A ON THE HISTORY AND CURATION OF THE ©fcetrttctfon of ttjt Ktitcfttftff s IN ALL THEIR MODIFICATIONS AND COMBINATIONS, COMPREHEND IN© THE FECULENT, THE BILIOUS, THE NERVOUS, THE SPASMODIC, THE METALIC, THE FLATULENT, THE HYSTERICAL, OR THE ILIAC CHOLIC OF AUTHORS; TOGETHER WITH SOME CASES OF THESE DISEASES, SUBJOINED IN CONFIRMATION OF THE SUCCESS OF THE METHOD PRO- POSED FOR THE GENERAL BENEFIT OF MAN. BY PETER DONALDSON, 31. E. C. NEW-YORK: PUBLISHED AND SOLD BY N. B. HOLMES, BOOKSELLER AND BINDER, No. 260 Greenwich-street. Printed by F. W. Ritter, JVo. 2 Dey-itreet, 1821. southern district &f new-vork, ss. Be it remembered that on the twenty-first day of Jidy, in the forty-sixth year qf the inde- pendence of the United States of America, feter. Donaldson of the said district, hath deposited in this office the title of a book the right Whereof he claims as Author, in the words following, to wit: A Dissertation on the History and Curation of the Obstruction of the Intestines, in all their Modifications and Combinations, comprehending the feculent, the bilious, the nervous, the spasmodic, the metalic, the flatulent, the hysterical or the iliac cholic of authors; together with some cases of these diseases, subjoined in confirmation of the success of the method proposed for the general benefit of man. By Peter Donaldson, M. E. C In conformity to the act of the Con- gress of the United States, entitled, " An Act for the encouragement of Learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the time therein mentioned." And also to an Act, entitled, " an Act, supplementary to an Act, entitled, * an Act for the encouragement of Learning, by securing the copies of maps, charts, and books, to the Authors and Proprietors of such copies, during the times therein mentioned, and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints.'" G. L. THOMPSON, Clerk of th« Southern District of New-York. V/'I i r~> i A ON THE HISTORY AND CURATION OF THE OBSTRUCTIONS 0¥ THE INTESTINES. INTRODUCTION. There is no disease that ever infested the human spe- cies more deserving the assiduous attention of physicians, or meriting the inquisitorial research of all men in general, than obstructions of the intestines, both on account of the deadliness of their nature, and the inefficacy of all the remedies commonly employed to effect their curation. Being fully convinced of the truth and reality of this position, we have deemed it our imperious duty to write a history, and institute the method of curing these perni- cious obstructions ,* in order, if possible, to render the method of cure more certain and infallible, in the use of remedies most effectual against every modification of these dreadful maladies, that we might liberate many of our fellow creatures from the most exquisite of all human tor- tures. We do not intend to advance any suppositions in the sub- sequent dissertation, which are not founded on certain facts and proved data, obtained in the course of years i from infallible experience and accurate observations, at- tested by many living credible witnesses, who have them- selves timely experienced the unspeakable benefits of the potent remedies, that we shall now propose, and have been snatched from the very gates of death by their mature ap- plication. We shall not call these new remedies or discoveries ; we only proffer them as very important improvements in the healing art. Yes, we mean to introduce such remedies into general use which have hitherto been accidentally em- ployed in the curation of these intestinal obstructions, and, like many other infallible remedies, inhabit the regions of du- bitation in books of medicine, and seldom appear in actual practice. Many physicians indeed, have considered it a dangerous expedient to use these remedies, either from the imaginary doubts of their powers, or from the fatal pre- judices of singular theories, and sometimes from the un- qualified timidity of their own minds, trembling to de- viate from their blind routine of practice, or have never dreamt of their application. But whatever apprehensions of their inefficacy, judicious. men may entertain, or whatever objections to their use invi- dious persons or jealous rivals may agitate or attempt to prejudice their patients against them, nothing, we imagine, will ever deter the tortured patients from trying the simple application of the remedies which they expect will save their mortal frames from sudden dissolution, and which we mean to propose to the world in the following pages. To cavilers we would only say, try them faithfully in the manner we shall prescribe, and then approve or dis- approve their use as ye find them by experience to answer or not answer the ends proposed. We can assure the world, that no bad consequences can ever arise from the use and application of the remedies, which we shall proffer to men in the exercise of the medical art. In the subsequent dissertation we only intend to exhibit the infallible remedies of pure obstructions of the intes- tines, complexions of disease so direful in their effects, and s»o deadly in their consequences, that very few ever emerge from the depths of their agonies, by the assistance of physicians, or the aid of medicine. How lamentable soever this may appear, how humbling it may be to the boasters of the science, it is as true as deplorable, that 5 most of those afflicted with obstinate cases of intestinal obstructions, perish under the eyes of their gazing physi- cians: all extolled remedies, all celebrated medicaments, all kinds of common means, have been employed to rescue them from sudden perdition ; all common remedies, we say, except the sovereign ones, which were adequate to restore every one of them to their wonted health and ter- restrial enjoyment; but alas for the unhappy patients! alas for the ignorance of practitioners, or the miserable physicians who content themselves with the stupid notions of having done all that can be done in such a case, quiet their consciences with the common delusion, in the belief of the incurability of the disease, being the great cause oi the failure in its curation ; and they excuse themselves accordingly in the most stupid manner—" We have done all that can be done for him; we have employed all the remedies ever recommended in this disease; nothing more can be done; the world cannot s »ve him; he must inev- itably die;" and such like ignorant and pitiful excuses for the ill success of their practice, or the untimely death of their patients, in order to hide their deplorable igno- rance of the remedies which would have infallibly cured them. When all their intellects are palled, all their skill exhausted, all their attempts made in continual disappoint- ments, and all their medicaments given in vain to relieve the unfortunate sufferers, they excuse theirignorance by say- ing the disease is incurable. Whereas there is a physician in existence, yes, lives in this city, that can cure the most inveterate case of intestinal obstruction in the course of an hour. But, alas! the miserable patient is not aware of this circumstance, and his credulity is irriposed upon by the murderous practitioners at the expense of his own life. Physicians have hitherto contemplated the different modifications of these obstructions, under the general term cholic: and all writers in medicine have considered it of several species, all comprehended in one generic cha- racter. Sauvages, Linneus, Vogel, Sager, Macbride, and others, class it among the internal pains of the belly. And the great Cullen, with no less impropriety, has classed it among his nervous diseases, under the order of spasms, and has enumerated seven different species of them, which all bear such a notable similarity of definition and symp- toms, th,at no utility can be derived from their distinction. 6 bome writers enumerate many species under distinguish- ing epithets, as the Nervous, the Inflammatory, the Bilious, the Flatulent, the Hysterical the Metalic cholic, and Iliac passion, which are mere symptoms of one and the same disease, in its various modifications and different combi- nations, in the particular assemblage of its morbid phe- nomena, depending on circumstances or peculiarities of constitution, and the powers of the efficient causes. For instance, in hysterical persons, in persons subject to ha- bitual constipation of the bowels, redundency of bile, ha- ving delicate constitution of the intestines, troubled with wind, or addicted to dram drinking; and where the pre- sence of metalic or other poisonous substances existed in them, to modify the accidental combinations of the ob- structions. We shall not waste our time by delaying to refute these chimerical notions of authors respecting the division of this disease into various species, which would neither enable us to institute a more certain method of curing it, nor assist us in comprehending its nature and combinations; but shall proceed to give some account of the nature, the causes, the distinction, the prognostication, and the cura- tion of the obstructions of the intestines themselves, com- monly denominated cholics in all their modifications, de- grees, and combinations, according to our new-method of characterizing every complication of morbid phenomena, or assemblage of symptoms, constituting every disease in its general and special characters, which we have uni- formly followed in our manuscript work On the practice of Medicine and Surgery, under the conviction of its being the most instructive and unexceptionable of any hitherto adopted in the discription and distinction of diseases. Under the guidance of this method, students of medicine will be led to understand, know, and distinguish every dis- ease of the animal constitution, in a single glance of their intellectual powers, by a certain assemblage and com- plexion of morbid symptoms, which always constitute the essential character, demonstrate the presence, manifest the existence of every particular disease in the functions of the animal economy, as well as enable them to distin- guish all modifications and combinations of the same iden- t ical diseases, lead them to institute the most rational me- thod of curation, and furnish them with an indelible 7 knowledge and understanding of all morbid signs; where- by they are qualified to recognize every complexion of morbid phenomena as easily, and with as great precision, as the intelligent and sagacious individual can distinguish the differences of the aspects and features in the counte- nances of men. It is most assuredly the ignorance of the distinguishing signs in every particular complexion of these morbid phe- nomena, constituting each disease distinctly and conjunct- ly, that has caused so many of medical practitioners to err egregiously, and to commit so many blunders in the exercise of the healing art; because, if physicians can- not comprehend the disease under their care, with one qualified intuition of their intellectual powers of recogni- tion, how can they institute the method of curation, being ignorant of the nature of the malady ? And it is impos- sible for them to direct the course of remedies or use of medicines, in any given case of disease which may come under their care, with any tolerable success, unpossessed of this internal discernment. Nay, more, they .may do ir- reparable mischief in their blind routine of practice. They observe a blind course of procedure in imitation of some celebrated author or after the false principles which they have imbibed in schools of medicine, or even adopted from the masters under whose tuition they have been trained to the practice of the art. They carefully conceal their deplorable ignorance of the nature and cure of diseases, by some artful manoeuvre of self-interest or impudence. They impose upon the credulity of their unfortunate pa- tients; they pretend to administer great medicines under the deceitful garb of coloured water, or exhibit random medicaments, which are either useless or pernicious in the disorder supposed to be present in the system. But ah! how chagrined they appear on