ADVERTISEMENT.

IN bringing out a second edition of my work on Diseases of the Alimentary Canal, I have been encouraged by the favorable manner in which the first edition has been received by the profession. Much care has been given in thoroughly revising each portion of the work; and important additions have been made, not only in numerous interesting cases still further illustrating the phases of disease, but large sections have been added to the text. My former suggestion of opening the stomach as a means of sustaining life in obstruction of the sophagus has been attempted; and the result is recorded, as warranting the repetition of the operation at an earlier period of the complaint. The functional, as well as the organic diseases of the stomach have received fresh elucidation, and prominent symptoms have been presented in their relative significance. The morbid affections of the cæcum, and obstructive disease of the intestines have been enlarged upon; and a chapter on Peritonitis has also been appended to the work.

PREFACE.

DISEASES of the Stomach have, during the last few years, received considerable attention, and our medical literature has been enriched by the labours of Budd, Handfield Jones, Chambers, Brinton, and others. Much, however, still remains to be done; and whilst some of the facts contained in the present volume will tend to confirm what is already known, other new ones will be found, which, we trust, will repay an attentive perusal of its pages.

The design in this work has been to illustrate the diseases treated upon, by cases which have come under our personal observation, with a few remarks upon them, and some general deductions. During the period of our curatorship of the Museum at Guy's, and of our demonstratorship of Morbid Anatomy for several years, very numerous opportunities were presented of noticing diseases of the stomach and intestines in their varied phases; and we would tender sincere thanks to those of our colleagues who have permitted the mention of instances under their care. Although we have sought definitely to distinguish some classes of diseased conditions, we should be very unwilling to regard them as entities superadded to the human frame, but rather, to quote the words of Sir John Forbes, "as new phases of vital manifestations."

Life may be considered as the resultant of certain forces, manifested in the performance of functions, which are combined harmoniously for one purpose; it has received varied appellations, each indicative of our inability to discover its real character; thus, we have had vital force, power of growth, nutrition,

development, organization, nature, &c., each new observer considering himself more clear-sighted than his predecessor, although he has merely substituted one term for another. This living force is in close correlative relation with other physical forces, and the fuller investigations of physiological science show that the same forces are in operation, namely, gravitation, chemical action, &c., in the living organism, as external to it; modified, it is true, by another force, namely, life. And as in the science of physics generally, so in the study of living phenomena, we must ever bear in mind that a like cause always produces a like effect. Vague observation, and the superficial remarks of some writers, would lead us to suppose, that, in living phenomena, the same cause is followed, at first by one effect, then by another; interpreting fixed realities by prejudice rather than by reason.

Some phraseology is necessary to express our meaning and ideas, and one great difficulty is overcome, if we can understand that the same words convey to each the same thought. It may be convenient, as we have mentioned, to regard life as the resultant of certain forces, and disease as a deviation from the normal direction. If any of the forces which are in natural operation be modified in intensity, a deviation is the result, and diseased action is produced, the resultant being necessarily changed; still the tendency is such that, on the withdrawal of the modifying force, the normal course is reassumed. Not only may it be natural force which has led to this departure from the healthy state, but new force may be added, as much as when the earth in its orbit is disturbed by the attraction of some other celestial body.

In diseases, many sources of change arise-modifying forcesthus syphilitic or miasmatic poison, small-pox, &c., alter the character of every function; new substance is added as much as in the voltaic battery, when the fluid in one or other cell may be changed by the admixture of any substance; this may be merely of the kind already existing, or a foreign body; in any case, the phenomena--the same in general development-are modified.

Such, to some extent, is the case in pathological changes. These changes, produced by perverted nutrition, or altered vital forces, are in many instances of such a character, that no examination of the structure itself could discern the state which had been produced; as fruitless would it be to search in the nerve of a limb for the altered force which had led to spasm, as to expect to find a telegraphic message by a microscopical examination of the wire, although the structure of both had been transiently modified by the disturbance of the forces they transmitted. If the character of the disturbance in disease is one, which, like a polar force, reverts to its former condition, no trace can be found on inspection, but, in many instances, obvious structural modifications are the result.

Diseased action, however, as generally manifested, is the resultant, not of one, but of several changes in the normal condition, and very few persons are literally in perfect health. The living forces are modified by hereditary tendency, as struma; to this, perhaps, is added syphilis, to that miasm; still further sudden changes of temperature, improper supply of nourishment, of heat, and light; each of these may act as fresh sources of deviation from the normal healthy direction of living action, superadded to the resultant produced by the previous combination.

Some have supposed that acute disease quickly passes off, and that with the subsidence of the more marked symptoms no trace is left behind, but very generally this is not the case; the attentive study of pathology will soon convince us of the contrary; new exciting causes of disease arise, perhaps of a different character, but the resultant (to revert to the previous phraseology of forces) is not precisely the same, the former diseased state acts as a modifying force. This course may be often repeated, and if the changes have been such as to entail discomfort or weakness, chronic disease is said to exist; but if without these, the patient generally passes for one in sound health. It is the acumen of the practical physician that detects the traces of previous morbid action, and he alone knows how