As a general observation, it is certain that a disposition to costiveness goes with physical strength. And this is easily accounted for; there is so much the less drain upon the system. But there are instances in which costiveness is associated with weakness; yet in which it is not only salutary and natural, but irremediable. In these cases, the suppression of alvine discharge depends upon organic feebleness of the bowels; which instead of having their proper strength and fabric, are, as it is found upon dissection, thin and structurally weak.

I attended a young person, a few months before her death, for what her friends were obstinate in supposing obstruction from local disease of the lower bowel. A year before, she had had scarlet fever, which left her debilitated, and liable to an occasional spasmodic difficulty of swallowing. She was very tall, thin, and extenuated, and weak; food went against her, so that she took scarcely any; once in a week or ten days, she passed a minute quantity of dark green fæces. Dr. Merriman afterwards saw this patient. She died, after having gradually wasted to the utmost degree of emaciation. On the inspection of the body, no appearance of disease was found, but the intestines were remarkably thin.

The following case exemplifies similar features, namely, irremediable inability of the bowels to secrete, united with general weakness of the frame,

not leading, however, as in the former instance, to a fatal atrophy, but allowing a permanent state of subdued health and strength, varied from time to time with alarming indisposition, of which the source is the suppressed intestinal function.

I was requested to see a young medical man, who, I heard, was in a fit. I found him lying on the floor, sensible, but exhausted with suffering; the flexor muscles of the limbs, and the muscles of the abdomen, were in strong spasmodic action. He had been in this state for several hours. Ammonia, and hot brandy and water were given him, and he gradually rallied. This, I learnt, was not the first seizure of the kind which he had experienced. Attacks of a similar description, but of less severity, would come on several times in the year; they were preceded by obstinate costiveness. This patient, now twenty-eight years of age, up to the age of fifteen, enjoyed excellent health. At that age, his bowels fell into the state of costiveness, which has continued since. He grew up of a slight and delicate frame, physically incapable of much bodily exertion, and indisposed to it by a languor and drowsiness which probably arose from the imperfect action of the bowels. The bowels now act once in five or six days only; what is then passed is healthy; it is only extraordinarily deficient in quantity. With this he has little appetite; and even that he is afraid of indulging, lest it should

lead to one of the attacks which I have described. These attacks, it has been mentioned, occur when the bowels have been confined for an unusually long period. The belly then becomes hard, and a little swollen; there is sickness, but nothing is thrown up but what has recently been taken into the stomach. There is a sense of uneasiness and pain above the navel. When at the close of such an attack, the bowels are relieved, the motions which pass are still extremely scanty.

There are other cases, equally rare with those which I have now cited, but of greater interest on account of the probable recovery of the patient, in which costiveness occurs in connexion with weakness and want of nutrition, from functional, and temporary, yet salutary inactivity of the bowels. The patient, either after illness, or without anything to lead to it, falls into a state of declining strength, yet no evidence of inward disease can be detected. The bowels, however, are habitually confined, and the motions scanty and insufficient. In cases of this description, the prescriptive practice is to combine invigorating diet and tonics with aperient medicine. The patient, however, instead of thriving upon this system, is liable to become weaker; but recovers when the bowels are left to themselves, and nature is allowed to recruit herself in her own way.

Ordinary cases of constipation, those in which

the affection is prejudicial to health, and require to be remedied by medical interference, differ among each other, as they depend or not upon an assignable cause, in the extent to which they derange the health, in their specially affecting this or that function, as they amount to complete or incomplete suppression of secretion, as they bear a chronic form, or threaten the invasion of acute disease, as they occur in infancy and youth, in middle life, in age.

The commonest form of constipation is that which results from inattention to regular times of relieving the bowels. Men of literary pursuits are naturally more prone to this error of selfmanagement than practical men. All the personal habits of the latter are necessarily more methodical. So every variety of general and local disorder of the stomach and bowels is more prevalent among the former. When costiveness proceeds from this cause in persons who live temperately, and take sufficient exercise, its usual consequences are one or other of the local affections of the lower bowels, which will be afterwards treated of.

A common source of costiveness is neglect of exercise. The circulation, in such cases, becomes loaded, the bowels torpid, the tongue furred, the appetite impaired, the patient suffers depression of spirits, a clouded intellect, headach, habitual drowsiness and heaviness, and indisposition to exertion.

Want of bile is a frequent source of costiveness. This itself may proceed from neglect of exercise. But there are persons to whom disorder of the liver is the certain result of any departure from wholesome habits; of these, some, which I have already exemplified, suffer by profuse biliary secretion; others by deficiency of bile. In the latter case, the motions are clay-coloured, adhesive, and the bowels sluggish and inactive from want of the stimulus the bile affords.

Those who have resided long in hot climates are liable to costiveness from deranged biliary secretion. They experience languor, depression, uncertain spirits, uncertain appetite and digestion, joined with a furred and white tongue, uneasiness about the belly, flatulence, irregular bowels, with evacuations always scanty, sometimes firm and clayey, at other times loose, and like pitch. Nothing can be more uncertain than their state of health. When the weather is dry, and not too cold, they are often perfectly well, their spirits cheerful, their digestion good; on the same occasions, their bowels act wholesomely. But in damp weather, especially combined with cold, they rise in the morning unrefreshed, depressed in mind, without appetite, with a sense of weight, pain, and uneasiness about the belly, sometimes with nausea, the bowels deranged as abovementioned. After dinner, the system is temporarily recruited; the next day, the