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these symptoms with dysentery or ordinary diarrhoea. The acid also, which, according to recent observation, is for the most part predominant in the larger bowels, may be in such excess as to produce various disturbance by sympathetic irritation. The cœcum, for obvious reasons, is the part most liable to distension; often from solid matters accumulated there in extraordinary quantity. Its effects when thus loaded, even upon distant organs, are so various and considerable as to require discrimination in practice. I have seen more than one case, where pains were produced in the right leg, severe and constant enough to suggest the idea of more permanent disease in the joint or limb.
There is some difficulty in understanding the cause of those circumscribed swellings, to which all parts of the intestines seem liable, and which are sometimes so contracted in extent as to convey to examination the idea of hard, welldefined tumours, occasionally deceiving for a time by the resemblance. These swellings, as well as all other distensions and inequalities of the bowels, are more frequent in the female habit, and seem in certain cases connected with the peculiarities of the hysterical temperament. As the passage along the intestine, though impeded, is not generally closed in these cases, we must suppose that its coats are distended into a sac out of the direct course of the canal; originally, perhaps, from air generated suddenly or detained in this part of the intestine, or from the irritation of other more solid matters producing partial contractions, with relaxation of the intervening membrane and loss of power in the muscular coat. The sudden and unequal distension of the bowels from certain articles of food, or during the action of irritating medicines, illustrate the nature of these more circumscribed swellings. They are often relieved by a single active purgative (with which creosote or cajeput oil may
beneficially be combined): but the habit of using frequent laxatives, by weakening the canal and rendering its motions irregular, increases the tendency to such disorders.
The whole subject of tympanitis, to which these circumscribed tumours have relation, is under some obscurity. It is certain that there occurs occasionally a powerless or palsied state of the intestine through more or less of its extent, concurrently with which tympanitic swellings come on;- whether as cause or effect is not well ascertained. I think it probable that each supposition may be correct in part. The distension of any portion of the canal beyond a certain point clearly impairs or destroys its power of action; and still further distension may thereby be produced. But we have reason to suppose that this state of intestine (especially when general throughout the canal), arises from other causes, such as belong either to the nervous system of these organs, or to the effects of inflammation on the surface of the lining membranes. It is not easy to discriminate among these cases of mutual action, nor is it often attempted, though some points of practice might be founded on the distinction.*
The various distressing sensations and disturbance to other parts, which thus arise from undue distensions of the canal of the colon, almost defy enumeration. They form part of the sufferings of the dyspeptic, affecting all parts of the nervous system; and are unhappily aggravated in general by the means which such patients are prone to employ. I have elsewhere spoken of the importance to the healthy state of this bowel and of the rectum, that there should be a proper and equable distension by the contents passing through them; and of the evils arising from habitual or frequent purging, in
* Dr. Abercrombie, in his work on the Diseases of the Abdominal Viscera, relates one or two cases in which large tympanitic swellings were speedily removed by the use of electricity.
reference to this point, as well as to the state of the secretions from the coats and glands of the canal. I again allude to the subject from persuasion of its importance in practice. I may add further that the habit in question seems occasionally to be chargeable with that opposite state of the colon, equally distressing in its results the permanent contraction of the canal for more or less of its extent, particularly along the transverse arch.*
I have often sought to ascertain what are the appearances of the tongue especially indicating disordered states of the colon. Such have been described, and it is likely that they exist, seeing how variously and delicately this organ gives testimony to changes in the long tract of internal membrane, of which it is one of the terminations. But so many are the complications here present, chiefly from the state of the intervening parts, that I have never been able to satisfy myself with having obtained any well-defined knowledge from this source alone.+
* In two of the most remarkable instances I have seen of this organic disease, there had been a long habit of using large and very frequent doses of salts; in one of these cases to a greater extent than I have ever before known it. This may have been casualty, but it is worth noticing.
+ Among the external indices of change within the body, the tongue is perhaps the most valuable. Constantly as it is referred to in practice, we are still only partially informed of all the diagnostic marks it affords. Scarcely can the pulse compare with it in the extent, variety, and accuracy of these indications; which are not limited to disorders of the membranes and secretions of the alimentary canal, or to the presence of fever in its several forms, but extend also to the nervous power, of various states of which it affords very correct evidence. The sensibility, the voluntary powers, and even the more intellectual functions are often exactly thus interpreted. (Αἱ τρομώδεες γλώσσαι σημείον ουκ ἱδρυμένης γνωμης. Hippocrates.) No one can doubt this who is familiar with the appearance of the tongue under great debility; slowly and with difficulty put out of the mouth; withdrawn with equal effort; tremulous the whole time; its surface parched from stoppage of all secretions; its sensations
I do not enter here into the treatment of disorders of the colon, which, in their more distinct forms, receive ample notice in all medical works. I will merely remark that, in many painful and spasmodic affections of this bowel, more aid might be got from external applications over the back, whether stimulating or anodyne, than is usually done. I have often found them greatly more effective here than on the abdomen, where they are generally used from regard to convenience; and this remark especially applies to the complaints of children. The remedy so employed, comes nearer in many places to the actual seat of disorder, and has more diffused effect on parts continuously affected. Where opium cannot be given internally, its employment in this way by embrocations is often very beneficial, provided these be adequately used. And even where such means are not effectual alone, they at all events come greatly in aid of those which are administered within.
blunted or depraved. There are various parts of morbid anatomy which less merit the care bestowed on their representation than do the disordered states of this organ. The fugitive nature of the appearances, and their less fixed relation to disease from the variety of parts they represent, are the obstacles here. But the opinion may be repeated, that the physician cannot better study any set of signs than those afforded by the tongue, the palate, and fauces; the terminating portions of that inner surface along which so many actions are carried on, both of health and disease. The observations of Dr. Beaumont on the precise and uniform relation between the tongue and stomach, in the case of St. Martin, might well justify this remark, were it needful to seek other authority than that of daily experience.
ON THE EPIDEMIC INFLUENZAS OF LATE YEARS.
In the whole history of disease, there are few subjects of greater interest than those epidemics, which, under the familiar name of influenza, have prevailed so frequently of late - with certain common characters not to be misyears; taken, and clearly identifying them with others which stand on earlier medical record. In a former chapter, I have mentioned the singular relation of these epidemics to other forms of disease; particularly to some of the exanthematous, intermittent, and continued fevers.* These connexions, though in no case sufficient to establish identity, yet are intimate enough to suggest some community of cause, and a closer correspondence in every part than is expressed in our nosological tables. The pathologist and practical physician may both draw knowledge from this source. While to the more general observer, the epidemics in question are matter of deep interest, in their sudden appearance, in their wide but successive diffusion over vast tracts of the earth's surface, in their very general yet unequal influence, and in the amount of mortality they inflict.
Little can be added to the many exact descriptions we possess of the course and symptoms of this malady. What I have to say chiefly regards the question as to origin; some particular points in the pathology of the disorder; and a few others, having reference to the principle and methods of
*See Chapter VII. On the Connexion of certain Diseases.