LIVE R. 



ffian from the adminiftration of an equally aflive dole of 

 the fulpiiate of magncfia, or other faline laxatives, dilFolvcd 

 in a proper quantity of water. Three dr^ms of this fait in 

 half a pint of fluid, as in the Scidlitz water prepared by 

 N. Paul and Co., may be taken every morninjr, or every 

 other morning, accoidiiig to the llrcni^th and Hate of bowels 

 of the patient. The regularity, temperance, and cxcrcife, 

 and likewife the abfence of the anxieties of bufinefs, which 

 contribute materially to alTift the beneficial influence of thofe 

 ■waters, when drunk at tlie fprings, flnonld, however, be 

 conjoined with the employment of thefe fubllitutes at 

 home. 



In the chronic derangements of the liver, producing a di- 

 jniiiirtied fccretion of bile, and particularly when fuch affec- 

 tions have avifen from inflammation, niercury has been found 

 one of the moll effeftual remedies. It is only, however, in 

 the chrnnic ftate of inflammation that this remedy is ad- 

 miniftcred with advantage. But tlie facccfs of it, in thefe 

 cafes, has led perhaps to an empirical practice, of exhibiting 

 it without fufijcient difcrimination between inflammations of 

 a more indolent, and thofe of a more active nature, on the 

 one hand, and between inflammation and the tuberculated 

 Hate, &c. on the other. But, as Dr. Saunders remarks, to 

 exhibit a medicine without due difcrimination, is to abufe it, 

 and at length to bring it into contempt and negleifl. And 

 this fate may perhaps await the ufe of mercury in complaints 

 of the liver, if, by a blind empirical adminiftration of it, it 

 be incautioufly employed in the aflivt pei'iods of inflammation, 

 when, from its ftimulant properties, it appears better calcu- 

 lated to accelerate than to retard the fuppurative procefs. 

 But upon this point we have enlarged, when treating of the 

 cure of Hepatitis; and (hall now only repeat, that it is 

 in the chronic ftate of inflammation alone, that the exhibi- 

 tion of mercury can be reforted to with benefit ; for it now 

 afts as a fpur upon the vafcular fyfl;em of the liver, and, 

 by its moderately ftimulating efiefts, occafions at length a 

 (degree of aftion, by which the bile is properly elaborated, 

 and health gradually refl;ored. 



That a great variety of complaints, both loeal and gene- 

 ral, which have been comprehended under the terms nervous, 

 hypochondriacal, bilious difeafcs, &c. originate from dimi- 

 Tiifhed fccretion of bile, which, under fuch diminution in 

 quantity, is alfo hable to be vitiated in quahty, prailitioners 

 are again coming to admit. By obfervmg phyficians of all 

 times, indeed, this general faft had been noticed ; and upon 

 it, a principal part of the ancient humoral pathology, which 

 afcribed thofe difeafcs to tlie prevalence of tilt: and t/aci htle, 

 was founded. We cannot now, with all the additional lights 

 afforded by a better cultivation of anatomy, phyfiology, and 

 the collateral fciences, lay down a perfeft theory of the fub- 

 ieft. A learned and ingenious phyfician to Guy's Hofpi- 

 tal has long invelligated the point, and has long been pledged 

 to lay the refult of his praftical inquiries before the public. 

 They have not, however, yet appeared. But from the 

 pubUcation of a fmall pamphlet, as the precurfor of his 

 volume, it would appear that he has fatisfied himfelf, both 

 with refpedl; to certain means of praftical difcrimination, and 

 as to the mode of operation of the mercurial remedies. It 

 would feem, from this pamphlet, that the author confiders 

 mofl: of thefe difeafes as dependent on a conftrifted or 

 obftrufted fl;ate of the hepatic dufts, and mercury, admi- 

 tiiftered in fmall dofes, and in its milder forms, as poflefring 

 the property of " emulging'' the duft?, efpecially when ir- 

 ritation about the parts is foothed by opiates : in other words, 

 that thefe mercurials are, in the llrift fenfe ot the word, 

 'tholago^ues. After having dcfcribed the cafe of a dthcate 

 female, affected wjth great irreguiarity of bowels, termi- 



nating in dvfentevy, and accompanied with paVncfs, languor, 

 dejedtion of fpirits, lofs of appetite, quick fmall pu!fe, &c. 

