IMPETIGINES. 659 



ing; which, by compressing the whole abdominal viscera, and 

 particularly the full and distended gall-bladder and biliary ves- 

 sels, may contribute, sometimes gently enough, to the dili- 

 tation of the biliary duct. Accordingly vomiting has often been 

 found useful for this purpose ; but at the same time it is possi- 

 ble, that the force exerted in the act of vomiting may be too 

 violent, and therefore gentle vomits ought only to be employed. 

 And either when, by the long continuance of the jaundice, it 

 may be suspected that the size of the concretion then passing 

 is large ; or more especially, when pain attending the disease 

 gives apprehension of inflammation, it may be prudent to avoid 

 vomiting altogether. 



" The ipecacuanha is not with any certainty suited to give a 

 powerful or permanent stimulus to the stomach ; but on this 

 very account, for the mere evacuation of the contents of the 

 stomach, it is the medicine that can be employed with the great- 

 est ease and safety ; and where it is proper to employ a moder- 

 ate vomiting only, as for promoting the passage of a biliary 

 concretion through the biliary ducts, it is the most proper 

 emetic, as its stimulus may be safe, and at the same time more 

 effectual than the other gentle means of exciting vomit- 

 ing. M.M. 



MDCCCXXVI. It has been usual in the jaundice to em- 

 ploy purgatives ; and it is possible that the action of the intes- 

 tines may excite the action of the biliary ducts, and thus favour 

 the expulsion of the biliary concretion ; but this, I think, can- 

 not be of much effect ; and the attempting it by the frequent 

 use of purgatives, may otherwise hurt the patient. For this 

 reason I apprehend, that purgatives can never be proper, ex- 

 cepting when there is a slow and bound belly. 



MDCCCXXVI I. As the relaxation of the skin contributes 

 to relax the whole system, and particularly to relieve the con- 

 striction of subjacent parts ; so, when the jaundice is attended 

 with pain, fomentations of the epigastrium may be of service. 



MDCCCXXVIII. As the solids of the living body are very 

 flexible and yielding ; so it is probable, that biliary concretions 

 would in many cases find the biliary duct readily admit of such 

 dilatation as to render their passage through it easy, were it not 

 that the distention occasions a preternatural spasmodic contrac- 



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