spontaneous resolution of inflammatory action ought never to be looked for in the European constitution, in an intertropical climate, and therefore should not be expected to assist in their removal. Functional disorders occasionally operate their own cure, by the increased discharges characterising their progress, or supervening in their advanced stages. But when inflammation is once established in an organ or structure of the body of an European residing in a hot country, unless controlled by very prompt and bold measures, it soon terminates in gangrene, in abscess, in effusion, or in a state of chronic inflammatory action, according to the nature of the part affected, and the habit and temperament of the patient.

When inflammation commences in the mucous surface of the bowels, we should never be induced, by the apparent mildness of the disease, to omit having recourse to very active local depletions. It should always be recollected that, however mild may be the character of the disease, the mucous surface of the bowel, in some part of its extent, may be very actively inflamed; the follicular glands underneath it may also be very seriously diseased, and the disorder may run rapidly into ulceration, without any more acute symptoms making their appearance. Therefore, if the patient complain at all of soreness, heat, or griping pain in the bowels; if the pulse be in any measure affected; if the motions be frequent, scanty, watery, mucous, and morbid in appearance; the tongue excited, white, or loaded; and still more especially if there be abdominal fulness, tension, soreness, sense of heat, which are increased upon a very firm pressure, -a large number of leeches should be immediately placed upon the abdomen. If the patient be at all plethoric, or have been previously in a tolerable state of health, from thirty to forty ounces of blood ought to be abstracted in this manner. When the leeches have entirely ceased to bleed, hot poultices should be applied over the abdomen, and frequently renewed; and twenty grains of calomel, with two grains, or even three, of opium, given immediately, if the leeches have been applied early in the day; but if they have been prescribed in the afternoon or evening, then the exhibition of the calomel and opium may be deferred till the time of repose.

If the more urgent symptoms are not altogether removed at the end of ten or twelve hours from the application of the leeches, the repetition of them will be requisite, but the number which should

be applied will necessarily depend upon circumstances connected with particular cases. If the symptoms are acute, and the abdomen full and tender, then the decided local depletions already mentioned may be ventured upon, especially if the strength of the patient be not much reduced. Hot poultices ought again to be applied, and the calomel and opium given as before.

The great advantages of hot poulticing are, that it tends more than any other remedy, particularly when the poultices are large and frequently renewed, and still more so if the calomel and opium have been given,—to determine the circulation to the surface of the body, to equalise its distribution, and to bring out a copious perspiration.

The practice of prescribing calomel and opium after vascular depletions, has been long adopted in India, and it has been employed with the most beneficial effects, in all cases of inflammatory affections of any of the abdominal viscera. When given after a decided blood-letting, whether general or local, it frequently keeps. down the vascular action nearly to the standard at which it was reduced by the blood-letting. It has also the great advantage of allaying the irritability of the stomach, when this symptom is present, more completely than other remedies; of tranquillising the nervous system, and disposing to sound repose-measures most beneficial in preventing the return of inflammatory action after large depletions; and of changing the morbid character of the secretions, on which the disease so often depends, and fitting them for removal by means of the subsequent administration of purgatives. The advantages of purges and aperients, particularly those which are of a mild and cooling quality, in this particular form of enteritis, are evident they carry off the morbid secretions, and prevent the supervention of ulceration and the progress of the inflammatory action, consequences frequently resulting from the retention of morbid matters in the primæ viæ, in warm climates. Similar advantages to those arising from the use of aperients and purgatives. also proceed from administering aperient and emollient enemata. Medicines exhibited in this latter way prevent accumulations from forming in the cells of the colon, and dissolve and remove them if they be already formed.

In the phlegmonoid form of enteritis, when the inflammation seizes primarily upon the substance of the intestines, or when it commences in, or extends to, the peritoneal coat of the bowel, the vascular depletion should be immediate and most copious. If the patient be plethoric, young, and not reduced by previous disease,

blood-letting from the arm to a considerable extent, followed by local depletion, is indispensably requisite. In these cases, the repeated application of hot poultices over the abdomen, and the exhibition of calomel and opium, as already recommended, should be always resorted to, and be followed by purgatives and cathartic enemata, to carry off offending matters.

