PHYSIOLOGICAL ACTIONS OF DRUGS ON THE SECRETION OF BILE. 167 
Result of Experiments with Gamboge.—It is a powerful hydrocathartic, but 
is not a hepatic stimulant. It is extremely interesting to contrast the negative 
effect on the liver of this hydrocathartic with the positive effect of colchicum, 
also a hydrocathartic. In both there was violent irritation of the mucous 
membrane of the duodenum and small intestine generally. And it is important 
to observe that in the case of gamboge this irritation gave rise to no increased 
action of the liver, showing that duodenal irritation is not of necessity followed 
by hepatic excitement. 
ACTION OF AMMONIUM CHLORIDE. 
According to GARROD (Op. viii. p. 51), chloride of ammonium is “ by some 
considered a cholagogue.” The most valuable evidence which we have regarding 
the action of this substance is that furnished by Dr Stewart of Brecon (Op. ix. 
p. 316). The large experience in the treatment of hepatic affections acquired by 
Dr Stewart in India has led him to regard ammonium chloride as an invaluable 
agent in the treatment of active hepatic congestion, chronic hepatitis, and in 
“torpor of the liver,” associated with congestion of the organ and lithemia. 
Many such cases he has seen cured by from ten to twenty grain doses, given twice 
or thrice daily, with attention to diet, rest, and such other general indications. The 
drug produces diuresis, a sensation of warmth beginning in the epigastrium and 
gradually extending over the whole body, diaphoresis, exhilaration of the nervous 
system, and an undoubted effect on the liver, as shown, not only by gradual 
disappearance of the symptoms referable to hepatic congestion, but by other and 
more immediate signs, “ peculiarly and directly referable to the liver and related 
parts.” Thus, within five minutes or half an hour after a dose of the salt, the 
patient may experience one or more “shocks” as of “something giving way,” 
or a “ pricking” or “ gnawing” sensation in the hepatic region. In addition to 
these, a full dose increases intestinal peristalsis, ‘‘as evidenced by the twisting 
and other movements experienced in the situation of the duodenum, or all over 
the abdomen, and which, at times, are more sensibly felt in the situation of the 
umbilicus, er in the inguinal region. The abdominal muscles may also be 
thrown into tonic contractions, which are perceptible at times to both sight and 
touch. ‘“Torpor of the liver,” and functional derangements attended by 
lithemia (Murcuison), associated with congestion of the liver, want of sleep, 
and depression of spirits, are benefited in a remarkable manner by a course of 
ammonium chloride, with careful attention to diet and regimen. In such cases, 
he has known a few twenty-grain doses of the salt ‘‘remove symptoms of dis- 
ordered liver, restore sleep, and revive the drooping spirits, after the failure of 
other remedies.” Dr Stewart, however, nowhere says that he ever observed 
any cholagogue effect of this remedy. 