their dismission where other physicians of real merit and knowledge are called to at- tend their patients, and justly to expose their ignorance and to save the patients from approaching destruction; they conceive malice, and bring forth revenge against the exposers of their unskillfulnes; whereas they ought to la- ment their own inscience and ignorance, and return to the studies of medicine, which they have affected to prac- tice. The want of candour produces in them an obstinate adherence to an unsuccessful method of treating diseases, and a belief of the infallibility of their systems, creates in 8 them an excessive degree of self-conceit and temerity, that they will not come forth nobly to acknowledge their er- rors, and wisely to seek the depth of knowh■■ jge to which they are strangers. This pride is incompatible with true dignity of soul and elevation of mind; and a species of pride, which has caused the lives of thousands of our fel- low creatures to be sacrificed at the altar of professional butchery !!! Heaven protect the unwary from the hands of such murderers !!! The qualifications of a proper education are wanting in them; a penetrating genius, a clear and solid judgment, a quick apprehension, a noble intelligence, and a dignified deportment, never enter their composition. Rough and blustering manners generally characterize the weakness of their understandings, and meanness of their soul. Irresolute temerity, and notori- ous affectation, argue them destitute of personal magna- nimity ; and the cruelty and avarice of their hearts, be- speaks their vast defects of sympathetic generosity and goodness. Alas ! time would fail us to unfold the deficien- cies in the knowledge, and the errors in the practice of nominal physicians, and consequently, we refer you to our dissertation on the causes and cure of these errors, which we composed on that painful subject. We intend in the following discourse to illustrate all the modifications and combinations of these intestinal obstruc- tions under one general character; because a specification of every variety in the aspect of the disease, does in no way enable us more accurately to understand the nature and the cure of the different cases that may come under our particular care ;' neither would it lead us to observe any diversity of method in the administration of the reme- dies employed in the treatment And we, therefore, deem it most expedient to describe obstructions of the intestines, as one complexion of morbid symptoms; including many modifications and combinations of the same original dis- ease, morbid phenomena, which will always manifest the presence of the disease, and characterize its very exis- tence. So we shall, in the first place, enumerate the es- sential symptoms, which demonstrate the existence of in- testinal obstruction. And, in the second place, mention the accidental symptoms, which occasionally occur to aug- ment the seveverity, and increase the agonies of the sub- jects of these direful maladies, as well as make some differ- ence in the selection and administration of the remedies 9 THE CHARACTER OF OBSTRUCTIONS OP THE INTESTINES. 1. This assemblage of morbid appearances compre- hends these five great characteristic symptoms :—an in- termittent pain of the contorted intestines, especially oc- cupying that portion of them lying in the region of the na- vel ; a constant vomiting of the contents of the stomach and bowels ; a retention of the excrements; and absence of fe- ver; which clearly manifest the existence of intestinal ob- struction in a regular concatenation of evils, through the no- table medium of the consent of motions and sensations in the animal economy. For the offensive excrements re- tained in the canal of the intestines, incites a spasm of their contractible fibres ; the spasm of the intestines pro- duces excruciating pains by its racking contortions and distentions of their sensible contexture; the agonizing pains produce sympathetic vomiting, probably designed in the order of nature to liberate the oppression and con- traction of the stomach and intestines; the vomiting ex- cites thirst, calls the muscles of the belly into action, pro- duces bitterness of the mouth from the ejection of aces- cent matter, and exhausts the strength of the living con- stitution; and the retention of the excrements is induced by the torpor or disease of the intestines themselves, ari- sing from the exciting causes, or by the inversion of the peristaltic motion, partially extended on their irritable tis- sue. Hence we may clearly see the accidental symptoms which may be added to the essential, in any particular case of obstruction. 2. The accidental and casual symptoms of obstruction of the intestines, are a redundancy of bile; an inversion of the peristaltic motion; dysuria; putrid eructuations; flatulences; fainting; distention of the belly; retraction of its muscles; watchfulness; delirium; cold sweats; tre- mour of the pulse and hands; frequent hiccup; great pros- tration of strength; dejection of spirits; thirst; whiteness of the tongue; torpor of the bowels; palsey of the extre- mities, on one side, or the whole of the voluntary muscles; pain of the head, back, and stomach; sometimes frequent dejections of bilious stools, and a temporary oblivion of the senses; which show a variety of evils, arising from some peculiarities of constitution; the circumstantial pow- ers of the exciting causes, the condition of the body, and the violence of the primary evils. 2 10 THE CAUSES OP OBSTRUCTIONS OF THE INTESTINES. 3. A long retention of indurated and bilious excrements in the bowels, crude, indigestible, flatulent, and aces- cent aliments, poisonous substances lodging in the intes- tines; aredundanqy of bile; irregularities pf diet; habitual dram drinking; want of due exercise; great heat; sud- den cold applied to the surface of the body; worms in the bowels, are the most common causes of these obstructions. As a judicious author attests-in his relation of the inter- nal and external causes of the cholic : Externae sunt, ut retentiolongiorfaecum praeter morem,creber usus acerbo- rum et astringentium, praesertim si assumantur principio mensae, exercitia et jejuna crebra, praesertim aestivo tem- pore, et in aestivis ardoribus immoderatae et assiduae ci- borum ingestiones, quos-nec vincere nee distribuere po- test,, cum non concedatur et tempus et spatium, item otium, decubitus, somnus longus, quibus natura hebetatur, et ig- nava redditur ad omnes actiones naturales. 4. Internae causae sunt tres: 1, hebetior sensns intestino- rum ex veterno, paralyse, apoplexia, aut cicatrice intes- tinorum contracta ex solutione ulcerum postdysenteiiam: 2, ex defectu flavae bilis extimulantis in intestinis vim ex- cretricem, ut fit in ictero ex obstructione meatus chola- gogi: 3, infarctione intestinoum ab aridis et duris faecibus, vel crassa pituita, vel inflammatione, vel frigore, vel astrin- gentium maleficio, vermibusque intcstinorum; which occa- sionally combine to produce the obstructions under con- sideration. As for the other causes enumerated by physi- cians, as some tumours in the intestines; concretions; col- lections of bloody masses; callosities; translations of gout; diseases of the reins, bladder, pancreas, spleen, liver, or intestines themselves, we shall not place among the cau- ses of obstructions of the intestines; because these are distinct diseases characterized by peculiarly essential symptoms. It is sufficient for us to add, that the causes above mentioned will produce the obstructions in question, in all persons who have an original or constitutional irri- tability and tenderness of the intestines, or have been fre- quently subjected to previous attacks of the same malady. 11 THE DISTINCTION OF THE OBSTRUCTIONS OF THE INTESTINES* 5. The accuracy of every physician's knowledge of dis- eases, mostly depends on his understanding, judgment, and sagacity in the great art of distinguishing them from each other, with an intuitive facility, and most infallible preci- sion, just as a penetrating eye would recognize the differ- ent countenances and features of distinct persons. His success, indeed, in practice, will always bear proportion to the depth and certainty of the distinguishing powers of his intellects; and all those who intend to use the reme- dies we shall propose to them in the subsequent pages, must be masters of distinguishing intestinal obstructions from all other diseases of the alimentary canal, that bear the least resemblance to them; such as inflammations of the intes- tines ; calcoreous concretions; callosities; fluxes; diffi- cult menstruation; dolors of the womb; spasms of the kid- neys; cholera ; worms; and diseases of the ventral mem- branes; which may deceive the inattentive practitioner; and lead him into the most egregious errors of employing the re- medies prescribed in these obstructions; when the existing disease is inflammation of the intestines, or inversely, the re- medies which ought to be used in these ventral inflamma- tions only, when intestinal obstructions were alone present; or apply the remedies of obstructions to painful spasms of the worn b, difficult menstruation, or scirrous diseases of that organ, which would increase these maladies; as many pompous physicians of this ignorant and avaricious age continually do, at the expense of the precious lives of my- riads of their unfortunate patients. But not to digress, we shall proceed to point out in particular those distinguish- ing signs of intestinal obstructions, which will infallibly specify the characteristic difference of this particular com- plexion of disease, from all others of similar morbid phe- nomena. 6. The infallible marks of distinction between obstruc- tion and inflammation of the intestines, are a total absence of fever; an alleviation of internal pain on manual pres- sure of the belly; perfect intermissions of the contorting pain; retraction of the navel and of the abdominal muscles, in all cases of obstruction; and the presence of high fe- ver, augmentation of the pungent pain by pressure; the 12 perpetuity of the pain ; tension of the abdomen; and an- guish and lassitude in all cases of inflammation of the in- testines; which will enable every intelligent practitioner to distinguish the one from the other, with infallible cer- tainty. THE PROGNOSTICATION OF OBSTRUCTIONS OF THE INTESTINES. 7. It is also of great importance to be able, intuitively, to foresee the issue of every disease under our care; and to foretel the approach of death, or return of health, in every given case, when it is required of us, especially in all cases of violent and tremendous disorders. A favour- able report will always encourage our patients; an unfa- vourable prognostication will satisfy and prepare the minds of their relations. But should a practitioner appear con- foundedly palled in conjecturing the probable event of the case, and hesitate to satisfy their inquiries, there would be every reason to suspect his abilities in every other re- spect, and they would call other physicians of superior fame. We may easily pronounce the probable termina- nation of all diseases advanced to their crisis, or even in the primordeal of their pefect formation. 8. The favourable termination of obstructions of the in- testines, is easily foreseen in the comfortable remains of strength; natural appearance of the countenance; the return of appetite ; free explosions of wind ; the fruition of natural repose, especially in the abatement of the pain, and copious evacuations of bilious, glutinous, hard, fetid, and putrid excrements, which foreshow the immediate re- turn of health. The fatal termination of them may be eas- ily conjectured from the permanent fixation of the pain; the invincible obstinacy of the constipation; the accession of hiccup; intolerable vomiting; perpetual watchfulness; faintings; irremediable inversion of the intestinal motion; the sudden cessation of all pains; the cold sweats; deli- rium ; tremour of the members; the great debilityof the pulse; livid colour of the lips; the lurid appearance of the visage; and the evident sinking of all the powers of animal life, indicating the sudden approach of dissolution. 