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dentary invalids with which this overgrown metropolis abounds. It is not beneath the dignity, or even the prudence, of the medical philosopher to saunter along the Mall, or through the different parks, on Sundays, or other days of relaxation, to study the civic physiognomy, and contrast it with that of rural life. He will read in almost every countenance the aspiration of the Augustan poét:

O Rus, quando te aspiciam!

But it is through the medium of atmospherical vicissitudes, that the digestive organs, in polished life, suffer the worst effects. In civic society, the human race are so little exposed, or at least inured to the inclemencies of the skies, that the surface of the body becomes highly susceptible of aërial transitions; and these impressions are quickly transmitted by sympathy, or otherwise, to the interior organs, particularly those concerned in digestion and biliary secretion, as I have shown, at great length, in my work on "the Influence of the Atmosphere," to which I must refer for the details. To counteract this enervated state of the surface, the cold, or even the air bath is the most powerful remedy.

It will not be questioned that the balance of enjoyment, in respect to air, points to the country; and that of suffering to the city.

Influence of civic Life, &c. on the digestive Organs, through the Medium of sedentary Habits. When men begun to congregate in cities, they in a great measure exchanged labor for art. Now, it is well known that the muscles, when highly exerted, acquire tone

and strength, and this tonicity is extended to the organs of digestion. But, on the other hand, by sedentary habits, the muscles are relaxed and debilitated, and the digestive apparatus participates in this debility. Besides, a certain degree of exercise is necessary to circulate the blood and other juices, and promote the various secretions; without which, the liver, stomach and intestines cannot perform their proper functions. This degree of exercise is rarely, if ever, taken by the sedentary citizen, and its effects are seen in two different ways; in morbid accumulations of fat, and in paleness, emaciation, nervous debility and hypochondriacal depression.

Another way, in which sedentary habits prove prejudicial to the digestive organs is, by the mechanical pressure which the stomach and liver sustain in numerous sedentary employments, where there is much stooping or leaning forward. A great deal of functional derangement is thus induced. Indeed, every class of artizans or mechanics has its peculiar train of prevailing diseases, which it behoves the medical practitioner to study with great care. compositor who sets up the types of this page, and the pressman who works off the sheets, are affected with quite a distinct set of complaints. It is the same with all other species and subdivisions of labor.

The

The remedies are, exercise, passive or active, the cold bath, where no organ is unsound, and alterative doses of the blue pill, with, or without sarsparilla. Tonics are more frequently hurtful than beneficial.

Influence of civic Life, &c. on the digestive Organs, through the Medium of mental Emotions. The nervous system and digestive organs act and react on each other with surprising force and rapidity. The intelligence of a severe loss, or the occurrence of an, unexpected calamity will instantaneously annihilate the appetite, suspend the process of digestion, and allow the contents of the stomach and bowels to run into all kinds of decomposition and fermentation. A piece of agreeable information, on the contrary, will recal the inclination for food, and quickly set all the digestive machine again in regular motion. Now it is quite evident, that in proportion as men accumulate in large societies, those events and circumstances which tend, in a thousand different ways, to disquiet the mind, ruffle the temper and excite the passions, multiply in an increasing ratio. Compare the whistling ploughboy with the calculating stockbroker; the shepherd on the mountains with the merchant in the city; the village magistrate with the prime minister. Compare the state of their minds, and the state of their digestive organs, and you will find a corresponding contrast in both! Indeed, I firmly believe, that the mental perturbations of a civic life cause, on the whole, more derangement of function, and ultimately of structure, in the stomach, liver and alimentary canal, than all the other agents which we have been investigating. This is a subject deserving the utmost attention of all classes in civic society, as well as of the medical practitioner, whose prime object should be to ascertain the real source of a disease; for this dis

covery gives him infinite advantages in the mode of removing it.

Of all the digestive organs, the liver suffers most in this way. This I know from long and painful experience in my own person, as well as observation on others, both in this country and in tropical regions. Indeed, I have ascertained that many of the depressing passions will instantaneously spasm the mouths of the biliary ducts, when a regurgitation of bile takes place into the system at large, tinging the eye yellow, and overcasting the mind with the most gloomy anticipations, and indescribable despondency.

