rightly to estimate the course likely to be assumed by any new addition to a state widely diverse from that of health; hence, also, the variety of diseases by which the same organ is affected, the causes are different and so of necessity their effect.

It is the province of medical science, rightly to estimate the effects produced on vital action by any disturbing causes, and to study their almost endless varieties; several general characters lead us to group these effects into classes; and although in this volume we have spoken of diseased action as manifesting itself especially in the alimentary canal in the changes described, and the symptoms depicted, it will be found that these parts are in many cases only affected in common with the whole economy, whilst in others that the special manifestation of morbid action is in the abdomen.

Numerous means are available for checking and modifying diseased action, and we must protest against the ignorance of those who regard the draught of medicine as the only important agent. The skill of the physician is often most manifest in the suggestion of hygienic measures which by many may be assumed as of trifling moment; and whilst it is perfectly true that many morbid conditions cease after a time, or that the frame becomes so accustomed to perverted action that the balance of functions is apparently maintained without cognizance on the part of the patient, still the aid of medical science is most important. The first agents to which we must refer are those which are in constant operation in the maintenance of life-in one state preservative of health, in another the cause of diseaseas the character of the air breathed, whether saturated with moisture, poisoned with miasm, or with the decomposing effluvia of crowded cities, as compared with that found in more elevated situations, on the sea or its coasts, &c.; so also with reference to diet, to light, to clothing, to temperature, to habits of mental or bodily training or exercise; the right use of all these is not less important in the restoration to health, than in the maintenance of it, and in both cases alike, is within the province of medical science.

Too frequently medicine is taxed to obviate the disease whilst its cause is pertinaciously adhered to. It is in vain to recommend to the dyspeptic patient remedies which would certainly mitigate his disease, whilst intense anxiety remains, and hurried, half masticated meals, are taken at irregular hours and without due moderation—or, again, it is useless to direct means to relieve a disturbed brain, whilst excitement is added to excitement, the senses stimulated by light, noise, animated conversation, and active thought-or to give opium to check peritonitis, to quiet muscular movement, when the patient is allowed to move from the recumbent position.

The consideration of the fundamental conditions of life demands strict attention, not only as indicating the tendency vital action has to assume its natural direction, but also in enabling us to use and apply effective means for the removal of morbid processes; and we are at no great loss to understand the intellectual power and acumen of those who, because everything is not known in the pathology and treatment of disease, would contemptuously discard that which is known and established. We deplore the ignorance of those who know not the value of opium in peritonitis, &c., of iodide of potassium in secondary syphilis, of purgatives and mercurials in hepatic engorgement, of preparations of steel in many forms of anæmia, of quinine and arsenic in intermittents; our object is not to confute errors which arise from wilfully closing the eye to light already attained, but to seek to add facts upon which science may safely advance.

We have generally divided the chapters according to the anatomical divisions, rather than in a strictly pathological manner. The first chapter contains many interesting cases of disease of the Esophagus, some of them obscure in their pathology, and very insidious in their origin; some instances of ulceration, perforating the trachea or bronchi, which we have described, have generally, and we believe incorrectly, been considered as instances of cancerous disease. The diseases of the stomach constitute the subject of the next section, and have obtained

rightly to estimate the course likely to be assumed by any new addition to a state widely diverse from that of health; hence, also, the variety of diseases by which the same organ is affected, the causes are different and so of necessity their effect.

It is the province of medical science, rightly to estimate the effects produced on vital action by any disturbing causes, and to study their almost endless varieties; several general characters lead us to group these effects into classes; and although in this volume we have spoken of diseased action as manifesting itself especially in the alimentary canal in the changes described, and the symptoms depicted, it will be found that these parts are in many cases only affected in common with the whole economy, whilst in others that the special manifestation of morbid action is in the abdomen.