13 THE CURATION OF OBSTRUCTIONS OF THE INTESTINES. 9. All men will readily perceive the indications of cure in all cases of obstructions of the intestines, viz. to re- move the present evils, and restore the strength of the pa- tient. But, alas! physicians do not agree on the method of executing these intentions, and differ egregiously on the use of remedies in their various modifications. Some rely on the virtue of the infusion of tobacco; others con- fide in the efficacy of purgative medicines, and clysters ; one trusts to the efficiencies of warm bath, blisters, bleed- ing, antispasmodics, fomentations, opiates, mercury, and me- chanical dilatation; another depends on the use of quicksil- ver and frictions; but, alas ! all these remedies have often failed, and all the efforts of physicians have been often baffled to effect a cure, or even to relieve their unhappy patients from the. pressure of exquisite tortures. They do not employ the remedies of infallible virtue that would ef- fectually remove the obstructions in every period of their existence, in every degree of severity, and in every case occurring in practice, unless the powers of animal life are sunk below the possibility of restoration, previous to their benign application. Some of these remedies above mentioned, are not only useless and inefficacious, but even ^ dangerous in their effects; for instance, the infusion or fumes of tobacco, and the use of quicksilver in large quantities, to dilate the contracted, and to relax the ob- structed intestines. 10. In the last stage of the obstructions of the intestines, when no relief could be obtained in any degree from the use of those powerful remedies above mentioned, practi- tioners have been recommended to flee to the infusion or fumes of tobacco, in the forms of clysters, in order to relax the spasm of the intestines, and procure evacuation of the alvine excretions. But this is a medicine of such strength and violence, that its administration must be accompanied with a great deal of caution, lest the deleterious effects of a large dose of this herb, be so great as to sink the ani- mal powers, and destroy the lives of the very persons whose existance we are attempting to preserve. It first excites dis- tressing nausea, fainting, an immense depression of the liv- ing powers of the system, and resolves the tone of every nerve; and we have heard of cases of immediate death u being induced by a strong clyster of the infusion of il? leaves. A drachm of the leaves of this herb, is enough to form a quart of the infusion of sufficient strength to be administered to an adult in two different clysters, and re- peated in the course of four, six, or twelve hours, if no bad effects arise from the first clyster. And the quick- silver, if it should meet with invincible resistence from the presence of intussusception or impenetrable obstruction, would increase, we suppose, the agonies by its unfriendly presence. 11. Opiates in the cure of obstructions of the intestines, are pernicious during the existence of constipation. They retard or suspend the natural motion; render them more torpid, and prevent the operation of purgative medicines. In the advanced period of the disease, when an inversion of the peristaltic motion of the intestines alone remains with all its spasmodic contractions, these opiates are the most efficacious of all remedies; and in all cases of grip- ings, produced by cold, or passions of the mind, or flatu- lence, or fermentation of the contents of the bowels, opi- ates may be useful in the absence of the intestinal obstruc- tions. 12. Warm bath has also been employed in the cure of obstructions of the intestines as an antispasmodic remedy, to relieve the torturing pain of the bowels. But we are of opinion, that immersion in warm water will increase the obstructions, by inducing copious sweats, which will dry up the excretions of the intestines, augmenting the constipation; and fomentations applied to the naked belly will only afford a temporary alleviation of the pain. 13. Bleeding is another remedy of no utility in the cure of intestinal obstructions, except to prevent apoplexy, epi- lepsy, or rupture of some important blood vessel, by the violence of straining, in full habits and robust constitutions. And it is manifest that all weak and puny individuals would be injured greatly by its use. In short we have never seen it produce the least benefit in any case of pure obstruc- tion. 14. Blisters applied to the belly in cases of pure obstruc- tions of the intestines, produce no good effects, either to remove the contraction of the intestines, or to alleviate the concomitant pains. We have never found any benefit to be obtained in these cases from their repeated applica- tion. Rubificients and frictions are equally useless. 15 15. Carminatives and antispasmodics, which have been highly recommended by authors of celebrity, produce no apparent good effects during the continuance of the vis- ceral obstructions. Use of oils is attended with no bene- fit whatever in the cure of such obstructions. 16. Mechanical dilatation of the intestines is another re- medy much extolled for the cure of these obstructions. This dil. station is to be effected by injecting through a pro- per syringe two gallons of warm water into the colon, in order to dissolve the compacted excrements, and nullify the obstruction. This powerful remedy has been attended with great success in some few cases, when the water was thrown up forcibly, till the patients began to experience a great uneasiness from the distention which it produced in the belly. 17. Emetics of Antimony have been administered to pa- tients labouring under obstructions of the intestines, on the supposition that they would concuss the whole body and expel the morbid matter, equally downwards as up- wards ; because emetics of ipecacuanha or antimony, or even spontaneous vomitings, have been often attended with subsequent evacuations of the excrements. But we we can assure the world of their inefficacy in almost all cases of obstruction, where excessive vomiting is always present to reject every kind of an emetic that can be ad- ministered to the sick. If vomiting is absent, purgative medicines will be far more effectual. And why should we excite one of the most distressing of all morbid symptoms, deadly nausea, and vomiting? thence let us reject their use in practice. 18. Cathartics to procure alvine evacuations, are the most effectual, in many cases, to remove intesinal obstruc- tions, if vomiting has not yet supervened to prevent their exhibition. But if vomiting should render the use of pow- erful cathartic medicines impossible, we must immediately have recourse to purging clysters of the most potent kinds; and must repeat these assiduously, for the space of four hours or until we should judge from the great numbers ad- ministered, and their total inefficacy, that no future trial would be attended with better success. The submuriate of mercury, in the form often grain pills, is the most effec- tual and powerful of all others in the class of cathartic medicines; the smallness of its bulk, its specific gravity, 16 and its great purging virtue, render it superior to all other purgative remedies, in the cure of intestinal obstructions; being most likely to be retained in the stomach, du- ring the most violent efforts of vomiting, and even to gra- vitate or work into the obstructed intestines; jalap, epsom salts, castor oil, colocynth, aloes, in large and repeated doses, vigorously employed, are the quickest and most efficacious in all cases, where the stomach can retain them, especially administered judiciously by skillful practition- ers, as the nature and urgency of every case may require. If the perpetual vomiting should render their use impracti- cable, we must flee to the exhibition of some other remedies. 19. Purging clysters are also powerful means to dissolve obstructions of the intestines, and the ohly remedies of cathartic powers on which we can rely and place our hopes of success in this painful dilemma. But, alas ! a few hours of experience or trial will soon convince us of their inutility, and frustrate all our expectations in every obstinate case of intestinal obstruction. These clysters should be composed of the muriate of soda, salts, jalap, castor oil, combined with the infusion of senna, and exhibited in the quantities of a quart, and repeated every half hour, for four hours, or till no hopes of relief can be entertained from their use; or concomitant circumstances are expected to render all future attempts abortive, the execution of this method of curation wholly depends on the good judg- ment of the administrators for any probable success. Very often this order of remedies, altogether fail in reliev- ing the agonies of these obstructions, and are never found efficacious in perfecting a cure. Clysters composed of sp. turpentine, yolks of eggs, and two pounds of warm water, formed into a clyster, to be immediately in- jected into the bowels ; and a clyster of five or six grains of tartar of antimony have been recommended as being more effectual than any other; but these are violent reme- dies, sometimes producing bad effects in the colon, and seldom attended with any great benefit; admissible only in cases of desperation. 20. Now we have used all the remedies which are com- monly employed in cases of intestinal obstruction, we have found them all frequently to fail in dissolving the obstruc- tions, or even in mitigating their violence; we have tried the virtues of them all in actual practice; we have expe- 17 rienced their effects in our own persons; we have accu- rately observed their powers in the constitutions of thou- sands; and must now draw this unfavourable conclusion of their sufficiency to remove intestinal obstructions, that all these are very uncertain or ineffectual remedies in the curation of this obstinate disease. How vain the hopes! how vast the frustrations of mortals! What would the careful physician not do to save his dying patient in this awful suspense ? What would his patient not undergo to be snatched from the brink of death and despair? What would he not give for the life and health of his lying frame in this hopeless condition ? The desertion of his physician; the prospects of dissolution; the fascination of the present world; the attraction of affectionate rela- tions—all unite to increase the tenacity of the present life! We have witnessed many desponding mortals, in this deplorable situation, and have been moved with com- passion towards them; but will all the sympathy and so- lace in the world quiet their despair, if we can not inspire them with the certain hopes of immediate salvation? Surely nothing will console the expectants of death, ex- cept the hopes of life. 21. Supposing, then, we have administered the most powerful cathartics, the most stimulating clysters, the most resolvent antispasmodics, the most efficacious corminatives, opiates, and mercurials; have practised bleeding, applied blisters, used the warm bath, employed mechanical dilata- tion and friction, and exhibited quicksilver, in vain, to re- solve these obstructions; what shall we do ? Is there no other remedy that can be employed to cure them? Yes; fortunate for the subjects of intestinal obstructions, an in- fallible remedy is discovered to relieve their horrible ago- nies ; a remedy, simple in its application, and sovereign in efficacy! worthy of the attention of men, and praise of ages! increasing the dignity, and advancing the glory of the healing art, through the absolute perfection of the sanative virtues of its application; this is the dashing of COLD WATER ON THE LOWER EXTREMITIES AND BOWELS, ever effectual to solve the most inveterate obstruction. 