During the intervals between the exhibition of those remedies, saline medicines may be prescribed, with a view of promoting perspiration and equalising the circulation: and in order still further to promote this effect, the hot poulticing already noticed may be persevered in for a long time after the local depletion, or a warm bath may be ordered.

If the biliary secretions are of a morbid quality, the calomel and opium, in the full doses recommended, may be repeated until they assume a healthy character, or the mouth becomes affected; for, until a tolerably natural state of the secretions be procured, we cannot expect permanent recovery from the disease.

With regard to the employment of blisters in the inflammatory affections of the bowels, much discretion is required on the part of the practitioner. If they be applied before inflammation is subdued, they either fail of being serviceable, or they tend to aggravate the disease, unless they are so large as to occasion a complete revulsion of the capillary action to the blistered surface,-an effect which they can seldom produce, unless the inflammatory action is slight in degree or small in extent, or has been nearly altogether removed by the previous treatment. When the disease is subdued, or nearly so, the external inflammation produced by blisters frequently seems to prevent the return of the internal disorder: at this period, therefore, of the malady, they should seldom be omitted.

During convalescence from inflammatory affections of the small intestines, the diet of the patient ought to receive great attention. As soon as an appetite returns, it must be indulged in with great caution; and mild broths, and farinaceous articles of diet only, such as arrow-root, sago, &c., be given for some time. The patient ought to wear flannel next his skin, and be very careful not to expose himself to vicissitudes of temperature or to moisture.

The regular action of the bowels is a matter of the greatest consequence in convalescence from this disease, and should be promoted by mild and cooling aperients and laxatives, such as the soluble tartar, manna, the bitter aperient mixture, &c. At the same time the secretions, particularly the biliary secretion, require attention, and should be corrected whenever they betray any morbid

tendency. For this purpose, the patient should take occasionally five or ten grains of blue-pill at bed-time, and have the abdomen sponged with the nitro-muriatic acid lotion, as previously recommended.

In the chronic cases of inflammation of the small intestines, supervening to neglect, or to a treatment which has been insufficiently active, where the state of the intestines, and other appearances, such as described at the conclusion of the foregoing section, are observed, large doses of calomel, given at bed-time, followed by warm aromatic purgatives, and poulticing over the whole abdomen with the nitro-muriatic lotion, have been found most serviceable. Large doses of calomel seem to act in a most appropriate and beneficial manner upon the thick, tenacious matter which seems to obstruct the calibre of the intestines in these cases, dissolving and detaching it from the mucous surface to which it so closely adheres, and thus preparing it for the operation of the purgative which is to follow. It is the combination of the calomel with this morbid secretion, and the admixture of bile with both, which gives the stools the dark or greenish-black, or even the greyish-brown appearance, which they often present in these and similar cases.

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CHAPTER III.

ON THE FUNCTIONAL DISORDERS OF THE LARGE BOWELS.

THE functional disorders of the large bowels are chiefly characterised by a deficient tone or action-by a torpid state of the functions usually performed by the different tissues composing these viscera: and although these disorders often are but little calculated to excite either the attention of the patient or the fears of the practitioner in their early stages, yet they not unfrequently lead to serious consequences, and excite dangerous diseases either of the structures in which they are seated, or of more remote organs.

In the present chapter, I shall first direct the attention of the reader to the morbid accumulations in the large bowels, and afterwards offer a few observations on some of the most important consequences which are induced, either in an immediate or in a remote manner, by this state of functional disorder.

SECT. I.—On Accumulations of Morbid Secretions and Fæcal Matters in the Large Bowels.

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Owing to the form and connexions of the cæcum and colon, matters discharged into them from the small intestines, as well as the secretions poured out from their own internal surface, are liable to be retained for a very considerable time. Even in health, a remora of these matters takes place; indeed the conformation and relative position of the cæcum and colon are such as are evidently intended to retain for a short time the various matters discharged into them, in order that the last act of the process of digestion shall be completed, and until their fæcal contents accumulate in sufficient quantity for removal. When, however, the fæcal matters are retained longer than is requisite for this purpose, morbid accumulations and obstructions supervene, occasioning mischief not only to these viscera themselves, but also to all the organs with which they have any relation.

Amongst the more immediate consequences of an inactive or torpid state of the functions of the cæcum and colon, is the retention