the fever would be liable to be heightened by the remedies before prescribed.

Rest in bed, and entire abstinence from food, are the first remedies, and essential; with this an effervescing saline draught, with five grains of carbonate of soda in excess, and three grains of Dover's powder, to be repeated every four hours; often, two grains of blue-pill twice a day are a judicious addition to this treatment.

That form of diarrhoea which is characterized by the absence of bile is known by the white clayey appearance of the first semifluid motions, and the appearance, like chalk and water, of those which follow; the motions have likewise a peculiar and offensive fœtor. The appropriate remedy for this attack, in addition to rest and abstinence, is mercury with opium. Three grains of blue-pill, or of chalk and mercury, with seven grains of opiate confection, made into two pills, to be taken every three hours, will at once control the excessive secretion, and bring back in a few hours the deficient flow of bile.

When looseness, which has commenced in either of the modes described, persists, what is principally to be apprehended is, ulceration of the mucous lining of the bowels. In the obstinate purging of certain fevers, of the last stages of consumption, in protracted dysentery, this change of structure is invariably present; and it is liable to occur in

such cases as I am now considering. The reme dies which are now appropriate are the strong mineral astringents, lunar caustic, or blue vitriol; of either of which half a grain, with a like quantity of opium, should be taken twice or three times a day. Of the two, the former is perhaps preferable; of the efficacy of which I happened very lately to see a notable instance in an old Frenchman of broken constitution, who was in the Middlesex Hospital for local sloughing, when diarrhoea supervened, that resisted every other

means.

The indigenous cholera of this country is characterized by purging of bile, frequently accompanied with vomiting of bile, cramps of the legs and belly, and considerable depression of strength. The things to be done are, to abstain from food, from mercury, and aperient medicine; to calm the stomach by perfect bodily stillness, by small quantities (half a wine-glass) of soda-water, with eight or ten drops of laudanum in it, given in the intervals of vomiting, by an opiate liniment or plaister applied over the stomach; the only object is to tranquillize. When there is great depression, æther, ammonia, and brandy are necessary,-often at the commencement of the attack.

I will conclude this section with some remarks on the treatment of Asiatic cholera, of which malady the following are the symptoms; after

diarrhoea, or sometimes no premonitory symptoms having occurred, sudden vomiting of the contents of the stomach without nausea, and sudden purging without pain; the vomiting and purging frequently recurring, the liquid discharged being like rice-water or gruel. With this, spasms of the muscles of the extremities and belly. In a short time, from one to three or four hours, col lapse supervenes; urine is not secreted; the pulse is extinguished; the eyes are sunk; the eyelids are surrounded by a dark circle; the voice is hardly audible; the tongue is cold; the skin cold and passively shrunk, with a dirty look, or livid and blueish, particularly on the extremities; cramps of the limbs constant; the vomiting and purging cease, and life.

In this tremendous malady, everything that has hitherto been extensively tried, appears to have failed. And the general disposition of medical practitioners is to fall back upon that which may be considered the rational treatment of the disease, namely, repeated doses of calomel and opium; calomel to excite bile, opium to allay the heightened irritability of the intestines. The saline treatment which Dr. Stevens introduced is scientific, but has proved nugatory; and the injection of hot salt and water in the veins (however wonderful in its temporary effects,) has not been successful enough to authorize much reliance on this danger

ous experiment upon the living œconomy. But there are other remedies, which however little they promise, certainly deserve to be more fully investigated. These are, lunar caustic with opium, oil of croton, cold affusions; the two first to stimulate the stomach and intestines to healthy action, the third to excite general reaction. It is obvious that these remedies should be tried separately. Some partial success, which each of these means has had, furnishes sufficient ground for recommending their further trial. It is probable, however, that in its worst forms, the appalling antithesis which Magendie used in describing Asiatic cholera, conveys no exaggeration: "It begins," said he," where other diseases end-in DEATH."

SECTION II.-CONSTIPATION OF THE BOWELS.

By constipation is meant, deficient action of the bowels, in consequence either of suppression or diminution of the alvine secretions, or of sluggishness of the muscular structure of the intestinal tube, or of both these causes united.

With most persons the bowels are usually relieved once a day, either on rising or after breakfast, the impulse to this function being increased pressure on the lower bowels through the change of posture on getting up, or through the distension of the stomach by the first meal. But as there

are some whose bowels are naturally disposed to act more than once in the twenty-four hours, so are there others to whom nature suggests one motion only in two or three days, or even at longer intervals. These peculiarities of constitution have to be carefully distinguished from the results of bad management of, or inattention to the right performance of the excretory function. For it would be not less injurious to health, though in a different manner, to force one of naturally slow bowels to daily evacuations, than to allow a person with the usual tendencies this way to pass several days without the natural relief.

There are circumstances, again, that produce temporary constipation, which cannot be considered unhealthy. After purging, whether from medicine or otherwise, the bowels are usually confined for a day or two; nor is it necessary to take means to obviate this. In travelling, costiveness is commonly experienced; here, however, it is often connected with a slight disposition towards feverishness; it is, therefore, prudent, when on a journey, to be moderate in diet. With many a sea-voyage produces continued constipation of the bowels, which is not found inconsistent with perfect health. Violent exercise again, especially if systematically continued, as in training, has an effect of the same kind; in the latter case, the superfluities of the body are carried off by another channel.