over a teaspoonful given at hour intervals. I have found this answer better than the old plan of administering calomel. In teething infants this treatment is of the most marked utility. I suppose the anodyne soothes their neuralgia. In their case too lancing the gums will sometimes stop a most violent diarrhoea where the stools show evident proofs of the inflammatory condition of the ilia. The action of the lancing is probably much the same as that of leeches, viz., a relief to the congestion of the mucous membrane. Upon the protrusion of the teeth it can hardly be supposed to have any influence, but that it alleviates toothache any adult can experience on himself, though it is impossible to get from his little patients an account of this remedial effect.

But there is no doubt that the most active cure in infantile diarrhoea is change of diet. Bringing up by hand or unwholesome states of the breast-milk are generally at the bottom of the ailment. No remedy is equal to a healthy wet-nurse, or where prejudice forbids that, as near an imitation as can be made of human milk by that of animals, such as the donkey's, or the cow's diluted and slightly sweetened.

In low fever the presence of diarrhoea indicates to many practitioners, and used to indicate to many more, the employment of mercury. The effect of this is the increase of solid sedimentary matter in the stools; in other words, a restoration of the destructive assimilation going on in the body. The motions are diminished in number and in fluidity, but not in actual quantity. In fact more solid effete matter is excreted, and thus the tissues devitalized by the typhoid poison are removed, and room is made for new nutriment. This increase of solid matter is taken as an evidence and test of benefit accruing from the use of mercury, and as a prognosis of good. But I must say without reserve (and am glad of the opportunity of so doing) that I think this an unwise hurrying of nature; for only the destructive assimilation is augmented, not the constructive, and thus the powers of the body and its resistance are lowered. Now the use of mineral acids both stops the diarrhoea and increases at the same time the absorption in the intestinal canal. For some years therefore I have employed no other remedy in low fever, and with singular success,

as

I have more largely set forth in my published Clinical Lectures.'

Where, in the absence of fever, blood is passed by the bowels, the two most powerful means of checking it I have found to be turpentine and acetate of lead, especially the latter. Its direct influence as a poison on the bowels would have led to an expectation of this. If the hæmorrhage has gone on for some time, I am inclined to think it must be sometimes due to a clot distending the bowel, and preventing it contracting upon the bleeding spot, for certainly a dose of castor-oil, in the results of whose action a quantity of pale clots were exhibited, has several times in my experience stopped bleeding.

Diarrhoea from ulceration of the ilia tends to prolong itself; for the weaker the system is, the more irritable are the sore places, and the less can the morbid actions they set up be resisted. It is wrong, therefore, to let it go on an hour longer than we can help. The readiest means for arresting it are such as blunt the sensibility of the ulcerated spots. Milk-and-limewater diet should be used first, then chalk and opium, which appear to act on the sore mucous membrane just as they do on a raw blistered surface of skin. If these fail, sulphate of copper should be used in doses increased from a quarter of a grain up to two grains.

Where there is a simple flux of transparent mucus without fever or pain on pressure, and no fibrine or blood in the motions, the vegetable astringents, such as logwood, bark, kino, and tannin, are often of great use. In such cases, too, I have prescribed iron with seeming benefit. I must, however, say, that I feel doubtful in the greater number of cases whether this form of flux be not due rather to the colon than to the ilia.

Where the solid matter is pale, fetid, and consists mainly of undigested food, inspissated bile may be given with benefit; the stools become less fetid and less frequent under its employment. This is particularly the case in children whose mesenteric glands are diseased. Pepsine also diminishes the fetor of the motions in the best way-namely, by promoting the normal solution of the food, and acting as a direct restorative.

Acid diarrhoea indicates the free employment of chalk.

The use of opiates in diarrhoea must never be made a matter

of routine. As a general rule, I have found them beneficial without consequent harm in cases where there was tenesmus and frequent stools; but where the fæces are bulky and copious they appear to impede the natural secretion. Where the stools also are putrid, caution is required in their use. In the diarrhoea which so often accompanies and proves fatal in uræmia, they check the debilitating flux, but they are apt to bring on

coma.

In some cases of diarrhoea from chronic mucous flux of the intestines, without ulceration or acute inflammation, I have known horse exercise to be serviceable. I suppose it is the gentle agitation of the abdomen, combined with the air and amusement, that proves of use.

In recommending the recreation of travelling to invalids subject to diarrhoea, you must be very careful of the route you select. The epidemic influence of cholera which has overspread Europe during the present generation, visiting almost every square mile of its surface several times during the last few years, has in many places left behind it a chronic endemic poison. The natives are insensible to it, but few strangers escape becoming affected more or less, according to their idiosyncrasies. Strong persons find it only an inconvenience, but an invalid is put in some danger, and certainly loses all the advantage of the tour. This is especially the case in the mountainous districts of the south of France, the Pyrenees, and Dauphiny, and in the volcanic regions bordering the Rhine, the Eifel and Moselle country, as well as those in the centre of France, the ancient province of Auvergne. All these places are attractive from their picturesque beauties, and therefore it is necessary that travellers should be warned of this evil attendant upon choosing them as the scene of a tour. It must not be supposed that this diarrhoea is solely the result of the foreign modes of cooking. I have known English biscuits and porter, and boiled eggs, adopted as a diet without relief, though of course nothing foreign could have got into them. I believe the cause to be as I have represented it—namely, a poison left endemic since the passage of cholera through the country, but to which the natives have become acclimatised. That it is of late years only that this diarrhoea has been prevalent is shown both by local report and

the omission of all mention of it from the well-known work on 'Climate,' by Sir James Clark.

One source from which strangers contract this diarrhoea is an evil capable of, and loudly calls for amendment: I refer to the filthy privies in continental inns. A gentleman, eminent in his profession and of good judgment, told me that, during a Pyrenean tour he entirely escaped the diarrhoea which everybody else without exception suffered from, by adhering to a strict rule of never entering one of these disgusting holes, but worshipping Cloacina under the pure light of the stars. Invalids and ladies cannot so well manage this, unless they are rich enough to travel with carriages and servants and locomotive water-closets.

In Italy I have found that the best remedy for the diarrhoea which so often attacks travellers from over-fatigue in summer and autumn, is lemon-juice and the horizontal posture. Lying down for a couple of hours on the back, and drinking two or three glasses of strong lemonade, with very little sugar, generally stops it. If that is not successful, opium must be had recourse to; but it is seldom required in that land of lemons.

CHAPTER VIII.

CONSTIPATION AND COSTIVENESS.

Definitions.-SECTION 1.-CONSTIPATION.-From mechanical obstruction-Nervous exaggeration of the sphincters-Catarrh -Atony of colon-Insoluble articles of diet-Remedies. SECTION 2.-COSTIVENESS.-From deficient excretive life— Quality of stools-Occasionally interchanged with Diarrhea -What diseases it accompanies-Effect on nervous systemIndications of treatment- Inconveniences of purgatives—What sort of purgatives are to be adopted-Dietary-WaterWatering places-Cautions respecting the use of them— Hydropathy.

THE words which head this chapter are sometimes employed as synonymous; but I do not wish them so to be understood here. By the former I would imply injury to the health from the quantity of fæces retained in the alimentary canal; by the latter a deficiency in the quantity expelled by reason of a deficiency in the quantity formed.

SECTION I.

Constipation.

The expulsive power is relatively or absolutely in defaultthe fæces, normal or abnormal in quality, collect in some part of the bowels, and give proof of that collection by being occasionally passed in considerable quantities at a time. In the stools there are portions drier than the general mass-scybala