suffers, in addition, bearing-down of the womb, irritation of the bladder, pain in making water, incontinence of urine. The difficulty and occasional obstruction of the passage of fæces produce fits of distension and of general pain and tenderness of the abdomen, accompanied with hiccup and vomiting.

The situation of cancer of the rectum depends, in some degree, upon its kind.

That which is without thickening generally commences half an inch or an inch within the anus, and from this point occupies from two or three inches to thirteen or fourteen. Sometimes, but very rarely, the hardness and ulceration commence quite at the orifice.

Cancer with thickening is commonly situated two or three inches from the anus; or here is the lower edge of the mass of disease, which may thence extend to two, three, or five or six inches of the intestine; generally it occupies about three or four inches of the bowel, and involves its entire circumference. Sometimes even to the close it is much more circumscribed, and occupies a small part only of one side of the bowel.

The severity of suffering in cancer of the rectum bears no proportion to the quantity of bowel implicated in it. There are two ways in which the disease proves fatal. In general the patient consumes gradually, worn out by long-continued suf

fering. In other instances the disease produces complete obstruction of the bowels, and the patient perishes more quickly. This form of the malady is attended with the severest distress. Complete obstruction of the bowels rarely occurs except in cases where there is a large mass of gristly substance in the intestine. But I have known the disease terminate in fatal obstruction, and with the most aggravated suffering, when the mass occupied no more than the last three inches of the rectum.

The treatment to be pursued in carcinoma of the rectum is the following.

The pain is to be allayed by opiates. Solid opium, laudanum, the acetate and muriate of morphia, the extract of stramonium, are each in their turn available. Opiates act more promptly and efficaciously in this disease when taken into the stomach, than when applied in injections or as suppositories. If administered in the latter form, the subacetate of lead may be advantageously combined with them.

The bowels in the early stages of the complaint should be regularly relieved. In general a drachm of the lenitive electuary taken over-night, with an injection of tepid water the following morning, will be sufficient for this purpose. A few drops of laudanum may be taken, if necessary, immediately after the action of the bowels.

The canal of the bowel is to be dilated with a

bougie, if it is so narrowed by the disease as to obstruct materially the passage of the fæces.

Towards the fatal period of the worst cases, when the canal is much obstructed, it is sometimes found of great relief to introduce a long flexible tube past the cancer, and by its means to break down, softening at the same time by water injected through it, the fæces that have accumulated above.

It sometimes happens that the disease is situated at the orifice of the intestine. In this case it admits of removal by a surgical operation. I have performed this operation three times. In one, in which I removed nearly two inches of the rectum, the patient lived two years, and died of an illness not directly connected with the original disease, which had, however, re-appeared. In the second, the patient did not recover from the operation, but died in about five weeks. In the third, in which the ulcerative disease did not occupy more than a square inch of one side of the extremity of the intestine, the patient recovered, and continues in good health at the present time.

Cancer of the rectum occasionally assumes the character of polypus; and a pendulous growth is forced down whenever the bowels act. Such a tumour has no sensibility, and had better be removed by ligature. In a case of this kind, which was under my care some years ago, the polypus

was thus taken away very much to the comfort of the patient. The pendulous growth was not reproduced, but a mass of indurated substance formed upon the fore-part of the bowel within the anus. Part of this I likewise removed by ligature, but the fungus again increased, and the complaint ended fatally.

THE PHILOSOPHY OF LIVING.

"For though we Christians do continually aspire and pant after the Land of Promise; yet it will be a token of God's favour towards us, in our journeyings through the world's wilderness, to have our shoes and garments (I mean those of our frail bodies) little worn or impaired.”—Bacon.

OUTLINES OF PHYSIOLOGY.

FOURTH EDITION, 1837.

"The information contained in the present volume is at the same time so complete, so much condensed, and so clearly arranged, that we conceive it ought to be in the hands of every student of physiology, and of every one who wishes to obtain a just view of the structure of the human frame, the uses of its various organs, and the nature of animal bodies generally."Edinburgh Medical Review, July, 1834.

OUTLINES OF PATHOLOGY.

"In barely more than a page we find condensed nearly all that is certainly known of the pathology of dropsy. We cannot forego the pleasure of presenting our readers with this passage," &c.

“ Cases are related illustrating distinctions in the anatomical appearances of cancer, to which succeeds an excellent account of the progress of that disease in the breast. The remarks upon an important practical question are very judicious.”

"We cannot afford space for noticing the diseases of joints, the description of which, as of other subjects of surgical pathology, the author conducts with even more than usual ability."Forbes's Medical Review, January, 1837.