22. Cold effusion then applied to the belly and extremi- ties, is the infallible remedy for dissolving these obstruc- tions of the intestines, and even for evacuating their noxious excrements, in cases of the most desperate com- • 18 plexion. The mode of the operation of this great remedy. effectually applied, appears evident to every disciple of iEsculapius, tolerably conversant with the studies of ani- mal nature,—the bracing powers or effects of cold water dashed on the belly and lower extremities, with sufficient force and duration, undoubtedly constringes the muscular fibres of the intestines by its refrigerant virtues, and in- cites the energy of their moving powers to propel their excremental contents downwards, and thence the ob- struction in every given case is completely removed on the evacuation of the bilious, glutinous, putrid, black, hard, or noxious excrements, that have been so long im- moveably fixed in the cavity of the compressing intestines, to the unspeakable relief of the distressed patient. In cases of these obstructions there is great retardation, or total suspension of the propellent motion of the intestines, or a cessation of their expulsive energy, in the weakened parts occupied by the indurated feces, depending on the torpor in the nerves and fibres of the perestaltic motion, or there is an inversion of this motion in the portion of intestine containing the obstructed excrements, whereby the vital part- below the obstruction will act in direct opposition to the sensible part above the obstruction, creating an orbicular compression of the contained excre- ments ; the preternatural contraction of the intestine be- low the obstruction, will oppose the natural contraction above the obstruction, producing a total retention of the excrements in the affected portion of the intestines, and all the evils of direful obstruction, on the supposition of a circular compression or action in the middle of the two opposite combatant contractions; hence we may account for the retention of excrement, and spasms of the sensible intestines. 23. But it may be asked, how does the powers of cold affu- sions remove the preternatural contractions below the re- tained feces, and re-establish the propellent energy of the af- fected portion of the intestines? We would only observe, in answer to this question, that the remedy designed by na- ture to effect the curation of these obstructions, relaxes the preternatural contraction, and restores the natural energy of the peristaltic motion of the torpid portions, whereby the natural motion is able to overcome all obsta- cles or impediments of the preternatural spasms in the 19 solution of the obstruction. If the retention of excrements is induced by a diminution or suspension of the peristaltic motion of the intestines, then the remedy will recreate the natural motion, which being increased beyond the usual degree of its natural energy, will soon remove the obstructions of their vital tube. 24. Some authors have recommended standing or walk- ing with the bare feet on a cold damp floor; the applica- tion of snow, or pounded ice, or towels wetted in a solu- tion of the muriate of ammonia and nitre in water, to the region of the belly, which have been found, in some cases of obstinate constipation, to have been attended with good effect, when all other remedies have failed; but the best mode of applying the cold affusion in the cure of in- testinal obstruction, is throwing cold water on the feet, legs, thighs, and lower region of the belly of our patient, in a sitting or standing position; the disease seldom re- quires a repetition of this operation; generally copious evacuations of offensive or bilious excrements are pro- duced in the course of half an hour, and all the distress- ing evils of local obstruction consequently cease. We can not depend so entirely on the other methods of ap- plying cold to the body, as we can rely on the general affusion or immersion of the inferior part of the naked body. This way of curing obstructions of the intestines, is the most infallible method ever proposed to the world, being always effectual in the most inveterate cases of the disease; the metalic, the spasmodic, the stercoraceous, the accidental, and the bilious modifications of obstruc- tion of the intestines, will all readily yield to the bracing powers of cold from the water dashed on the body. 25. *" Two obstinate cases of colica pictonum, arising from exposures to cold," says a writer oh medicine, "very lately came under my care, which resisted fomentations, warm bath, anodyne and tobacco clysters, the internal use of opium and cathartics, and which at last were rea- dily and quickly removed by placing the patient in a large tub, and throwing a pail of cold water over the abdomen and thighs. The operation was not required a second time; for copious evacuations soon took place, when the spasmodic affection was prevented from returning, by small doses of opium repeated from time to time;" and then delivers his false theory respecting the manner of the action of cold on the intestines: «the benefit obtained by 20 dashing cold water upon the extremities in this disease then seems to be owing to the sympathy which exists between them and the intestines; the fibres of the latter being relaxed, while the sudden contraction of the vessels on the skin, in consequence of the application of cold, determines the flow of blood inwardly, and occasions a copious secretion from the internal surface, whereby a free expulsion of their contents quickly ensues;" which, in our opinion, seems to be owing to the tonic power of cold oh the moving fibres of the intestines, bracing them, and imparting a sufficient quantity of energy of the peris- taltic motion, to expel their indurated or noxious contents, and to liberate them from the irritating presence of such excrements, which continually excited intermittent spasms and pains, or continued the spasmodic contractions of their muscular tube. The celebrated and judicious Cullen, had far correcter views of the action of cold on the intestinal viscera, in the cure of this disease, when he observed in his first lines of the practice of medicine, " When every purgative has failed, the action of the intestines has been effectually excited bv throwing* cold water on the lower extremities," which implies the manner of its action and a perfect re- liance on its virtues; whereas the observations of Tho- mas, intimate his own doubts of the infallible efficacy of the application of cold water; and clearly indicate, that he placed no confidence in the remedy, more than he depended on the virtues of others which he enumerates, having had no experience of its benign effects, except in the two solitary cases, wherein he found it sovereignly effectual in removing the obstructions. He mentions the remedy in a cursory manner, he uses a vague way of ex- pressing his sentiments of its utility, he urges its applica- tion with no apparent confidence of its great and infalli- ble sufficiency; he cursorily enumerates it among the other sets of remedies, which have been occasionally attended with success in the practice of former ages, and even in- sinuates its total failure in curing these obstructions of the intestines, when he says, in reference to all the foremen- tioned remedies,«' Where these means fail to produce the desired effect, i^.is customary to have recourse to ano- dyne or tobacco clysters, either in the form of infusion" or fumes, giving the pre-eminence to the virtues of this deleterious herb. 21 27. And we are not conscious of its being ever consi- dered an infallible remedy, and employed as ^uch in every case of intestinal obstructions, formerly invincible to all other remedies, previous to our promulgation of its all- sufficient virtue and efficacy; yet we do not mean to pro- pose the application of cold affusion and immersion, as a sovereign specific in every gradation of the disease, as mercury in the venereal contagion, or sulphur in the cure of itch ; but we intend to recommend its application as an infallible catholicon in curing every gradation and modi- fication of intestinal obstruction, consisting of an inversion of the peristaltic motion, partial constrictions, spasms, or torpor of the moving fibres, a total retention of the ex- crements, or presence of worms in the intestines. We promise an infallible cure of every case of obstruction, from the proper application of this remedy in the hands of all practitioners, who perfectly understand the nature of the disease, and the virtues of the remedy proposed; we do not promise universal success from the mere appli- cation of this certain dissolver of intestinal obstructions, em- ployed by every ignorant pretender to the healing art, no, because such an unskillful practitioner may apply this re- medy in the last period of the disease, when an inversion of the peristaltic motion and morbid constriction of the in- testines may be the only evils remaining after the com- plete annihilation of the obstructions themselves; he may suppose the pains, gripings, and spasms of the intestines in cases of callosities, concretions, collections of bloody matter, acidities, and crudities, and inflammations of the intestines, pains of the womb in cases of difficult menstru- ation, to proceed from pure obstructions, especially when the agonies of these diseases in some degree resemble the intermitting pangs of feculent obstruction. The blunder committed in such an instance would be egregious and dis- mal ; the application of cold affusion would be followed by no benefits in these diseases, and the infamous blun- derer would be so chagrined on his ill success, that he would maliciously attempt to asperse the discoverer, and to deny the sufficiency of the remedy, as happens continu- ally in the common course of the practice of impostors. 28. How often do we perceive medicines to rise into verbal repute, and die in the field of practice, without per- forming a single cure. Behold the scullcap, the stinkweed, 22 the hemlock, the cinchona, the motherwort, the ergot, the lichen, &c. which have been highly recommended in the cure of different diseases at their introduction, and have now sunk into oblivion. Witness the fate of wine and brandy in the treatment of tetanus, or lockjaw ! behold the end of salivation in consumptions, fevers, and fluxes! forbid that we should propose remedies like these which always fail us in the trial of their virtues, or destroy the subjects of their administration. We profer remedies which will stand the test of experience, and answer all the pro- posed ends and intentions in the hands of the judicious practitioner. Purgative mecidines, opiates, warm bath, and nourishment properly administered, and timely em- ployed with all the judgment, perseverance, urgency, and vigilance, necessary in every case of violent disease, will never fail to effect the cure of dysentery. So in all cases of intestinal obstruction we are to depend on the whole me- thod of curation in the use of special remedies; a method of treatment which every wise practitioner will rightly in- stitute to himself, and will accommodate all the remedies to every particular case of disease, as well as conform the medicines to the strength and peculiarities of each con- stitution ; we must not depend upon any particular medi- cine or application in curing these obstructions; we must confide in the virtues of all the remedies properly adapted to every period and degree of the disease, in their proper order, according to the indications of cure; and not to the bare cold affusion alone in cases of obstinate inversion of the intestinal motion, after the removal of obstruction, lest we should experience the painful mortification of seeing our patients languishing under the agonies of un- subdued commotion of the intestines, and the dismal evils of great exhaustion; we therefore recommend the use of cold affusion to remove the obstructions; purgative medi- cines to cleanse the intestines; opiates to assuage the tor- turing spasms; mercurials to alter the morbid condition ; and nourishment to support and impart strength to the constitution in regular order of their absolute requisitions. This shows us the necessity of attending to the indications of cure in the new method of treating these obstructions. 