upon the system. It may then be repeated at intervals of one or two hours, a great many times, if the case do not speedily yield; and, with the precautions now mentioned, I have never seen any unpleasant effect from the free use of this powerful remedy.

If, while the tobacco injection is used in this manner, mild purgatives, such as aloes and hyosciamus, are repeated in full doses, every hour or two, the treatment is perhaps that which is most generally adapted to the ordinary cases of ileus; with the assistance of one or two bleedings, especially if the patient should be of a full habit, if the pulse should be rising, or if there should be fixed pain or tenderness on any part of the abdomen.

(3.) The application of cold;-I have repeatedly employed the method so often recommended, of raising the patient into a standing posture and dashing cold water about his legs, but I cannot say that I have seen benefit from it. The best effects, however, I think are often produced by the continued application of cold to the abdomen by cloths wet in vinegar and water. In tympanitic states of the abdomen, when not accompanied by coldness of the surface, and in cases attended with local circumscribed pain and tenderness, this remedy is often followed by the most beneficial results. Cold injections have also been recommended. Of these I have had less experience, but, for various interesting statements in regard to the effects of cold in this class of diseases, I refer to a paper by Dr. Smith in the 9th volume of the Edinburgh Medical Journal.

(4.) Opiates. I have already alluded to a modification of the disease which yields to a full opiate, more readily than to any other mode of treatment. The case to which this practice is particularly applicable, is perhaps chiefly characterized by the paroxysms of violent tormina. If

these are accompanied by frequency of pulse, and fixed pain or tenderness, a full bleeding, followed by an opiate, is often a successful mode of treatment; and, when the patient has been brought fully under the influence of these, the bowels will often be moved without any other remedy, or yield to the very mildest means. The tobacco injection, however, is also peculiarly adapted to these cases, and it is, perhaps, in general a safer remedy than opiates.

treatment.

(5.) In the advanced stages of the disease, when the system begins to become exhausted, stimulants must be given freely; and, under the use of these, a case will often give way which had previously resisted the most active The aloetic wine is a convenient remedy in this stage of the disease, combining the stimulating with the mild purgative quality; and it is often found of great efficacy when given in full doses, of one or two ounces, repeated at the intervals perhaps of an hour. Tincture of aloes may be given in the same manner; and it is a remarkable fact, that, in this state of the system, and even with a tympanitic state of the abdomen, the tobacco injection, if given with sufficient caution, may still be employed with much advantage, along with the use of stimulants. Of a recovery under these circumstances, I give the following example, which also tends to show the formidable characters which the disease may assume, without having gone on beyond the chance of recovery.

CASE LVI-A woman, aged 20, was affected with the usual symptoms of ileus in a very violent form, which, up to the fifth day, resisted all the usual remedies, assisted by general blood-letting. On the sixth day, her pulse, which had been at first natural, had risen to 120; the pain continued very violent over the whole abdomen, with urgent vomiting, and there had been no evacuation from the

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bowels. Farther bleeding was now employed, and various other means, without relief. In the afternoon, the pain nearly ceased; there was collapse of the features, with coldness of the surface; the pulse 140 and very weak; the vomiting continued; and she appeared to be nearly moribund. Wine was now given in the quantity of a glass every hour; and, after a few hours, her appearance being rather improved, the tobacco injection was employed, at first in very small quantity, and was repeated several times. It did not increase the sinking, but seemed rather to abate both it and the vomiting. On the following day, there was a decided improvement, and some scanty evacuation had taken place from the bowels; wine was continued in smaller quantities, and the tobacco injection was repeated several times with partial but good effect. The vomiting abated, and some Epsom salt was retained, and operated. In the evening she was free from pain, and the pulse 96; and from this time she continued convalescent.

The remedies which I have now mentioned are those of which I have most experience; but various others are to be kept in mind, as being sometimes useful. The warm bath is often beneficial at an early period of the disease, before there are any inflammatory symptoms. Crude mercury, in doses of one or two pounds, I have tried repeatedly, and in some cases it certainly appeared to allay the vomiting; I have not observed any other effect from it. The forcible injection of a large quantity of fluid, to the amount of six or eight pounds, is said to have been successful in some cases. In the memoirs of the Medical Society of London, vol. ii. some interesting cases are described in which it was used with advantage. Large blisters over the abdomen are likewise extremely beneficial; also the oil of turpentine applied externally or by injection.

When the vomiting is very urgent, so as to prevent medicines from remaining on the stomach, large doses of calomel, of from fifteen to twenty grains, often remain better than any other medicine, and even seem to allay the vomiting. In such cases, also, I have sometimes found benefit from giving powdered aloes, repeated at short intervals in combination with the oxide of bismuth. Whatever practice is employed ought to be zealously persevered in, notwithstanding the most unfavourable appearances; for the disease has been known to resist the most active remedies, and yet terminate favourably, as late as the 17th day.

PART II.

INFLAMMATORY AFFECTIONS OF THE MORE EXTERNAL PARTS OF THE INTESTINAL CANAL, INCLUDING PERITONITIS AND ENTERITIS.

IN tracing the phenomena connected with inflammation in the intestinal canal, we cannot fail to take notice of three remarkable varieties in the symptoms. We find inflammation existing in the canal, and going on to a fatal termination, with a natural or easily regulated state of the bowels, -with insuperable obstruction of the bowels,-and with severe and uncontrollable diarrhoea or dysentery. In the first of these forms of the disease, we find on dissection extensive adhesion of the parts from pseudo-membranous deposition, and frequently some puriform fluid; in the second, we generally observe this appearance combined with gangrene; in the third, we find ulceration, or some other result of inflammation, on the internal surface of the canal, often without any morbid appearance in the external coats. From what we observe of the results of inflammation in