of dysentery have been found to be owing to a similar affection of the large intestines. It is when this inflammation supervenes in the autumnal diarrhea of infants that the disease assumes its serious and threatening aspect; and it is at this time that the popular remark is made, that now "the canker has seized the bowels."* This inflammation is no doubt much more extensive and more severe during life, than it is found to be after a slow and lingering death. In different cases it no doubt varies in extent and violence; whence it happens that the symptoms appear more or less fully, and that there are "cases intermediate" between this disease and the diarrhoea, as stated in section XXII.

LIV. A partial view of this subject might lead to the opinion, that the cholera does not differ from what we have called the diarrhoea of teething children, except in degree; that when the causes of the diarrhoea act with unusual force, or for a long time, they produce that disease in its more severe form, and that it is then called cholera. Such however we are persuaded is not the case. The cholera may be produced by the same remote causes, as those which produce the diarrhoea, only acting with greater force, or for a longer time. But the cholera does not appear to be merely an increase of the other disease. The evacuations in the diarrhoea may be frequent and copious for a considerable length of time, without producing that prostration and general irritation which ensue at once in cholera, even in cases where the discharges are not frequent nor copious; and those formidable effects will sometimes take place suddenly in cholera, when affecting children previously in full vigour. The cholera is not therefore a discase to be distinguished from diarrhoea as to its cause, only by greater debility in the parts affected. This conclusion is strengthened by comparing the effects of cholera with those of diarrhoea in young infants, as described in section XLI.

The author is ready to acknowledge his own error in having often unjustly ridiculed this popular distinction. The real similarity of the affection of the bowels to that affection of the mouth, vulgarly called canker, and described in section xxx. is very obvious. In the small intestines it is not commonly, if ever, accompanied by ulcerations, like those in the mouth; but in the large intestines this sometimes occurs. See note to § XXXVI.

LV. The inflammation of the mucous membrane of the stomach &c. which exists in cholera is rather of the chronic than acute kind. It varies in force in different subjects, but is never, or very seldom extremely severe. When it is so, it produces the symptoms of cholera suddenly and in great severity; and for the most part, when not counteracted by medical treatment, proves fatal in a short time. All this happens more readily if the inflammation be near the cardiac orifice of the stomach.

it

LVI. To the foregoing considerations it may be added, that the effects of inflammation of the mucous membrane of the stomach and small intestines, in subjects of all ages, are in the most important respects, similar to those displayed in cholera infantum. This last disease has certainly individual features, which distinguish it from other diseases of the same family. It has been the endeavour of the author to point out those peculiar features, but the task is a difficult one, and he is not altogether satisfied with his own success. The causes of this individuality are to be sought in the characteristics of the subjects of the disease; and those are referable to age and to the process of dentition in which those subjects are engaged. See section

LVII. A few remarks shall be added with a view to the ratio symptomatum. The effects of inflammation vary according to its kind and degree, according to the structure of the part affected, and according to the organ affected. To discuss the subject in all these respects would lead us too far. It will suffice to state that the following are the legitimate effects of the inflammation in cholera infantum.

First. The sensibility and the irritability of the parts will be augmented.

Second. The parts will cease to perform duly their proper or peculiar functions; as for instance the stomach will not digest food, or not without difficulty.

Third. The parts will secrete fluids different in quantity and quality from those secreted in health.

Fourth. The organs affected will be in some measure incapacitated from contracting strongly and vigorously to propel their contents; while, in consequence of the increase in their

irritability and sensibility, they will frequently be excited to painful efforts for this purpose.

Fifth. Not only the organs immediately affected, but others, subsidiary to them, will have their secretions altered in quality, and for the most part increased in quantity.

Sixth. The constitution will be affected by sympathy; more powerfully, if the inflammation affects the stomach in any considerable degree; less, if it be confined to the bowels. Also the whole system will suffer, though not so immediately, from the want of nourishment.

A comparison of these remarks with the description of symptoms will perhaps afford a sufficient explanation of those symp

toms.

(To be continued.)

CASES

OF

ORGANIC DISEASES OF THE HEART AND LUNGS.

BY JOHN C. WARREN, M. D.

In the commencement of the year 1809, I had the honour of communicating to the Massachusetts Medical Society some cases of organic diseases of the heart, in which were mentioned the Clinical Lectures of Professor Corvisart, a few of which I had attended in the hospital of La Charité in the year 1802. Since the time of that communication M. Corvisart's lectures have reached us, and unfolded the history of these diseases in the most satisfactory manner. As a translation of this valuable work is promised the American public, I shall not pretend to give any account of it at present; but continue to contribute my labours to the general stock of information, by occasionally selecting and publishing a few of the numerous cases that are presenting themselves. Of the three cases, which I have at present selected, the first has been chosen because it affords an opportunity of comparing the symptoms produced by an aneurism