29. 1, We should attempt to remove the present obstruc- tion of the intestines by the most vigorous use of evacua- ting remedies, viz. purgative medicines administered in potions and injections. 23 2, We should immediately flee to cold affusion or im- mersion, on the event of their failure in solving the ob- struction, as the safest and most effectual remedy in this direful malady. 3. We should administer powerful cathartic medicines to evacuate the morbid contents of the intestines, in order to liberate them from the irritation of acrid excrements, after the solution of the obstruction. 4, We should endeavour to restore the natural condition and motion of the diseased intestines by alterants, opi- ates, and corroborants, when injuries of their coats, palsy of the extremities, &c. exist. 30. The first indication of cure, is to remove the ob- struction of the intestines by the urgent administration of cathartic medicines, as the most natural way to commence the treatment of a disease of obstinate constipation. The submuriate of mercury, given in doses of 10, 15, or 20 grains in the form of pills, and repeated as circumstance? may demand in every particular case, is the most effectual and eligible of all other purgatives in the obstructions of the internal viscera, especially exerting its powerful and saluta- ry effects on the intestines themselves. The great* specific gravity, the smallness of the bulk, and the searching quali- ty of this medicine, render it more likely to be retained on the stomach to solve the obstruction, than any other substance of cathartic powers, known in the dominion oi nature. This preparation of mercury ought to be admi- nistered in preference to all others, in all those cases where great irritability of the stomach, and great efforts of vomiting exist. Epsom salts, jalap, aloes, colocynth, castor oil, senna, supertartrate of potass, and tartrate and sulphate of potass, sulphate of soda, rhubarb, seneca scammony, in proper preparations and forms, are ex- cellent purgative medicines, and may be largely exhi- bited during the absence of vomiting; some other drastic purgatives might be enumerated among this class of reme- dies, as gamboge, gratiola, elaterium, asarum, sanguina- ria canadensis, mercurialis, iris, panduratus, tarpethum, mechoacanha, carthamus, agaricus, anona, anagallis, flo- res sambuci, veratrum, esula, necotiana, linum cathar- ticum, rhamnus, but these are seldom exhibited in the prac- tice of the present day, either on account of the intole- rable violence of their operation, or of our having substi- 24 tutes far milder and more effectual in their cathartic pow- ers, to their utter rejection in practice. Strong clysters, composed of common salt, sulphate of soda, castor oil, sulphate of magnesia, jalap, turpentine, marine water, or aloes and an infusion of senna, or the blossoms of elder, or a decoction of mallows, must be administered at the same lime, and repeated every half hour, till copious eva cuations are produced, either by them, or the purges re- ceived into the stomach; should they have great irritation and uneasiness in the great intestine, we should then in- ject a gallon or two of tepid water into the bowels in or- der to dissolve, if possible, the obstinate obstruction of their living and sensible canal. But if the obstruction re- sists all these remedies, vigorously employed and executed by the skillful head and benign hands of the faithful practi- tioner, even after they have been continued a sufficient length of time and abundantly repeated, we must, without a moment's hesitation, flee to the great remedy for dissolv- ing these intestinal obstructions; namely, the application of cold water to the lower portion of the naked body. This course of treatment seems to be absolutely necessary; more especially when the most excellent and powerful ca- thartic medicines have been rejected from the stomach, and all those clysters tried in vain to solve the obstruction. We would dissuade all men from administering matalic quicksilver, or the terrible infusion of tobacco, unless the repeated application of cold immersion and infusion should totally fail with the use of all other auxiliaries, when we might, as a dernier resort, exhibit the infusion, in expec- tation of solving the spasmodic contractions of the intes- tines. This brings us to the second part of our method of curation, included in the same indication presented to our view. 31. As soon as we find ourselves baffled in all our efforts to remove the invincible obstructions of the intestines, with the assiduous and vigorous administration of the most powerful cathartics, in the form of potions, pills, and clys- ters, on account of the incessant vomiting; we must re- sort necessarily to some other remedy, deemed efficacious in dissolving these obstructions. None in the wide do- mainof nature can so effectually exterminate such obstruc- tions of this vascular tube, as the dashing of cold water on the belly and lower extremities, in the manner we have 25 directed in a preceding part of our dissertation. If we had the least apprehensions of any frustration being ever experienced in the curation of intestinal obstruction, with the application of cold water, in any given case, we should wisely prescribe another remedy, which might infallibly educe the stagnated excrements, and solve the obstruc- tions ; untill we are defeated to remove them by the appli- cation of this remedy, we shall ever persist Ho urge and employ it in all cases of pertinacious obstructions of the intestines. 33. The second indication of cure in the treatment of this disease is to exonerate the bowels of all their bilious, glutinous, indurated, and noxious contents, by the use of purgative medicines. The effects of cathartic remedies in the evils consequent to obstructions of the intestines, are very salutary and beneficial to empty them of all the acrid, putrid, and acid contents; whether hardened ex- crements, extraneous substances, irritating bile, or tere- brating worms. The proposition of this evacuation is founded on the certain facts of hard and glutinous lumps of excrements, or collections of bilious matter being re- tained and lodging in the folds and valves of the irritable intestines, producing all the evils of pains and spasms, inversion of the peristaltic motion, and vomiting; even after the solution of obstructions effected by the cold af- fusion; which noxious excrements must be completely evacuated previous to the administration of opiates to calm the internal commotions, and to afford an opportu- nity of taking nourishment. 34. The most efficacious of all the purgative medicines, in this second stage of the disease, is the omnipotent sub- muriate of mercury; this medicine operates effectually in emptying the bowels, it acts benignly on the absorbent and excretory functions, it resolves the constricted fibres of the intestines, it revives the natural mobility and acti- vity of their muscular contexture; it restores their peris- taltic energy, it promotes all the secretions, it permeates the universal system, and exterminates every obstruction ofthe nerves and glands; it is owing to its general influence on the functions ofthe animal body, that we have preferred it to all others injthe cure ofthe bad consequences ofthe in- testinal obstructions, or in the curation of the injuries of the intestines; it is on account of the super-excellent vir< 4 26 tues of the submuriate of mercury in the diseasedtstatc of these viscera, it is the good local effects on the affected portions of the intestines, and functions ofthe brain, which induce us to urge the administration of this medicine, pos- sessed of so many singular virtues. 35. To accelerate the opperation of purgation, we may combine with ttie submuriate of mercury any other cathar- tic medicine, such as jalap, aloes, colocynth, rhubarb, gamboge, or scammony, or we may exhibit the sulphate of magnesia, super-tartrate of potash, the phosphate of soda, the infusion of senna, tartrate of potass, castor oil, or the sulphate of soda, in the course of three or four hours after the sumption of the submuriate of mercury, to insure ample evacuations. If the peristaltic motion is so intolerably inverted that nothing will descend into the rejecting intestines, we must in such a horrible case of reversed action, have recourse to the use of mild ca- thartic clysters; as marine water, salts, infusion of senna, or decoction of barley with tartrate of potass, which will most probably ascend into the stomach and be ejected by the mouth, cleansing the universal canal ofthe intestines. 36. In all cases of the disease, accompanied by an ob- stinate inversion of the expellent motion, mercury, and denulcents, are most potent remedies to reverse this pre- ternatural action, and to re-establish the natural and sound uniformity of their motion and sensation. The morbid secretion of bile, the imbecility of the irritable intestines, the diseased condition of their tender fibres may all unite to perpetuate the terrible commotion, and to prevent the reception of nutricious aliment; these are the great evils which render all our efforts seemingly fruitless, in violent cases of inversion of the motion oi the intestines; and we should exert all the powers of our medical intellects, to remedy these mighty impediments in the way of a complete restoration. But we must never give up the use of these powerful means, we must never abandon our patients in the midst of accumulated miseries, we must endeavour to rescue our patients from approach- ing dissolution; we must conscientiously and faithfully persevere with all diligence in the use of remedies; let us exert every nerve, and we shall soon enjoy the un- speakable pleasure of being able ultimately to overcome all those obstacles, and of restoring our suffering patients to perfect health. 27 37. Opiates suspend the inverted commotion, still the spasms, numb the pains of the intestines, and compose the sick into a desirable repose; they also resolve the morbid actions of the muscular fibres of these viscera, open the pores of the skin, and afford grand opportuni- ties of administering nourishment sufficient to preserve the poor remains of life, during the intervals of relief ob- tained by them, till these important viscera are perma- nently established in the healthy exercise of all their na- tural functions. If we should apprehend the least degree of inflammation in the surface of the intestines, bathing the feet in warm water, warm fomentations of hops to the belly, warm bath, and in robust patients, bleeding, are necessary, and ought to be employed in the first approach of the inflammation, repeating them according to circum- stances. 38. Refreshing draughts of mild aromatic cordials, car- minative beverages, reficient infusions of tonic bitters, nourishing soups, demulcent decoctions, and grateful po- tions of exhilarating and chalybeate waters to comfort and support the sick, labouring under the pressure of the evil consequences of this horrible malady, are necessary in the last period of the disease to perfect their restora- tion. Whenever the great violence of the evils of intes- tinal disease affects the nervous system in an alarming de- gree, producing torpor and stupor of the extremities, we may apprehend the approach of total and dismal palsy of these members, and sometimes permanent contractions of the hands and the feet, which would render the pa- tients completely miserable, and cause them to linger many wretched years of an intolerable existence. In such threatening appearances we ought to proceed with tenfold diligence and penetration in the urgent adminis- tration of those remedies, which are most effectual and sanative in pfeventing or removing these dismal conse- quences of intestinal obstructions; and none, we imagine, is as beneficial as the internal use of the submuriate of mercury in combination with diuretic, diaphoretic, and cathartic medicines. 