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with judicious diet, warmth, demulcents, &c., recovery generally takes place. Whilst we strongly recommend, in many of these instances of gastro-enteritis, the avoidance of mercurials, the value of salines, of bicarbonate and chlorate of potash, and carbonate of soda, are well known to those who have carefully watched the effect that has followed their administration.

In the chapter on Strumous Disease of the Intestine and Peritoneum we have sought to show that these diseases are only part of a general perverted nutrition, and that, in many instances, disease in other organs is entirely obscured by the more marked affection of the abdominal viscera; here, also, we should strongly urge the avoidance of mercurial medicines and of drastic purgatives; the lives of many delicate children are sacrificed by worm powders and quack nostrums administered in these diseases.

The next class of cases in Chapter VIII is on diseases of the Cæcum and its Appendix. We have shown that unusual freedom of the cæcal attachments may determine intestinal obstruction from rotatory movements of the intestine; the symptoms and treatment of cæcal distension and of local enteritis are described, as well as the more serious consequences of perforation of the appendix; we have given numerous instances of these forms of affection, and their perusal will show the great similarity in the symptoms and their general course. Dr. Burns, in a valuable paper in the 'Medico-Chirurgical Transactions,' described, several years ago, some of these affections. It would appear that the symptoms of cancerous disease of the cæcum are different from simple cæcal enteritis and perforation; and that in many cases we may discriminate the character of the complaint. It will be found that treatment may do much to relieve and to assist the cure of cæcal disease; the pain demands rest, and it is well after the acute pain has subsided, still to maintain absolute repose for several days. The bowels are often confined, but the use of purgatives generally aggravates the disease without effecting the desired operation; this is better obtained by the application of leeches and by opium; those remedies, which

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 research 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,

with judicious diet, warmth, demulcents, &c., recovery generally takes place. Whilst we strongly recommend, in many of these instances of gastro-enteritis, the avoidance of mercurials, the value of salines, of bicarbonate and chlorate of potash, and carbonate of soda, are well known to those who have carefully watched the effect that has followed their administration.

In the chapter on Strumous Disease of the Intestine and Peritoneum we have sought to show that these discases are only part of a general perverted nutrition, and that, in many instances, disease in other organs is entirely obscured by the more marked affection of the abdominal viscera; here, also, we should strongly urge the avoidance of mercurial medicines and of drastic purgatives; the lives of many delicate children are sacrificed by worm powders and quack nostrums administered in these diseases.

The next class of cases in Chapter VIII is on diseases of the Cæcum and its Appendix. We have shown that unusual freedom of the cæcal attachments may determine intestinal obstruction from rotatory movements of the intestine; the symptoms and treatment of cæcal distension and of local enteritis are described, as well as the more serious consequences of perforation of the appendix; we have given numerous instances of these forms of affection, and their perusal will show the great similarity in the symptoms and their general course. Dr. Burns, in a valuable paper in the 'Medico-Chirurgical Transactions,' described, several years ago, some of these affections. It would appear that the symptoms of cancerous disease of the cæcum are different from simple cæcal enteritis and perforation; and that in many cases we may discriminate the character of the complaint. It will be found that treatment may do much to relieve and to assist the cure of cæcal disease; the pain demands rest, and it is well after the acute pain has subsided, still to maintain absolute repose for several days. The bowels are often confined, but the use of purgatives generally aggravates the disease without effecting the desired operation; this is better obtained by the application of leeches and by opium; those remedies, which

diminish the enteric inflammation lead most speedily to the subsidence of the morbid symptoms.

In the ninth chapter we have pointed out the characters of the several forms of Diarrhoea, but we are well aware that diarrhoea is merely a symptom of very different conditions, and that in many instances it passes almost imperceptibly into dysentery.

Dysentery and Colitis are the subjects of the tenth chapter; and the instances we have adduced show that inflammation of the colon, of a most severe form, arises in our own country. Most of the writers on this subject are those who have observed it in its worst forms abroad or in Ireland. In some of the cases typhoid fever was simulated; in others, perforation of the colon had taken place; in one there was pyæmia and commencing suppuration in the liver; in several chronic cases the secondary effects were shown in producing contraction of the intestine, perforation, and artificial anus, &c.; as regards abscess in the liver, in one case the abscess had dried and contracted; in another, fresh diseased action was set up around it, and abscess in the brain was the result. We must confess, that in some of the most severe forms all treatment is ineffectual to cure, whilst it partially soothes and relieves; but in the great majority of instances means may be used which effectually combat the symptoms of disease.

We had intended to give some observations on Asiatic cholera, but for several reasons have not done so; first, because although the disease manifests itself more apparently in the disturbed functions of the alimentary canal, it has not been clearly shown that the disease is really one affecting alone or even principally the abdomen; and secondly, all the facts known in reference to this disease are better and more clearly given in the report drawn up by Dr. Baly and Dr. Gull.

In the chapter on Typhoid Fever, we have merely described the condition of the abdominal affection, without entering into the general question of fever, and its treatment;—in the latter, it is well to guard against the danger of so freely administering

opiates to check diarrhoea as to lead to cerebral oppression, and excessive engorgement of the lungs, from imperfect performance of the respiratory function.

In the chapter on Colic, we have cursorily spoken of the simpler forms of the disease, and have separated the more severe varieties of ileus-internal strangulation, intussusception, and cancerous disease of the colon-in Chapter XIV. It will be found that whilst the latter conditions bear a strong general resemblance in producing fatal constipation, they may, in many instances, be distinguished, the one from the other; intussusception closely simulates simple colic, but, in not a few instances, is accompanied by discharge of bloody mucus, or with actual diarrhoea; and this latter symptom sometimes arises even with cancerous disease of the sigmoid flexure. We have very strongly urged the avoidance of drastic purgatives, calomel, colocynth, and even milder purgatives, and as strongly recommended the free administration of opium; the cases detailed almost uniformly show that, where purgatives were given, vomiting, pain, and distress, were increased, whilst these and other symptoms were, on the contrary, relieved by opium. Opium, in such cases, appears to be the best means of procuring relief to the bowels, if an action be possible. In the chapter on Worms, we have designedly been very brief in our remarks.

The cases of Suppuration in the Abdominal Parietes, and of Perforation of the Intestine from Without, are an interesting series; many of them are obscure in their diagnosis, and different in their course. Great care is required in watching the symptoms as they become fully developed, and in avoiding the aggravation of them by too active treatment.

The serous membrane of the intestines, the peritoneum, is so intimately connected with the morbid conditions of the alimentary canal, that we have appended some remarks on its diseases. In very many instances the serous membrane is implicated by direct extension of disease; in other cases, the peritoneal change is the expression of a general morbid condition of the whole system.

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