Numerous means are available for checking and modifying diseased action, and we must protest against the ignorance of those who regard the draught of medicine as the only important agent. The skill of the physician is often most manifest in the suggestion of hygienic measures which by many may be assumed as of trifling moment; and whilst it is perfectly true that many morbid conditions cease after a time, or that the frame becomes so accustomed to perverted action that the balance of functions is apparently maintained without cognizance on the part of the patient, still the aid of medical science is most important. The first agents to which we must refer are those which are in constant operation in the maintenance of life-in one state preservative of health, in another the cause of diseaseas the character of the air breathed, whether saturated with moisture, poisoned with miasm, or with the decomposing effluvia of crowded cities, as compared with that found in more elevated situations, on the sea or its coasts, &c.; so also with reference to diet, to light, to clothing, to temperature, to habits of mental or bodily training or exercise; the right use of all these is not less important in the restoration to health, than in the maintenance of it, and in both cases alike, is within the province of medical science.

Too frequently medicine is taxed to obviate the disease whilst its cause is pertinaciously adhered to. It is in vain to recommend to the dyspeptic patient remedies which would certainly mitigate his disease, whilst intense anxiety remains, and hurried, half masticated meals, are taken at irregular hours and without due moderation—or, again, it is useless to direct means to relieve a disturbed brain, whilst excitement is added to excitement, the senses stimulated by light, noise, animated conversation, and active thought-or to give opium to check peritonitis, to quiet muscular movement, when the patient is allowed to move from the recumbent position.

The consideration of the fundamental conditions of life demands strict attention, not only as indicating the tendency vital action has to assume its natural direction, but also in enabling us to use and apply effective means for the removal of morbid processes; and we are at no great loss to understand the intellectual power and acumen of those who, because everything is not known in the pathology and treatment of disease, would contemptuously discard that which is known and established. We deplore the ignorance of those who know not the value of opium in peritonitis, &c., of iodide of potassium in secondary syphilis, of purgatives and mercurials in hepatic engorgement, of preparations of steel in many forms of anæmia, of quinine and arsenic in intermittents; our object is not to confute errors which arise from wilfully closing the eye to light already attained, but to seek to add facts upon which science may safely advance.

We have generally divided the chapters according to the anatomical divisions, rather than in a strictly pathological manner. The first chapter contains many interesting cases of disease of the Esophagus, some of them obscure in their pathology, and very insidious in their origin; some instances of ulceration, perforating the trachea or bronchi, which we have described, have generally, and we believe incorrectly, been considered as instances of cancerous disease. The diseases of the stomach constitute the subject of the next section, and have obtained

from authors very considerable attention; we believe that there are forms of ulceration, superficial and evanescent, which leave scarcely more trace in the mucous membrane of the stomach than the aphthous ulceration of the mucous membrane of the mouth, whilst others are permanent, and are manifest after death; and indeed we find the same forms of diseased action in the mouth as in the stomach; thus both are affected by inflammatory congestion, perverted epithelial growth and secretion, sluggish condition of the circulation, acute inflammatory disease, as well as by fibroid and cancerous disease. Ulceration of the stomach is probably a more common condition than is generally supposed, and in many instances yields to judicious treatment; the instances we have adduced show that there are several distinguishing marks by which it may be known from cancer. Fibroid degeneration of the pylorus has generally been considered as of a cancerous nature; and whilst we are unable to remove this almost certainly fatal form of disease, we may, as in cancer, do much to mitigate the symptoms and to prolong life.

In the so-called functional disease of the stomach, chemical rescarch has removed much that was obscure, and will do still more to clear up the pathological changes induced; and the investigation of the physiological connections of the sympathetic nerve and the branches of the semilunar ganglia will enable us more correctly to estimate the very diverse symptoms produced in dyspepsia, many of which have their origin in this source. The right estimate of such symptoms as pain in the region of the stomach and vomiting are most important in the diagnosis, and equally so in the treatment of gastric affections.

The chapter on the Duodenum presents us with instances of disease which closely simulate maladies of the pyloric extremity of the stomach.

The next chapter is on Gastro-Enteritis and Enteritis, discases in which correct diagnosis is very important; in the latter class of diseases especially, life may be easily sacrificed by time being thrown away, and by improper treatment; in the former,