source of suffering. When flatulence is in the small intestine, it is apt to give rise to rumbling, as a contraction of the bowels moves the gas (borborygmus); and with some females this is very audible to others as well as the individual.

Relaxed. Here the contents of the bowels are passed in a fluid state. This may be due to the activity of the bowel passing on the food so quickly that the fluid portion cannot be absorbed; or to excessive secretion of the intestinal glands or both. Lientery is the term used when the food is passed per anum shortly after being swallowed, and practically unchanged by the digestive act; and is an instance of the first. The diarrhoea of copious watery stools is probably the latter, chiefly at least.

The character of the stools should be examined whenever there is any question as to the nature of the diarrhoea.

Diarrhoea. This hyper-activity of the bowel may have various associations.

It may be due to irritant matter in the bowel, setting up excessive secretion with increased vermicular action for its removal. Here it is a physiological diarrhoea. (This is the form of diarrhoea 'cured' by castor-oil.)

It may be a catarrh from cold. If of the lower bowel, mucus will be present.

Or it may be compensatory to arrested renal action, the fluid having an urinous odour. Such diarrhoea is not uncommon with the subjects of old-standing renal disease.

In dysentery there are flakes of the exfoliated mucous membrane, telling of the mucous inflammation present.

Or it may be due to ulceration of the bowel, which may be tubercular.

The Stools.-The stools may be 'fatty,' when there is disease involving the head of the pancreas, and the fat is not emulsionized. With some phthisical patients their cod-liver oil passes en masse, unchanged by any digestion.

They contain mucus in muco-enteritis. They may con

tain pus when an abscess bursts into the bowels as a liverabscess.

Or the food may appear unacted upon when there is an ulcer betwixt the stomach and the transverse colon.

The stools are dark and offensive in certain bilious derangements; even dark and tarry when old secretion from the liver is passed; at least, so old practitioners talk and think, perhaps not unwisely!

Or they may be pale, as in the white stools of jaundice, indicating lack of bile. The white-scour' is a diarrhoea of children in hot climates, where the bile is deficient. In some forms of diarrhoea, and notably in typhoid fever, the stools contain milk curd. (When this is the case, it is well to stir some farinaceous matter into the milk to prevent its too firm curdling. Or some chalk in cases of diarrhoea which is not typhoid.)

In typhoid fever, the stools resemble pea soup, and are very offensive. Indeed, the character of the motion often plays an important part in the diagnosis.

In children, the stools are apt to be clay-coloured in hydrocephalus, or 'green as grass,' though this last colour is not due always to hydrocephalus; but may follow a dose of calomel. Grass-green stools usually go with malnutrition.

Then the stools may be blackened by iron taken as medicine; especially when the iron is not well-absorbed. Such stools often cause needless alarm.

The stools of meat-eaters are usually more offensive than those of vegetarians; just as are those of the carnivora as compared to the herbivora. A farinaceous dietary with milk will usually give light-coloured, and comparatively inoffensive, or odourless stools.

Small scanty fluid stools are alone possible when there is a mass, whether fæcal, or piles, or an ovary, or even the fundus of the womb is pressing into the anal ring.

Blood is found in the stools in melæna when it has been mixed high up in the bowels and blackened by the intes

tinal gases. Or from hæmorrhoids, or anal fissure. Sometimes it comes in a hot gush at stool from the rectal lining membrane, without a gross lesion, as 'passive hæmorrhage.' Or it may be due to a foreign body in the rectum.

Relation of Bowels to Brain.-These relations are interesting, curious, and often of practical importance. Disease of the brain commonly leads to lessened vermicular action and · constipation; while emotion may cause diarrhoea. Fear may relax the sphincter without affecting the fæces. Tubercular meningitis with diarrhoea closely simulates typhoid fever. A sharp purgative will often, by unloading the bowel, improve the circulation through the brain.

One point is of importance, and that is the melancholic feelings produced by a load in the colon, and relieved by its removal. Schroeder Van der Kolk pointed this out very clearly. In one case of constipation the depression of spirits was so marked that I felt sure there was some pelvic cause. The reproductive organs were examined without result by Dr. Broadbent; but on my persisting he examined the bowel and found a polypus, which was removed by Mr. W. F. Teevan, with satisfactory results. It is in a woman of highly developed nervous system that such reflex effects may be looked for. Some women are like an instrument so highly strung the least touch vibrates throughout the whole. A displaced uterus will often set up violent palpitation, which disappears with the replacement of that viscus.

Reflex Constipation.-When the vermicular action of the bowels causes pain, it is apt to be inhibited; perhaps without consciousness. Thus a tender ovary often gives rise to acute pain when the bowels move, from the pressure on it in defæcation; not only the general pressure of the expulsive efforts of the abdominal walls, but the pressure of the moving fæcal mass. Consequently the action of the bowels is arrested, and then constipation follows, with a load in the bowels and a generally worse state of matters.

Or it may be a tender uterus, or an irritable bladder, or piles, or fissure. Not uncommonly when there is tenderness of the lower lobe of the liver, there is an arrest of action in the ascending colon, with an accumulation making things worse. (Obviously here the bowels must be cleared, and be kept clear of load.) This is a form of constipation too little insisted upon in medical teaching.

Irritable Bowels.-With some persons the bowels are very irritable, and any laxative, however mild, gives great pain. As a comparatively temporary state this is seen commonly at the menopause. It is found with some delicate persons at all ages, but increases with years, speaking broadly. With such persons laxatives warm alike with carminatives and in temperature, alone are tolerated. (Hyoscyamus, or other of the solanaceæ, may be indicated to restrain the activity of the 'circular' fibre of the bowel.)

The old writers called the alimentary canal the prima vice, and paid great respect to it accordingly.

The anus may itch, with or without any eruption, when the liver is inactive: while a coppery blush around it in a baby may light up its father's early history, and, with it, much family trouble.

CHAPTER VII.

THE URINE.

Not

THE subject of the urine has never been underrated by students of medicine: whether as the water-doctor' of a by-past time; or as the physiological chemist of the present day. Views have changed as knowledge increased. more than a generation ago the deposits in the urine were carefully examined; while now there remains only the general impression that phosphates are linked with exhaustion of the nervous system. Instead of the hopes of that day being realized, the very views themselves-that in such deposits the clue to many morbid states would be found-have fallen into oblivion. The significance of tubecasts remains unchanged. The interest now seems rather to centre round albumen; and its presence or absence is assumed to be the evidence on which the opinion is to be formed as to whether the kidneys are diseased or not.

[In writing on this matter the greatest caution has to be exercised. The examination-table has hard and fast lines which nature does not always rigidly observe. I must, then, insist upon the student who pays me the compliment of reading this book, fully recognising the fact that this work is not written for the examination-table. To the examiner he must carry what is taught him at his medical school. Examiners are generally teachers: they have some general agreement among themselves as to what will be expected, and what must be taught. The medical school takes the