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 connexions of the sympathetic nerve and the branches of the semilunar ganglia will enable us more correctly to estimate the very varied symptoms produced in dyspepsia, many of which have their origin in this source.

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

The next chapter is on Gastro-Enteritis and Enteritis, diseases in which correct diagnosis is very important; in the latter class of disease especially life may be easily sacrificed by time 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 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 very many instances of cæcal distension and of local enteritis arise, as well as the more serious class consequent on 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

ulceration, perforating the trachea or bronchi, which we have described, have generally, and we believe incorrectly, been considered as instances of cancerous disease. The forms of disease of the stomach, the subject of the next section, 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 show themselves after death; and that in some respects we find the same forms of diseased action in the mouth as in the stomach; the inflammatory congestion, perverted epithelial growth and secretion, sluggish condition of the circulation, or acute inflammatory disease, as stomatitis, as well as 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 pyloris 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. During the time that this work has been in the press, the investigations of Dr. Murchison on gastro-colic fistula have been published, and we are indebted to him for them; he has shown, by extensive research, the pathology of these cases by collecting the experience of numerous observers. In the two or three cases that have come under our own observation, it has appeared that cancerous growth in the stomach had led to adhesion with the omentum, or colon, or both, that new product has become effused, and the mucous membrane of the colon infiltrated, and the perforation taken place from the disintegration of this secondary product, rather than by direct perforation from the part primarily affected; this appeared to be the reason, in the case we have recorded, that no fæcal vomiting took place.

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tro-Enteritis and Enteritis, diseases very important; in the latter class be easily sacrificed by time thrown ent; in the former, with judicious c., recovery generally takes place. nd, in many of these instances of of mercurials, the value of salines, f potash, and carbonate of soda, are e carefully watched the effect that tion.

s Disease of the Intestine and Perishow that these are only part of n, and that, in many instances, irely obscured by the more marked cera; here, also, we should strongly ial medicines and of drastic purgaate children are sacrificed by worm administered in these diseases. Chapter VIII. is on diseases of the We have shown that very many and of local enteritis arise, as well consequent on perforation of the merous instances of these forms of ill show the great similarity in the course. Dr. Burns, in a valuable ical Transactions, described, several

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ulceration, perforating the trachea or bronchi, which we have described, have generally, and we believe incorrectly, been considered as instances of cancerous disease. The forms of disease of the stomach, the subject of the next section, 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 show themselves after death; and that in some respects we find the same forms of diseased action in the mouth as in the stomach; the inflammatory congestion, perverted epithelial growth and secretion, sluggish condition of the circulation, or acute inflammatory disease, as stomatitis, as well as 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 pyloris 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. During the time that this work has been in the press, the investigations of Dr. Murchison on gastro-colic fistula have been published, and we are indebted to him for them; he has shown, by extensive research, the pathology of these cases by collecting the experience of numerous observers. In the two or three cases that have come under our own observation, it has appeared that cancerous growth in the stomach had led to adhesion with the omentum, or colon, or both, that new product has become effused, and the mucous membrane of the colon infiltrated, and the perforation taken place from the disintegration of this secondary product, rather than by direct perforation from the part primarily affected; this appeared to be the reason, in the case we have recorded, that no fæcal vomiting took place.

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 connexions of the sympathetic nerve and the branches of the semilunar ganglia will enable us more correctly to estimate the very varied symptoms produced in dyspepsia, many of which have their origin in this source.

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

The next chapter is on Gastro-Enteritis and Enteritis, diseases in which correct diagnosis is very important; in the latter class of disease especially life may be easily sacrificed by time 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 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 very many instances of cæcal distension and of local enteritis arise, as well as the more serious class consequent on 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