It is a curious but undoubted fact, that the different mental emotions, or passions, even of the same class, produce different effects on the organs of digestion, and especially on the biliary secretion. This is so strikingly the case, that by examining the morbid conditions of these organs, I have often guessed the real origin of them; and, on the other hand, by being told the malady of the mind, I have stated, without inquiry, the corporeal symptoms in the digestive viscera. The effects of anger, for instance, are very different from those of grief. The former will often increase, and render acrid the biliary and gastric secretions, producing irritation all along the line of the bowels. The latter, on the co trary, will diminish the same s cretions, and often leave the alimentary canal completely torpid. Corresponding differences are seen to result from love, fear, jealousy, inordinate ambition, envy, &c. and the corporeal effects require an appropriate modification of treatment, a circumstance that is too much overlooked.

Study and deep thought, not only among the literary, but among the professional, mechanical and manufacturing classes of society, exert a most powerful and deleterious effect on the digestive organs, by drawing the vital energy and circulation to the brain and nervous system, and robbing the lower viscera of their due share of these important principles. This subject I have already touched on, in my work on "Tropical Climates," and also in that on "the Influence of the British Atmosphere." The subject will be again taken up in the third Chapter on the Intellectual Sys

tem.

The remedies here are partly moral and partly physical. The nature of the moral causes must be explained to the patient; though advice, in respect to the passions, or mental emotions, has seldom much effect. It is fortunate, however, that in no instance is the efficacy of well directed remedies more conspicuous than in derangements of the biliary and digestive organs, resulting from mental perturbations and anxieties. Indeed, it is astonishing how easily, not only these de rangements themselves, but even the causes that produced them, may be relieved or removed, by a few simple remedies, when the real seat of the corporeal disorder is ascertained by accurate and careful examination of the symptoms and phenomena.

Influence of civic Life, &c. on the digestive Organs, through the Medium of late Hours. Such is the harmonious balance, or sympathy, between the various organs and functions of the human frame, that no one can be disturb

ed, without annoyance to others. Thus the intellectual and animal systems being greatly deranged by the unnatural custom of turning night into day, and day into night, which so universally prevails in civic life, the digestive organs come in for their share of the mischief, through the sympathy or connexion in question; and that at a time too, when the said organs are laboring under the evil consequence of inordinate irritation from food and drink! The united effects are such as we might expect, and such as we actually meet with at every step., They are in exact ratio to the cause, and follow the commission of our crimes against Nature as closely as the shadow follows the substance!

JAMES JOHNSON.

HERNIA.

Case of Strangulated Inguinal Hernia, in which the Operation was performed a second Time in the same Place. Treated by Mr. BOYLE, at the MIDDLESEX INFIRMARY, Great Pulteney St. ON the morning of the 20th of November, 1825, Mr. Boyle was called to visit Thomas Rook, residing in Turner's court, St. Martin's lane, laboring under strangulated inguinal hernia. This patient had been operated on about four years before, and had worn a truss till within a short period of the present account, when it was left off in consequence of being out of repair. He stated that, at nine o'clock the preceding evening, twelve hours previous to his being visited, he suddenly felt a sensation as if something had given away in the groin. On examina. tion, an unusual enlargement presented itself, which increased up to the time specified above, ac

companied by gradually increasing pain over the whole abdominal region, great restlessness, and nau

sea.

The taxis was repeatedly tried in vain. An ounce of castor oil was administered, but immediately returned; and a tobacco enema was ordered to be prepared.

At twelve o'clock, the pain and the disordered state of the stomand had increased; the hernial tumor had become enlarged, and the countenance was demonstrative of considerable suffering. The tobacco enema was now admisistered; but, being unattended with benefit, and there being no immediate means of procuring a warm bath, the gentlemen present, Mr. Jewel, Mr. Wade, and Mr. Boyle, coincided in opinion that an operation should not be long deferred.