39. Should our patients appear to sink in a state of great debility from the long duration of the disease, sto- machic bitters, genial tonics, aromatic restoratives, be- nign nutritives, pure cool air, cold aspersion of the body 28 with a sponge in the summer season, generous drinks, ex- hilarating company, sound sleep, mental solace, and con- genial sympathy of the attendants are absolutely neces- sary, and mightily contribute to complete the recovery. These are powerful auxiliaries in cases of extreme ex- haustion and emaciation to strengthen convalescents, who have long suffered the agonizing tortures, and the con- suming evil effects of a protracted disease; but the timely use of the cold water will always dissolve the obstruc- tions in good time to prevent all these fatal or pernicious consequences of inverted motion, injury ofthe intestines, and extreme emaciation. When palsy supervenes in the first stage of the disease, before this universal exhaus- tion ensues, the external frictions of the palsied extremi- ties with mercurial ointment, contribute powerfully to re- move the loss of sensation and motion; we have often cured this species of palsy, originating in obstructions of the intestines, by the internal use of the submuriate of mercury, and the applications of mercurial ointment ex- ternally, carried to the full completion of salivation, even where great affection ofthe brain had ensued in previous attacks of the disease. In cases of long and repeated obstructions, we have seen the brain affected with violent intermittent pain; the patients during the paroxysms con- vulsed into apoplectic stupor of all their senses, epileptic contraction and tetanic torpor of the universal frame, and restored to perfect health by the use of diffusive stimu- lants, and the resolving powers of the submuriate of mer- cury, even after complete palsy of the one half of the body had long existed. 40. Dysuria and Ischuria are other great evils that often occur in cases of violent bilious obstructions, and invert- ed commotions of the intestines, especially in the latter period ofthe disease; these diseases, as well as other fixed pains ofthe viscera, may be relie^sd by opiates, demulcents, warm baths, and the catheter. Epilepsia, or convulsions, may also supervene in violent cases of the disease, and we must proceed to remedy it in the same method we have instituted for the cure of consequent palsy and falling sickness, and of the bad consequences of the obstructions. Hysteria too often occurs in these ob- structions ; and in addition to the remedies we have already prescribed in the obstructions themselves, we have only 29 to add the medicines most beneficial for removing that flatulent disease, as assafcetida, sulphuric eether, ginger infusion, decoction of valerian, hartshorn conjoined with aloectic purges. 41. Tetanus, or rigid spasms of the jaws and neck, or whole body, often arise in obstinate cases of intestinal obstructions; but this combination ofthe disease requires the same remedies recommended for the obstructions themselves. Many other combinations of this horrible disease might be mentioned in this place, but as the suc- cess in the method of cure, which we have proposed, depends on the skill and judgment of the practitioner wisely and diligently fulfilling its great indications of cu- ration, we shall leave them to his penetration and wisdom, and shall close our discourse with a subjunction of a few testimonies and attestations of the constant and infallible success of our method of curing the forementioned ob- structions of the intestines. Especially as we consider them cases of the most direful intestinal obstructions, with all their terrible combinations successfully treated, of great importance to the world, and of great advantage to physicians in the history of their curation. We shall, therefore, subjoin a concise history of three or four cases, which have lately occured in this city; and we venture to say that the living monuments of the restorative powers of the remedies employed, would come forward to attest the notorious facts of their surprising recoveries. CASUS PRIMUS, 42. G. A. aged 35 years, strong and robust, accustomed to full living, habituated to the frequent use of spirituous liquors, formerly inured to hard labour, exposed to the heat of a burning sun, constitutionally costive in the bowels, is subject to obstructions of the intestines with violent pains in the posterior part of the brain, and ac- companied with palsy of the right side, especially of the muscles ofthe mouth and eye; has undergone temporary oblivion of all the senses, or fits ; has been frequently re- lieved by the use of strong purgative medicines, given to remove the agonies of the head; has been attended by 30 many physicians of the city, none comprehended the real nature of the disease; supposed it to be an organic affec- tion ofthe brain; has been bled, and blistered in the head repeatedly, for the supposed disease of the brain; has de- voured an ocean of medicines in vain; has already been six weeks under the most excruciating tortures of an ago- nized brain; has a family dependent on him, and his at- tending physician invidiously refused to receive my consul- tation on his dreadful malady. These are the principal circumstances of the case related by the patient himself, in answer to my scrutinous inquisition into the causes and nature ofthe disease. For he dismissed all the other phy- sicians. 43. On the 11th of October, 1817, he sent for me in opposition to all the invidious objections of his former physician; and in compliance with the salutary advice of a real friend, in the morning watch of the night; and on my appearance he informed me of all the circumstances of his sufferings in expressions of despair, viz. that he had not slept an hour together, for six weeks; had been all that time confined to bed; had undergone agonies worse than death; was now about to perish under them in this state of horrible emaciation; had vomited all kinds of food and drink, from the beginning of the head-ache : adding, that he had called me to see if I could afford him any relief and that if I could not help him, he would pe- rish in the course of fourty-eight hours; because no other physician was able to save him, and he was unable to en- dure such impatible torture; I was moved with pity at his deplorable condition ! I was struck with the consumed appearance of his miserable body! I became impatient to relieve the intolerable agonies of his afflicted brain, and the incessant vomiting, returning with every accession of the intermittant pain! and repljed, in the confidence of helping him—* I think I can help you very soon;" in order to inspire him with some hopes of recovery, and to ensure the confident use of my^ remedies, and immediately pro- ceeded to administer those medicines, which I intuitively proposed to myself on understanding the nature of the disease. 44. The first indication in the method of curation, which I then instituted for this dreadful malady, was to remove the internal obstructions of the intestines, and evacuate 31 iheir injurious contents, and to correct their morbid con- dition, that had induced all those agonies of the brain, palsy of the right side, in consequence of the disease of the fountain of all nervous influence, and the in- cessant vomiting induced by the combined irritation ofthe obstructions of the intestines, and the secondary confu- sion and disturbance of the brain, morbidly affected at the origin of the nerves of motion and sensation. Thus I intended the removal of the efficient causes existing in the bowels. The second indication of cure was to eradicate the mor- bid effects produced m ihe bain, and to remove the ob- structions of the nervous influence thence proceeding, to perfect tiie restoration of the health of my patient. 45. I proceeded to remove the exciting causes, viz. the obstruction and torpor of the moving fibres, and the ex- cremental load of the intestines, in order to prevent the repetition of the awful paroxysm of insufferable agonies, which consisted in excruciating intermittent pain in the posterior part of the brain, within the inferior portion of the projection of the occipital bone of the head; conco- mitant vomiting of the contents of the stomach and intes- tines ; vehement contortions of the whole body during the continuance of the agonies; consequent stupor of the senses, and torpor of the universal frame, or a total obli- vion of all sensation and motion, following in regular suc- cession the dreadful agitation. This paroxysm of consum- mate miseries was generally finished in the course of half an hour, and as often reverted in all its violence. No fever existed in the body; the pulse was rather slow and hard; belly was contracted; no evacuations for many days; tongue white; urine red; great thirst; skin dry; immense prostra tion of strength; countenance ghastly; which clearly de- monstrated to my intellectual discernment, the causes and nature of the disease, characterized by two great signs of distinction, the primary obstruction of the intestines, and the secondary perturbations of the brain, which immedi- ately imparted to me the immediate knowledge of the me- thod of curing them, followed in the course of the treat- ment of the subsequent case of this distressing malady. 46. The first medicine 1 administered in conformity to this instituted method of cure, was the following energetic purge:—I took ten grains ofthe submuriate of mercury, and a drachm ofjalap, and mixed them in combination, in currant odi jelly, as a convenient vehicle, and caused him to swallow it in my presence, and ordered it to be repeated in the course of two hours, on the event of its not purging the bowels. After the effectual operation of thislmedicine,l commanded him to take twenty drops of the tincture of digitalis, four times a day in cold water, in order to relieve the confused brain, and assist the effects of the purge; allowed him saline draughts of the water of the acetate of ammonia, and ginger beer, decoctions of Indian arrowroot and bar- ley , forbid all solid food; enforced quietness in the apart- ment; ordered bathing of the feet and head. 47. I called in the evening, and received the joyful in- telligence of the remarkable effects of the purgative me- dicine, which had completely evacuated the intestines of the most offensive, putrid, and noxious excrements; and so wonderfully relieved his stomach and brain, that he slept soundly all the remaining part of the day. This was the first sleep he had enjoyed these six weeks past; says he feels as if he was in a new world. I prescribed the repetition of the dose of the submuriate of mercury alone, and ordered all the other remedies to be continued. Oct. 12th, Appeared very easy; had two slight parox- ysms in the course ofthe past night, slept a considerable time, vomiting has ceased, complains of a numb feeling in the affected part of the head, the palsied eye remains wide open during sleep, muscles of the mouth on the right side, are still destitute of motion. I again ordered four ounces of epsom salts to be taken immediately, as the calomel had not operated, and the dose of mercury to be repeated again at bed time, to solve the general torpor of the intestines. 