The first variety indicates a strong tendency to the lithic acid diathesis: although in some cases an opposite state of system prevails, and an alkalescent condition of the stomach and bowels may be supposed to exist; in general the nearer such sediments approach to white, the more of the phosphates they contain. He says, that the second variety varies in tint from nearly white, in which state it is with difficulty distinguished from the last variety, to a deep brick-red or brown. It is to be considered as a symptom indicative of phlogistic fever, or very frequently of local inflammatory action. The third variety of sediment owes its colour principally to the Purpurate of Ammonia: its presence indicates the existence of certain chronic visceral affections, especially of the liver.

345. These observations are sufficient to impress upon the practitioner the necessity of inspecting the urine of his patient, but the indications it affords are not to be received without due caution. If taken alone, they may not be worthy of any considerable degree of credit, but when viewed in conjunction with other symptoms, they will undoubtedly assist his diagnosis.

346. We come now to consider the "Particular Circumstances" of the patient under examination. His age, for obvious reasons, is a fact of importance. By learning the nature of his occupation, we shall be enabled to form some judgment with respect to the causes that may have excited his disease. The posture in which some persons are accustomed to sit is a frequent source of affections of the stomach and bowels. Literary people and clerks, from bending to the desk or table, are frequently thus affected. Tailors and shoemakers are notoriously obnoxious to serious obstructions from such a cause: by the position in which these artisans pass a considerable portion of the day, the margin of their ribs is pressed upwards so as to force the stomach against the diaphragm, and to impede the passage through the pylorus. It is equally essential to inquire into the former habits and customs of the patient; we thus become acquainted with his dietetic irregularities, the degree of exercise to which he has been accustomed, and with various other circumstances which may have contributed to produce the disease under which he labours.

Nor ought we to overlook the mental condition of the patient; for while one class of persons are suffering from the anxious and intemperate exercise of the mind, another class become the victims of an ever wearying indolence and a blighting ennui. It is perhaps difficult to say from which of these two cardinal evils the greatest portion of mischief arises; whether the machine suffer most from excessive friction or from rust. Persons, whose minds are wholly unoccupied, especially after active employment, are led to exaggerate every sensation, and to watch and criticise each action of the body, as if life were nothing more than a wearisome reiteration of the animal functions; give a man, under such circumstances, occupation, and you will cure him; idleness has been "the head and source of his distemper," and would you charm away the dusky gnome by which he is possessed, you must treat him, as the enchanter Michael Scott treated his demon, by finding him constant employment. If he has resided in a warm climate, we shall be led to suspect the existence of hepatic affection. The "Occasional Questions" which I have introduced, as necessary for the examination of females and children, are too obvious in their importance to require any further comment.

With respect to the value of "General Observations" upon the physical character of the individual, I have only to state, that those accustomed to medical physiognomy will derive much information from such an inspection; although the evidence is of such a nature that it cannot well be described: it is to be learnt only by experience. There is, however, an important fact, in connection with the colour of the skin, which deserves some notice, as it has given origin to a very general and fallacious opinion. The sallow and subdued yellow aspect of the dyspeptic has almost universally been placed to the account of bile, morbidly afloat in the circulation. This is not the fact, the appearance to which I allude arises from a degenerated state of the serum of the blood.