This was accordingly commenced by the latter gentleman, who carried an incision from about three fourths of an inch above the abdominal ring, in a parallel direction to the cicatrix of the former operation, to the bottom of the tumor: thus avoiding, as much as possible, the old indurated seam of the integuments. The skin, of necessity, was divided somewhat behind the centre of the tumor The cellular membrane was now exposed, and was observed to be so condensed and thickened as to have almost changed its structure, requiring particularly cautious dissection, from the further circumstance of its being composed of five separate layers, like fascia. These having been divided, the hernial sac was perforated with due caution it was laid open to the bottom of the tumor, and about a tablespoonful of serous fluid escaped. The stricture was now sought

for, and was found at the inner margin of the tendon of the external oblique muscle, and was removed by a gently conducted sawing motion of a probepointed bistoury; the index finger of the left hand serving as a director. Every part of the protruded intestine had a livid appearance it was returned as quickly, yet as gently, as possible, and the parts were brought in apposition; but, from their peculiarly thickened state, it was deemed necessary to unite them by two stitches, after which the parts were dressed in the ordinary manner, with adhesive straps, &c. All pain and uneasiness were removed on freeing the strangulated gut. The bowels were soon after opened by a dose of castor oil; and, at the expiration of six days from the performance of the operation, the parts were completely united, and the patient was in perfect health.

Case of incarcerated Scrotal Hernis of the Omentum, in which, from the Absence of urgent Symptoms, no Operation was required. Treated by Mr. BRODIE, at St. George's Hospital.

May 15th, 1826.-Stephen King, aged about thirty; admitted at seven o'clock this morning, with a scrotal hernia on the right side, which had come down a Saturday, the day before yester day, in consequence of his having broken his truss, and been irreducible since that time, though he had always been able to return it for the last fifteen years, during which period he had labored under the disease. Took some operating medicine yesterday, Sunday, which operated very many times, as he expresses it,

both upwards and downwards he likewise had a stool early this morning. The tumor is nearly of the size of a man's fist, unattended with pain or any unpleasant symptom, except its being irreducible.

As the attempts to reduce it proved unsuccessful, he was advised to remain and use the bath, &c.; feeling no inconvenience, however, and having urgent business, he refused to stop then, but promised to return in a few hours.

Took Ol. Ricini, 3i.

16th, seven A. M.--Bowels not opened; in other respects as before.

Ol. Ricini, 3i.

Three P. M.-VS. ad 3x. During the evening and following night, he had several evacuations.

17th. He is free from all bad symptoms.

24th.-Discharged, free from complaint; the tumor remaining unaltered, and being supported by a suspensory bandage. He has since applied a truss.

The following case is analogous to the preceding.

Mr. -, aged fifty one, has had inguinal hernia of the right side about seventeen years, which was originally brought on by running violently for six miles after a stage coach. The first symptom of its existence was a swell

Returned at three P. M., having had three liquid motions from the oil, and the tumor being exactly in the same state, and still unattended by pain. Was put into the warm bath, bled, and took Tinct. Opii, gtt. xl. Being then faint, the taxis was employed, and kept up for twenty minutes, during which time something appearing in the scrotum, with dull ached to pass up, and the tumor became rather smaller; but still its reduction was not accomplished.

At a quarter past seven, he was again put into the bath, and remained there till Mr. Brodie's arrival, at a quarter past eight, at which time he was very faint. The tumor being then examined, was found distinctly to consist of omentum, having several hard knobs or masses in it; but no distinct feeling was perceptible either to Mr. Brodie or Mr. Jeffreys. Though the hernia remained unreduced and was rather painful, still, being unattended by anything like urgent symptoms, the operation was not thought ne

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ing pain. This was allowed to go on for a fortnight before anything was done the hernia was then

returned, and has been kept up ever since by means of a truss. It has always been reducible by the patient's placing himself in the horizontal position, raising his lower extremities, and using gentle and steady pressure with his hand. But, on the 25th of February, 1826, it came down, in consequence of the patient's having broken his truss, and at the same time taken unusual exercise, having walked twelve miles. In addition to the want of pressure from without, there was increased pressure from within, as Mr. ——— had become eight inches larger round the abdomen within the last twelve months. On endeavoring to reduce it as usual, he did not succeed, and now felt at one part

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