48. Oct. 13th. He has experienced very slight and evanescent accessions of the pain since yesterday; a ge- nial moisture on the skin; urine more natural; pulse regu- lar; medicines produced little purging effects; watched all last night, on account of sleeping in the day; now in- clined to sleep; desires food ; allowed him soup, and or- dered the dose of ten grains of the submuriate of mercu- ry to be repeated in two pills ; all the functions nearly na- tural. Oct. 14th. He complained of no pain in the head ; bow- els are well purged by the combined powers of cathartic medicines; the palsy still remains ; let him have nutritious diet. 33 Oct. loth. He experienced some slight tingling pains, of the head since yesterday; has had no stool to day ; let him take the submuriate of mercury in five grain pills every two hours, till salivation is produced. Let him omit the digitalis. Oct. 16th. His gums are tumid and painful, belly rather bound; let him take a drachm of jalap. Oct. 17. Medi- cine operated little; he walks about in his apartments, eats and drinks, has experienced no return of the head- ache let him take four ounces of epsom salts. Oct. 18th. The medicine produced two or three scanty motions; bowels still labour under the influence of torpor; let him have drastic pills composed of the sub- muriate of mercury, aloes, colocynth, gamboge, scammo- ny, and oil of peppermint, to excite purging and correct the state of the intestines, and let him use the warm bath in the evenings. Oct. 19th. He has no complaint except the numbness of the head; evacuations still scanty, let all the medicines be continued. Oct. 20. Copious discharges of very putrid excrements, by the drastic purges; let him continue his medicines. Oct. 21. His appetite is good, dejections free, still of a black and noxious appearance; let him omit the pills and take epsom salts to-day. Oct. 21. Functions all natural; alvine evacuations co* pious, and walks about as usual; but the palsy still re- mains in the same degree. I have considered him con- valescent. He may repeat the pills occasionally, to pre- serve the regular dejections of the intestines, till the na- tural activity of their moving powers is perfectly restored, omitting the submuriate of mercury in the composition, as the gums are greatly inflamed and teeth loosened. 50. Now we may learn from the history of this remark- able case of obstruction of the intestines, producing a loss of sensation and motion in the side; especially ofthe head, without any great pains of the bowels themselves, these three important facts and positions, 1, that all the evils in the head proceeded from the obstruction of the intestines as appears from the notorious facts of the disease of the brain vanishing as soon as the dead and obstructed state and condition ofthe bowels were corrected and removed by the use of purgative medicines. I believe, however, that the a 34 virtues and effects of mercury on the bowels, on the brain, on the nerves and muscular fibres, were the efficient powers which eradicated all the morbid evils existing in those important viscera, and permanently re-established their sound and healthy actions and motions in his con-* stitution, together with the auxiliaries of the warm bath, and those other medicines exhibited in combination. 51. 2, That the secondary mischiefin the brain and nerves, continued sometime after the primary local affection of the bowels was removed, and that it required a considerable length of time to dissolve the nervous obstructions. 3, That the disease was unfortunately misunderstood in its nature, and origin, and seat; and that the method of cure was in consequence of this error, falsely instituted, even to the danger of the perdition of the unhappy patient; and that he was saved only by the wise interposition of providence, in directing him to a bodily saviour. CASUS SECUNDUS. 52. This is a case of violent obstruction of the intestines, supposed to be produced by the action of lead on their muscular and nervous fibres, constituting the most dismal complication of bodily disease, that can be conceived in the wide domains of human intellect. June 25th, 1817. Elias R----s, a native of England, aged 35 years, strong and robust, a painter by trade, com- plains of violent pains in the belly, concomitant vomit- ing, obstinate constipation ofthe bowels, loss of appetite,- anxiety, &c. Let him take a drachm of jalap, and ten grains of the submuriate of mercury in composition imme- diately, and if this dose does not operate in the course of three hours, let him take two ounces of castor oil, or four ounces of epsom salts in repeated doses, till purging is pro- duced, unless constant vomiting should forbid and defy their administration; and cathartic clysters may also be given. June 25th. Medicines all rejected, symptoms still ur- gent; let him take two pills of the submuriate of mercury, containing ten grains each, in the course of four hours, and the strong clyster of the muriate of soda, jalap, 35 and the infusion of senna must be perseveringly repeated every half hour, till ten are administered; should these fail, inject two gallons of warm water into the colon, in order to solve the intestinal obstruction. 53. June 26th. These remedies have seemingly dis- solved the obstruction, and induced copious evacuations. I left him convalescent. July 9th. Mr. Gordon entreated me to visit him again and try to save his life to his poor family, and promised to pay my charges. Now I find him labouring under a more violeVit attack of the same relapsed disease, and Dr. S. has attended for several days, and has given many purga- tive doses of medicines in vain; ordered many clysters; prescribed fomentations ; and bled him, supposing the dis- ease to be colica pictonum, painters'' cholic, degenerated into inflammation ofthe intestines. We consulted together respecting the best method of cure. He considered the patient as mine, as I attended him previous to his being called in, and he proposed a repetition of the bleeding, blistering of the belly, warm bath and laudanum, infusion of senna, and a solution of salts. I agreed to this course of treatment, and put all these remedies in execu- tion. July 10th. Our patient somewhat easier. Dr. S. again proposed clysters of starch and laudanum, and calomel pills, as the dejections were small. I also administered these remedies with great perseverance. * July 11th. The symptoms have returned with all their former violence; no solution of the obstruction seems to have taken place. Dr. S. neglected to come, and I ordered two ounces of the sulphate of magnesia to be given and repeated in the course of the day, and if the stomach rejected them, the submuriate of mercury to be exhibited in ten grain pills, till three weie taken before bed-time gave eight strong clysters, used frictions and fomentations of the belly with my own hands, and again left him to en- dure another sleepless night. 54. July 12th. All the most powerful cathartics, clys- ters, anodynes, antispasmodics, frictions of the belly, were again tried in vain. Dr. S. never returned ; his opi- nion, and the opinions of all weie, that he would inevi- tably perish. I reluctantly left him to suffer another miserable night. 36 July 13th and 14th. The severity ofthe symptoms somewhat abated. July 15th, 16th, 17th, 18th, and 19th. The disease seemed to vanish by the powers of drastic purges. July 20th. All the symptoms returned in their wonted violence. I proceeded on the same plan of cure to re- move the obstruction; but principally depended on the use of the submuriate of mercury for dissolving it, as I found the bowels in a very torpid state. I also adminis- , tered epsom salts. I believed the whole cause of the re- petition of the disease 'to be this torpor of the intestines, and consequently always endeavoured to remove it. July 21. The submuriate of mercury has affetced the mouth without loosening the obstruction of the bowels, and all the evils continue, notwithstanding every remedy being urged with the utmost exertions. I gave him an opiate to compose him in the night. July 22d and 23d. Continued in the same state; I used tobacco clysters in vain. July 24th. Experienced a notable remission of the ur- gent symptoms, by the use of the cathartic mercury and salts. 55. July 25th. All the evils returned in their usual ve- hemence, and I began to observe a remarkable sinking of the animal powers; great exhaustion; racking tortures; incessant vomiting; and deplorable emaciation seemed to prenipnstrate the approach of sudden dissolution ; yes, in the course of twenty four hours, if immediate relief is not obtained. I used all the remedies ever employed in the cure of intestinal obstructions. Tobacco clysters and quicksilver, I urged with the greatest vigour. I continued these till all hopes of success in any future trials had for ever vanished ; when it just occured to me that some external remedy might still be tried to dissolve the hi- therto invincible obstruction of the intestines. I remem- bered the great effects of cold bath on my own body in educing the excrements—I recollected the wonderful powers of pounded ice and snow on a strangulated hernia— I considered the remarkable effects of cold applied to the naked body, on the sensible intestines, and immediately concluded, in my own mind, that cold water, applied to the lower extremities, would infallibly dissolve the obstruction of the intestines^ by bracing their fibres, 37 and restoring the natural energy of their peristaltic mo- tion. Then I lifted my emaciated patient out of bed, placed him in a chair, and dashed cold water over his belly and lower extremities with great force and replaced him in bed in the evening of the day. July 26th. In the course of half an hour after the cold affusion last night, great lumps of glutinous, black, putrid, and offensive excrements were evacuated, and all the symp- toms of intestinal obstruction in consequence vanished, to the unspeakable joy of his poor family, and all the surround- ing friends. I then corrected the torpid condition of the intestines with calomel and other purges, and charged him respecting his future diet, and the disease has never re- turned, even to this day. CASUS TERTIUS. 56. Another case of obstinate obstruction of the intes- tines, which proved invincible to all remedies commonly recommended in cases of indissolvable constipation ofthe bowels, ultimately cured by the cold effusion alone. March 25th, 1820. Terence T----y, aged 34 years, a native of Ireland; complains of violent pain in the region of the navel; incessant vomiting; pains in the head ; long costiveness; and of having been thrown into convulsions in consequence of these agonies. I found that he was ad- dicted to spirituous liquors; irregular living; lived in a damp house, and was much exposed to the vicissitudes of the weather; has some fever. I gave him a powerful dose of the submuriate of mercury, and administered many strong clyters in the course of this day, which re- medies produced no good effects in removing the obstruc- tions; although the clysters caused copious discharges of fetid excrement. March 26th. Has taken six five grain pills of calomel without any operation; medicine yesterday was rejected. 1 again repeated the clysters, ordered fomentations, and commanded the pills to be continued. 64. March 27th. All the symptoms of a most grievous obstruction of the intestines are now increased; no hopes of relief from any of them, except the cold adfusion, and 38 he will not submit to its application, on account of the coldness of the weather and his chillness. I left him to reap the fruits of a miserable night. March 28th. Yesterday he called Dr. S. who proposed warm bath, blisters to the belly, clysters, and mechanical dilatation by warm water; all these were employed in vain, and we had to leave our patient to another restless night March 29th. Sent for me early in the morning, prayed me for God's sake to come and save his life, in the appli- cation of any remedy I pleased. I hasted to his chamber, ordered him out of bed, dashed cold water over his shiver- ing limbs, and replaced him under the blankets, and in the course of half an hour, a pint of oily gall and putrid matter was dejected from the intestines, and all the symptoms of obstructions for ever disappearedr CASUS QUARTUS. This is a most important and notorious case of an ob- struction of the intestines, produced evidently by long fasting, cold feet, and a voracious repast, and cured by the urgent administration of cathartic potions and injec- tions, where the direful sonsequences of it were far more intolerable than the obstruction itself. For the peristal- tic motion of the intestines being inverted previous to the solution of the obstruction, augmented insufferably with the presence of bilious excretions, and of excrements re- tained in the valular complications, or doubles of the ir- ritable colon, notwithstanding the daily and multiplied use of purgative medicines. Some physicians considered this case of inveterate disease bilious cholic; others ima- gined the presence of great inflammation of the intestines; but all unanimously agreed to pronounce it irremediable. Alas, for the helpless patient! alas, for his helpless infants and miserable spouse ! may the God of mercy protect the innocents. 