much to change its state after secretion, at the same time that we use means to prevent such abnormal character of secretion from taking place-demulcents are thus used: milk, arrow-root, gum acacia, linseed, or lime-water, chalk, solution of potash, carbonate of soda. At the same time, to diminish inflammatory congestion, other agents are called for, as ipecacuanha, salines— as potash, or soda, magnesia, and some of their salts, or mercurials, antimony, &c. If to correct secretions arising from enfeebled or relaxed state of the membrane, we have vegetable and mineral astringents and tonics, mineral acids, &c.; others stimulate to greater secretion, where it may be deficient, as some irritants, ipecacuanha, salt, capsicum, pepper, &c.

4. Among remedies which act on the muscular movements of the intestine, increasing or diminishing peristaltic action, I may enumerate among the former, the class of purgatives, magnesia, and strychnia; among the latter, conium, opium, henbane.

5. Those which act on the sympathetic nerve, diminishing its sensibility, are chloroform, hydrocyanic acid, opium, bismuth, oxide and nitrate of silver; as tending to increase its sensibility, steel, quinine, vegetable and mineral tonics, alcohol, &c.

These remedies are variously combined in the treatment of disease, sometimes modifying each other in their action, or increasing their efficiency, or enabling the mucous membrane so to tolerate them, that they become absorbed, and act with benefit.

The rules of diet, the administration of proper and suitable food, is one of the most important subjects in diseases of the intestine; as in other visceral diseases we cannot obtain rest of the affected organ, but we can shield it from unnecessary irritation or fresh excitement. These few remarks are sufficient, as to the different structures affected by remedies, and some indication of the principles which should guide us.

It will often be found, that the state of the nervous system modifies the effect of remedies. If a highly sensitive patient, hysterical or hypochondriacal, be led to suppose that a medicine will produce a certain effect, the mind is so directed and influenced, that a powerful action may be produced; or if a patient firmly believe that a particular medicine or treatment will do

him injury, we shall, in all probability, find that the symptoms are described as greatly aggravated thereby, which no persuasion can mitigate. Thus, in a patient who had suffered from hemiplegia, and was in a nervous condition, but who could not be persuaded to discontinue medicine; two table-spoonfuls of spring water were followed by violent purging, and when changed for a pill of bread the same effect was produced; and nothing could induce her to take a second pill. She believed them to be powerfully aperient, and purging took place. Hence a wide field is opened for the charlatan and the quack; while the experienced practitioner often finds, that in many ailments he will in vain prescribe remedial agents unless he acquires the confidence of the patient.

The connexion of one disease with another is a subject of great importance, and of much interest to the practical physician. It is far from frequent to find that a patient has died free from all disease, except the one which has been the immediate cause of death; it is, indeed, the exception to find such a case. It may be; that an acute inflammation of the lungs has led to fatal results, whilst chronic disease may have been going on in the abdomen, the heart, or the brain, perhaps quite independently, but having an important influence on the curative or non-curative condition of the disease: chronic disease creeps along with unobserved step, till some acute affection proves fatal. This relation of disease is worthy of our consideration, in studying the affections of the alimentary canal; and we may find that the diseased conditions arrange themselves in the following manner :—

1. They take place simultaneously in the same body, without any connexion,-mere coincidents.

2. The connexion may be that of different manifestations of the same disease in its progressive action, rather than a really different diseased condition.

3. One disease may have important modifying or predisposing influence upon another.

4. Several organs may be affected simultaneously by one exciting cause.

5. One disease may be antagonistic of another.

6. Other diseases, or abnormal conditions, are conservative the one to the other.

I might enumerate many instances of these associations, in diseases of the nervous system, or of the thoracic viscera, but must content myself with a few illustrations from disease of the abdomen.

1. As coincidents: was that of a patient who had been employed in working lead, and was affected with severe colic. This was partially relieved, but he suddenly had intense collapse, and died with all the symptoms of perforated intestine. We found, on inspection, that there was in the stomach a large chronic ulcer, and at its base a minute perforation, which had extended into the peritoneal cavity. A child affected with chorea was relieved by sulphate of zinc, and was about to go home, when it was seized with severe dysentery during the time that cholera prevailed, and the little patient died in three days. Or again, in a patient who lately died under my care, affected with phthisis, we found a large hydated cyst close to the kidney, in addition to advanced degeneration of the lungs. These diseases could not be looked upon as cause or effect, and are probably correctly regarded as coincidents.