 which had been rather augmented than relieved, by repeated 

 dofes of calomel and rluilwrb, alternated with opiates, and 

 which yielded to fmall dofes of the fnhila hydrargyrL pre- 

 ceded by an opiate, and followed by a dofc of cailor-oil ;— 

 he thus ftates his view of the difeafe, and of the mctiiis opt- 

 rnnrll of thefe remedies. " The deprefled aftion of the braia 

 which anxiety occafions, produced a correfponding defcft of 

 aftion in the liver ; whence the intefljncs, from not being fup- 

 plied with bile in fufficicnt quantity, or healthy in quality, 

 became irritated by the food paflTing through them in an un^ 

 digefled ftate. The purgatives, aftringents and opiates, 

 which were firft employed, gave temporary rchcf, but left 

 \.\vi fource of the diforder as it was ; whilft thccahmiel, sitt- 

 ing merely as a fimple evacuant, carried off nothing but ths 

 exifting contents of the inteftines, and ftill farther weakened 

 tiieir tone. But, by allaying intcftinal irritation by opium, 

 then relaxing the liepatie dufts by the ^/7. hytirargyn, ?nd 

 laftly, emulging them by the aid of a mild cathartic, tile 

 order of nature was rcftorcd, and that harmony of ftinftion 

 between thefe parts, which is ntceflary to healtii, complete- 

 ly eftablifticd." (See An Examin.^tion of the J'rejudices 

 commonly entertained againft Mercun', &c. by .lames 

 Curry, M.I)., &c. 2d edit. p. 20, note. Lord. iSlC.) 

 This explanation of the alleviation of the difeafe is fuffi- 

 ciently plaufible ; it is, however, but an hypothefis ; for tlie 

 previous conJlriBion, the fubfequent relaxation, and the ulti- 

 mate cmKi^/nj- of the biliary dufts, are incapable of demon-, 

 ftration ; neither is the firft afl'umcd circumftance adequate 

 to explain the altered quality of the bile, nor the two latter 

 its changes to the healthy ftfte. It is fufficient, however, if 

 it be piaftically afcertained, that this mode of mercurials, 

 preceded or combined with anodynes, and followed by gentle 

 cathartics, is an efficient mode of treatment in thefe cafes of 

 diminiflied or vitiated fecretion of bile. 



In thofe cafes of difeafed liver, which have been fome- 

 times denominated fchirrous, when, either from previous 

 acute inflammation, or from frequent accelerated fccretion 

 of bile, during along refidence in a warm climate, the vcf- 

 fels of the liver have poured out, into tlie parenchjmatous 

 fubftance, fo much coagulable lympli, as to render it firm and 

 indurated, — then it is often neceflary to pufli the ufc of mer- 

 cury farther, fo as to produce a gentle falivation, which, 

 when kept up for a length of time, often effefts a cure, by 

 promoting abforption. In the exhibition of mercury for 

 this purpofe, a preference has been given to its introduilion 

 by friftion on the ll<iu, through the cutaneous abforbents ; 

 and the part oh which the mercurial ointm.ent has been 

 rubbed is the right hypochonilnum, from a notion of its cS- 

 cacy being greater when applied to the vicinity of the 

 difeafed organ. But it is pretty obvious, that, except in 

 fo far as friftion mav ferve the purpofe of gentle cxcrcife to 

 the part, and thus aifTift in emulging the biliary dufts, there 

 is no material advantage derived from this ; and that it is of 

 little importance what part is made choice of, provided the 

 effefts produced on the' general fyftem be equally itrcng. 

 The knowledge derived from anatomy rcfpefting the ftruc- 

 ture, origin, and direftion of the abforbent veffels, fiiffi- 

 ciently proves that, whether ufed internally, or intrwduced 

 by external friftion, none of the mercury can be made to 

 pafs through the liver in its way into the conftitutlon : it 

 cannot, therefore, aft on the liver, but by being firft intro- 

 duced into the blood-veffels. Such parts of the body as have 

 the fineit cuticle, as in the infide of the thighs, between the 

 fingers, in the groin, &c. which afford the befl ahforbing 

 furface, ftiould be chofen for the purpofe of the friftion. 



Go 