57. Dr. K. Dr. M. Dr. M. Dr, M. Dr. G. Dr. C. and Dr. D. all visited him successively, and in consultation. One proposed bleeding,and he was bled; another advised warm bath and fomentation, and he was bathed in warm water? a third mentioned purgatives of calomel, and he was re- peatedly purged; a fourth promised success in the use of 39 laudanum and barks; his stomach rejected them both ; a fifth urged the necessity of nourishing aliments; the sto- mach retained nothing; a sixth ordered opiate clysters; they instantaneously escaped from the mouth; and the se- venth suggested pills of solid opiumrand chicken soup to be administered alternately in regular succession, and saved his life, after the endurance of ten days of despair, under the awful pressure of multiplied agonies. 58. This divine course, suggested to the judicious patient, was conceived in the depth of human wisdom, and ma- tured in the womb of penetrating genius! Either the su- perior power of human skill, or the God of nature saved him ! The unparalleled nurse so divinely qualified, and providentially sent, directed the wheels of the saving course ! no deviation of her intellects, no alterations of her benevolent hands ever marred the course of her pro- cedure ! and the anxious patient was the sovereign guide. Ten days tolerance of the exquisite tortures of inverted action drained the patient's vital moisture, and presented him a spectacle of emaciation ! eight weeks of diurnal and nocturnal vigilence, unnerved the faithful matron, and constrained her to repose ! nothing was wanting to solace the mind and refresh the body of the wretched sufferer! no species of nutriment, no kind of application, no sort of beverage, no situation of his macilent frame was de- nied him. 59. Having in that space of time affected a notable tran- quillity of the internal commotion, and diffused a hopeful serenity over his meagre countenenance, by the constant use of opium, reficient aliment, and conducive attendance, I still continued my incessant exertions to raise my patient from sinking extenuation and debility, as well as to remedy the new evils which daily occured in consquence. Dysu- ria was a long, tedious, and painful mischief to retard his convalescence. I applied warm fomentations to the pubes or bottom of the belly, ordered small doses of nitre and gum arabic, allowed the opiates in diminished doses, and prescribed bathing ofthe feet, and it vanished in the course of two months. Tumours of the feet and legs were other great evils, which I had to combat during his convales- cence. To brace the weakened contexture of the crural integuments, I ordered cold marine water to wash them frequently; a cotton roller to enwrap his swollen limbs, 40 and, as he could drink nothing vinious, or spirituous, or warm, I ordered soda water for his constant drink; bitters occasionally, and mild laxatives. This tumid state ofthe feet was attended with the most excruciating pain in the calf of the leg, that my patient could not move it out of bed for two or three weeks. I applied blisters, fomenta- tions, anodyne frictions, and ultimately cold affusion, in vain; it ran its course, and disappeared on the acquisition of strength. Another consequent evil continued to im- pede the convalescence, viz. the great irritability of the stomach and intestines, which prevented the use of solid food, wine, and even thin and light gruels, except in very small quantities. The presence of any thing in the bowels, irritated and distressed him. His belly was tender, and painful on pressure; he had a slight fever in the course of the protracted disease, arising from irritation and debility, and the tongue was white. The disease occupied the colon principally, and there seemed to be a constriction of it near its left curvature, about the middle of the stomach. As this case is so interesting to all parties, I shall also translate some particulars of the treatment, as an extract from my latin journal. Feb. 6th, 1817. M. E. aged 30 years, a native of Ca- ledonia, lank and tall, delicate in the constitution of his intestines, subject to bowel disorders, otherwise strong and healthy in the absence of ventral diseases; was seized last night immediately after a hearty repast, in con- sequence of twelve hours fasting in the damp cold of the brumal month, with a violent pain in the region of the navel, arising from the intermittent spasms of the intes- tines, extending its intolerable anguish inversely along their capacious tube, even to the sensible stomach, pro- ducing nausea, and distressing vomiting of their contents; this dreadful paroxysm of spasm, with all its concomitants. was generally finished in the course of half or quarter of an hour, and as often repeated; a total suppression of the natural excrements also existed. His stomach rejected all purgative medicines, and twenty clysters were exhi- bited in the course of this restless day, without affording any alleviation of the present agonies; orders were given to administer fifty drops of laudanum, and in the remis- sion of spasm, twenty grains ofthe submuriate of mercury in two separate doses; and the patient was left to consume a sleepless night. 41 Feb. 7th. AH the symptoms continued in their hester- nal violence; some scanty evacuations of hardened feces happened in the night. The submuriate of mercury was totally ejected from the stomach by vomiting. Injections of warm water, to distend the universal bowels were em- ployed this day in vain. Feb. 8th. The distressing evils are greatly increase&in their frequency and violence; impatible spasms of the sto- mach, and faintings ensued to augment his misery; the ob- struction remains: let the affusion of cold water be immedi- ately put in execution. In the course of an hour copious dejections of bilious excrements followed this application in the total solution ofthe obstruction. Let the submuriate of mercury be now repeated, to cleanse the loaded intestines, and to permeate their vascular tissue ; and let an anodyne be given on the event of its effectual operation. The pa- tient was composed to rest. Feb. 9th. All the sypmtoms of inverted motion of the intestines began to appear in all the severity of an exter- minating disease. The calomel purged previous to the re- turn of pain, and now every thing is rejected, and even the very clysters injected at the fundament, whirled in- stantaneously up into the stomach and rushed out of the mouth in one continued Btream. All the attendants were alarmed at the occurrence, and supposed the immediate approach of death. This produced the most excellent ex- purgation that ever was induced in the case : but, alas ! in a direction repugnant and contrary to nature. I then considered the present stage and progress of the disease, and inferred, that this inversion of the intestinal motion, was the only remaining symptom of a dangerous tendency, that some morbid secretion of the liver, bowels, pancreas, or an abrasion of the intestines themselves, perpetuated this preternatural action, and I determined to pursue the following sanative course of treatment, viz. to still the spasms of the morbid commotion, to dilute the diseased excretion, to correct the morbid secretion, to support the cadent system, and to heal the injured bowels. I com- manded the faithful and obedient nurse to give him a grain of opium every six hours, or every eight hours, if it induced any stupor; and during the intervals of ease thus procured by it to administer the most nutritious aliment in small 6 42 quantities, and to increase it, as the stomach of the patient could bear the presence of food. Feb. 10th. I now found this method of curation most successful, and repeated all my orders with one addition- al command, to give any kind Of light nutriment- that he desired, and that rested easy on the stomach, as he had a peculiar choice of chicken soup, indian arrow root, boiled bread, eggs, soda water, ginger beer, cold water, infusions of columba root and chamomile flowers; and an utter aversion to all vinous or spiritous liquors, barks, every kind of solid food, calybeates, milk, lime water, and every other kind of drug, except the submuriate of mercury and epsom salts, to exonerate the bowels occa- sionally of their irritating contents. I again ordered the same course to be continued every day, until all the com- motion of the intestines should be finally calmed; and the five days following were consumed in the diligent pursu- ance of this method of cure, before the natural peristaltic motion of the intestines was permanently restored, when a tedious period of convalescence ensued, in the use of every means to repair the broken constitution. Many other cases of direful obstructions of the intes- tines successfully treated on the same method, might be translated and subjoined to this dissertation, but we have deemed these sufficient to attest the facts of the infallible success of this plan in all cases which have come under our care, and to establish the doctrines of their nature and cure which we have advanced in the forgoing discourse. Morbumque vidi, tractavi, recentem, provectum, diu- turnum, annosum, inveteratum, cum omnibus suis varian- tibus quidem signis, eundum et concomitantibus et subse- quentibus modificatum. Nondum morbi naturam obstru- sam reperii, nequaquam curandi methodum esse difficilem. Ipsi paroxysmum neque praesentem horruimus, neque ex- haurientes vomitus, intolerabiles dolores, convulsiones ter- ribiles,ejulatus penentrantes, spasmos maxillarum dirissi- mos, distentiones nervorum violentes, paralyses membro- num miserabiles, quae omnes medici recentes et veteres reperierunt et stupuirunt, ignorantes naturam et curatio- nem. Vitam conservare, dixerunt, oportet emeticis, pur- gantibus, immutantibus, diaphoreticis, sedantibus, em- mollientibus, omni modo applicatis, interne, externe, ore, aon, utamur. Sed experientia vera docuit omnia esse in- 43 utilia, casijius in multis, eosque ad alia potentiora confu- gere induxit, ut clysmata fumi et infusi nicotianae, cata- plasmata emmollientia toti abdomini circumdata, compres- siones manibus, decocta farinosa, balnea tepida, dilata- tiones intestinorum artificiales aqua in anum injicienda, aliaque remedia pauca, quae infauste omnes eorum spes aeque felellerunt. Ratio atque experientia externum aquae gelidae usum in obstructiones intestinorum Iliacas aeque ac colicas, educendo dura et retenta excrementa reme- dendas, comprobarunt. Ileum saepe dirum allidendo in- ferioribus nudis aquam frigidam sanavimus, aqua enim frigida in corporis nudati inferiora incussa miro operandi modo omnigenas intestinorum obstructiones a faecibus valde noxiis in horae dimidio slovet. Frigus, quam dix- imus priore, constringendo et reficiendo inas intestinorum, materiem obstruentem ileos liberiorem in partem impellit, animando motum intestini peristalticum ad solvendum im- pedimenfum, eademque constrictionis vi solvet alvum: ignavia enim actionis, inertia motus, paralysis intestino- sum, naturalem energiam impertire stimulantissima reme- dia et cathartica postulant, intus-susceptio intestinorum partium est plaerumque irremediabilis stercoris duri bili- osi, glutinosi, globatique coacervatio et stagnatio, potenti- tissima quidem purgantia requirunt. Et medicos tandem omnes orbem terrae incolantes universum, ut singuli ob- servationibus suis inlucem proditis, testimoniisque prola- tis methodum sanandi nostrum in conspectu omnium comprobarent tentandis remediis, expereintia discendis eorum vertutes, secundum praestantia superioris rationem, serio petimus. Dantur nonnunquan colicae pictonum, ci- tra notabiles dolores: quas attamen amaurosis, paralysis, aphonia, insequantur. Id observavimus in casu G. A. et sanavimus aegrum. FINIS