The body was examined by Stoll himself. The pleura, the internal and external surface of the pericardium, each surface of the diaphragm, the fat behind the heart, were dotted with petechial spots. The blood contained in the larger veins was dark, and perfectly fluid; the heart itself was dotted with petechiæ. There were a few on the peritoneum and intestines.

The outer surface of the rectum was perfectly black, the colour of ink; and the omentum had the appearance of being bespread with pulverized charcoal. The uterus had, on its exterior, substances of the character of white warts.

With respect to the brain, each of its meninges was spotted, principally on the left side, where there had been hemicrania, with large petechia, of red, blue, or black colour. There were also many in the substance of the brain. The left ventricle was highly distended with a very yellow fluid, and the walls of each lateral ventricle were thickly spotted with petechiæ.

The cerebellum was marked with unnumbered spots of this kind, large in size, red or black in colour, both as to its surface and in its substance.

The petechiae on the surface of the body penetrated very deeply even to the subjacent fat, but not into its substance.

When we construct nosological distinctions, it is not meant that the several heads of the arrangement are distinct in essence, but that they have sufficient points of difference to warrant our viewing them as distinct

for practical purposes. And thus, I imagine, the petechial fever, extracted from Stoll, may be considered as distinct from the petechial phlegmasia, of which the three preceding cases bear the character; while these again have affinities, and, at the same time, important distinguishing points, in reference to enteritis.

CHAPTER III.

GASTRODYNIA.

THE method which I am adopting, ought, if I do it justice, at least to have the advantage of affording food for a love of novelty. For whereas the language of system must be unvarying, so far as the system is rightly laid down, those details, on the other hand, by which the system is broken up into varieties, present faces endlessly new, according to the direction in which we make the fracture.

But if any doubt exist, whether this latter process be one greatly desired in the present state of our knowledge, we need turn over but a few pages of any systematic writer of the present day, in order to solve it. In the 76th page of Dr. Abercrombie, "On Diseases of the Stomach, and other Abdominal Viscera," we find the disorder, Gastrodynia, admirably described under

three heads.

1st. Pain occurring when the stomach is empty, and rather relieved by taking food.

2ndly. Pain occurring immediately after taking food, and continuing either during the whole process of digestion, or until the stomach is relieved by vomiting.

3rdly. Pain beginning from two to four hours after a meal, and continuing for some hours.

Both the two last heads Dr. Abercrombie, in some degree, connects with inflammatory action. But when we proceed to those distinctions in the principle of treatment, which may give practical effect to the nosological division, we are met by an admission, "that it is difficult to say what remedies are best adapted to each of these forms of gastrodynia." That he has found nothing of more general utility than the sulphate of iron in doses of two grains combined with one grain of aloes, and five grains of aromatic powder, taken three times a day; that oxide of bismuth, combined with rhubarb in the same manner, is also very useful, likewise lime-water and small opiates; and that when the affection (what affection?) proves obstinate, it must be treated with topical bleeding and blistering, with farinaceous diet.

This is that triumph of pathology over therapeutics which our brethren on the other side of the water have so successfully achieved, and which moreover they have taught us to emulate. Meanwhile, it is to be observed, that our wayward taskmaster, the public, is by no means satisfied with this vagueness of practice, however candidly avowed, and that they anxiously appeal from us to the various classes of irregular practitioners, whose ignorance of pathology guarantees them against attaching undue weight to that element of the subject of medicine. Whether the system applied to be gigantic or infinitesimal in the quantities of its doses or affusions, it is sure to be a therapeutical system confidently laid down, and generally drawn out with much attention to minutiæ and detail.

July 31, 1831.-Mr. A., a gentleman who had practised the medical profession in India, aged about 54, tall, thin, of the bilious temperament, having seen much service, and lived rather freely in early life, had been cured of a chronic affection, similar, he said, to that which I shall presently describe, about four years before, by a course of Pil. Hydrarg., continued for eleven weeks, and followed up by a visit to Carlsbad, and the use of the waters. About eight months ago he was again attacked by pain at the epigastrium, constant in some degree, but greatly increased after eating, and attended by progressive marasmus. For this he had at first recourse again to Pil. Hydrarg. ; but on this occasion it increased his uneasiness, irritating his bowels. After trying ineffectually many remedies, among the rest abstraction of blood, tonics, and alkalies, he then had recourse to mercurial inunction, which he had continued to the day on which I saw him, viz. eight weeks, with relief of pain and improvement of his general feelings, but without any arrestation of his decline in strength and weight; the latter was ascertained weekly. His pulse was quiet, and of average strength and frequency; his respiration good; his evacuations were healthy; his urine moderately acid, rather high coloured, not deficient in quantity.

Presuming that Mr. A. required the internal use of a mercurial for its perfect effect, I exchanged the mercurial inunction for the Pil. Hydrarg. Submuriat. C. gr. v. to be taken twice daily. This course was continued to the 20th of August with the most marked good effect; at first he increased in weight, but in this