If in the outset of these observations I may seem to contradict my concluding remarks, I wish it to be understood that I admit the partial, but not the total, fitness of the doctrines in question. I object still more to the rigid practice which is enjoined of avoiding the use of purgative medicine, when the appearances of the tongue are such as I have described, notwithstanding that the patient may be free from nausea, or from tenderness or pain of the stomach or bowels. I consider that the preference is greatly due to our English practice of giving occasional doses of calomel, or some mercurial alterative, in combination with suitable purgatives, by means of which the vitiated secretions, always a source of irritation, are removed. But here again, I admit that we should look watchfully to the symptoms which may indicate the necessity or the propriety of applying, with freedom, leeches to the epigastric region, and subsequent fomentations, for the relief of inflammatory action, and of using purgative medicine, in such circumstances, with proportionate caution. As a general statement, I would assert, that in the commencement of fever, continued, intermittent, or remittent, the action of an emetic, and of calomel joined with purgative medicine, is most beneficial and important; and the fear of producing _gastro-enterite_ by such measures, would lead us into the serious error of _omission_. In cases of confirmed indigestion, our improved modern pathology leads us to the employment of those means which remove inflammatory irritation; as, the application of leeches, and other local remedies; the use of mild corrective medicines, abstinence from food, which calls the digestive powers into much action, and general regimen. We avoid using bitters and stimulants to provoke that appetite which nature has so wisely denied during the irritation of disease. In active inflammation of the intestines, existing in conjunction with their obstruction, it must be our first care to remove the inflammatory action by general and local bleedings, and to refrain from the use of purgative medicines by the mouth, till this first object is accomplished, in case that such medicine causes sickness and vomiting, and evidently aggravates irritation. I do not doubt that much mischief is often produced by the solicitude of the practitioner to remove obstructed action of the bowels, instead of directing his treatment to the removal of inflammation, as the immediate and primary object to be fulfilled. I will here take occasion to offer a few remarks on the subject of Gout and Rheumatism. The theoretical opinions advanced by M. Goupil to prove the identity of the two diseases, are to me quite unsatisfactory.