2. As manifestations of the same disease in progressive action, and which ought not to be considered as two but as one. Thus, the sympathetic vomiting which we find in hydrocephalus, or in diseases of the kidney or uterus. The diarrhoea in albuminuria, which follows an anasarcous condition of the mucous membrane, or the constipation in diseased spine; the extension of strumous disease affecting one organ or viscus after another, as of the intestine in phthisis. So again, the severe neuralgic pain in the parietes of the abdomen, simulating colic, but arising from disease of the spine, may be only the early manifestations of the spinal disease, though preceding its more marked indications by several months or years. Numerous instances might be adduced in the progressive symptoms of spinal disease, or of valvular disease of the heart, or of chronic disease of the lungs.

3. One disease predisposing to, or modifying, another. Thus, in affections of the lungs, of the heart, or of the liver, the circulation through the vena porta may become exceedingly impeded, the whole of the mucous membrane engorged and turgid with blood; in this state a slight exciting cause will set up distressing

flatulence and distension of the abdomen; chronic catarrh of the mucous membrane is produced, or hæmorrhage, or ulceration. A patient in incipient phthisis, with tubercles or slight ulceration in the mucous membrane of the intestine, is exposed to cold and wet, to hardship and miasm, and very severe diarrhoea or dysentery is set up; whilst his friend, who has had no such predisposing cause, eseapes, though exposed to the same exciting influence.

The instances which Dr. Budd has deduced, of abscess in the liver following ulceration of some part of the tract of the canal which supplies the vena porta, are also illustrations of one diseased state exciting another; here it does not follow as a necessary sequence, or a continuance of the same diseased action, but a new disease is produced.

Again: a strumous subject, after recovering from typhoid fever, becomes affected with tubercular disease of the intestine. The previous exhaustion has rendered the patient, already of feeble power, subject to another disease; and the typhoid ulceration of the intestine is sufficient to excite the manifestation of its action: these are by no means rare occurences.

A sailor was admitted into Guy's, four years ago, with Asiatic cholera. He died, and in his colon a large circumscribed ulcer was found, about the size of a crown piece, and covered by a slough, with adherent cherry-stones; the presence of such irritation and inflammation in the colon would render him more amenable to an attack of the disease, although it would not produce it.

A young man fell into the Thames, and afterwards was seized with diarrhoea; he was shortly attacked with typhoid fever, and admitted into Guy's. He quickly died; the dysenteric diarrhoea rendered the fever more severe in its character, and perhaps was the immediate cause of the fatal termination.

4. Two diseases sometimes arise from the same exciting cause, or rather two organs become affected: thus, acute inflammation of the colon sometimes comes on with pneumonia. Of these cases we shall speak more fully in our remarks on dysentery.

5. Diseases are in some instances antagonistic. Cancerous disease and struma appear to be in this relation, or it may be

that they are so diverse in their mode of operations that they cannot exist together; an excess of formative action, although quite abnormal, being incapable of existing with a deficiency. We sometimes find in cancerous disease of the abdomen, chronic disease of some of the mesenteric glands, contracted, and calcareous, with old strumous change; such evidently indicates a mode of action which has given place to another of a different kind; and the same kind of deposit is occasionally found in the lung in cancerous disease, which has proved fatal.

6. Disease may be conservative in its character. We have many instances of this in the abdomen. A chronic ulcer of the stomach is prevented oftentimes by adhesions from perforating the peritoneal sac, so that the liver, or the pancreas, forms the base of the ulcer. So again in ulceration of the ileum or colon, in disease of the cœcum, and in gall-stone, adhesions prevent extravasation, or limit it when such takes place. Many instances of this kind might be adduced in which life has been prolonged by these means.

These associations of disease have an important bearing on the correct diagnosis, and still more the prognosis, of disease; they may oftentimes serve to explain its intractable character, as well as the different effect of remedies under apparently similar circumstances, and place us on our guard in making close observation of every sign which presents itself to us, and a strict inquiry into the history of the patient, and the previous ailments to which he may have been subject.