COMMUNICATIONS AND EXTRACTS. 67 



laxing effect upon the mucous membrane of the bowels, 

 it is greatly resorted to in habitual constipation. But 

 it will be seen that^is weakening influence is exerted 

 upon the organ liable to be most seriously affected in 

 typhoid fever, and very frequently is the predisposing 

 cause of the uncontrollable diarrhoea and haemorrhage 

 which occur in such cases. / have seen very rtiild oases 

 of typhoid fever rendered fatal, from the excessive use 

 of tobacco, either from diarrhoea or peritonitis, the result 

 of perforation. Now perforation scarcely ever occurs 

 until the patient is moribund, and the body semi-putrid ; 

 but the immoderate use of tobacco will predispose to 

 perforation under very diffei-ent circumstances. For in- 

 stance, a gentleman in my practice had progressed very 

 favorably to the fifteenth day^f typhoid fever: the 

 diarrhoea was very moderate, and the symptoms altoge- 

 ther so mild as to call for a purely expectant treatment, 

 nourishment, with very little stimulant, sufficing to keep 

 the patient in a very fair condition from day to day. On 

 the fifteenth day his bowels were relaxed at 6 in the 

 morning ; at 5 p. M. he got out to have his bed made, 

 and as his bowels had not moved since 6 A.M., he thought 

 it might save getting out again if he could evacuate them 

 at the same time ; for this purpose he made a straining 

 effort, and almost instantly felt something give way; a 

 violent pain ran rapidly across the region of the bladder, 

 and soon diffused itself over the whole abdomen; tym- 

 pany occurred within an hour, and in twenty-four hours 

 he died from peritonitis, the residt of perforation of the 

 small intestine. A milder case than this I never saw, 

 hut the patient was accustomed to smolce ten or twelve 



