PATHOLOGY. 
146 
ployed. We referve, however, further remarks on the 
due regulation of the bowels till we come to the next 
genus. 
The functional derangement of the liver occurring as a 
confequence of dyfpepfia, requires the particular treat¬ 
ment of the former complaints to be conjoined with that 
of the latter difeafe. The medicine bell calculated to 
promote the fecretion of bile is mercury. The different 
preparations of this mineral may be ufed according to the 
peculiar conftitution of the patient. The moft common 
are Abernethy’s blue pill, Plummer’s pill, and calomel. 
The firft of thefe, given in dofes of four or five grains 
every fecond or third night, as recommended by Mr. 
Abernethy, is particularly ferviceable in thofe cafes 
where the affection of the liver has fupervened early, and 
where, confequently, it is the principal caufe which fup- 
ports and aggravates the dyfpepfia. This pill difagrees 
however with fome conftitutions. We do not allude to 
the tranfient fenfation of pain which is felt in fome fto- 
rnachs for the firft half-hour after its reception ; but the 
more permanent fenfations of the fame kind that are fome- 
times experienced. Calomel is perhaps, after all, the belt 
kind of mercurial for the firft ftage of indigeftion ; and is 
chiefly applicable when irregularity of the fecretion of 
bile is prefent. It alfo deferves notice that calomel ne- 
ceffariJy occafions brifk purging, on which the benefit 
derived from it often greatly depends; fo that, while, by 
its peculiar effedl on the firft paffages, it excites a better 
action of the liver, by its purgative effedl it tends fur¬ 
ther to emulge the gall-du&s, and relieve the diftended 
ftate of the liver. Its operation, then, is moft wanted 
where this diftention is greateft, which may be known, we 
have feen, by the ftate of the right hypochondrium, and 
will be Jeaft injurious where the ftrength is moft able to 
bear fo confiderable a call upon it. When there is little 
diftention of the liver, and the ftrength is much reduced, 
the operation of the blue pill, provided it agrees tolera¬ 
bly well with the ftomach, is preferable. The relief ob¬ 
tained from it may be lefs fpeedy, but it will be obtained 
at lefs expenfe to the conftitution. Inftances frequently 
occur of the bad effedts of not attending to this difting- 
tion. What is only a falutary evacuation in one cafe, 
is an overpowering caufe of debility in another. 
Plummer’s pill often fits well on the ftomach when both 
of the former preparations of mercury fail. The propor¬ 
tion of antimony in its compofition tends to caufe its in¬ 
fluence to be exerted on the Ikin as well as on the liver; 
and hence in the cure of cutaneous affections it is held 
in merited eftimation. 
As the effedl of mercury is only required to be tran¬ 
fient in the firft ftage of dyfpepfia, whatever form of the 
mercurial remedy we employ fliould be carried off by an 
aperient, either given with it or at a proper interval after¬ 
wards. Of thefe alternatives, we fliould (with the excep¬ 
tion of peculiar cafes) incline to the latter; for it can¬ 
not be queftioned, that much larger dofes are required to 
promote the hepatic fecretion when combined with the 
dry purgatives, as colocynth, aloes, &c. and we have feen 
cafes where it failed entirely to produce fuch effedl. In 
the milder form of difeafe we are now fpeaking of, a 
draught of falts and fenna, taken in the morning after a 
mercurial pill the over night, will we think be found the 
leaft painful or debilitating in its operation. When mer¬ 
cury occafions much irritation of the bowels, its conti¬ 
nued ule brings on a degree of dyfentery. The patient 
is tormented with griping and tenefmus, and at length 
paffes little befides mucus, often mixed with a fmall 
quantity of blood. In fuch cafes, we mull difcontinue 
its ufe for a fliort time ; and when we find, as fometimes 
happens in fuch cafes, that on returning to it the fame 
fymptoms conftantly recur, and cannot be prevented by 
changing the preparation, or the ufe of anodynes and 
mucilages, it muff be entirely laid afide. 
Given under the above regulations, mercury is a very 
excellent remedy for the hepatic derangements of indi¬ 
geftion. Its indifcriminate ufe undoubtedly does much 
harm ; and there can be little doubt that various kinds 
of “ antibilious pills” (as they are foolilhly called), which 
are daily vended in great quantities, do upon the whole 
more harm than good. Indeed this muft always be the 
cafe with patent medicines ; no medicine can be energe¬ 
tic, unlefs it has the property of inducing derangement 
of fome part; and therefore, if the production of a de¬ 
rangement from the natural ftate be not properly di¬ 
rected, much mifchief muft enfue. The indifcriminate 
ufe of mercury in gaftric complaints has called forth thefe 
remarks j and we with particularly to repeat to our me¬ 
dical brethren a faCl well eftablilhed by the teftimony of 
the bell authors; that mercury Ihould hold no place in 
the treatment of Ample indigeftion, while the fecretion 
of bile is unchanged; and that, when that change has 
occurred, its cure Ihould be effeCled by the leaft pofllble 
quantity of this potent mineral. As mercury fometimes ir¬ 
ritates the fyftem at a rate not balanced by its beneficial 
influence, it becomes neceffary to fearch for a fubftitute 
which may be employed inilead of it. The combination 
of the nitric and muriatic acids, taken internally or ufed 
externally, as Dr. Scott firft recommended, has appeared 
to us the moft fuccefsful. See Nitro-Muriatic Acid, 
vol. xvii. p. 104. 
With refpedl to the more diftant affedlions arifing from 
dyfpepfia, we have before Ihown, that, numerous as they 
are, they are for the moft part the products of nervous ir¬ 
ritation ; hence depletion has little effect on them. 
When they are of that violent and uncontinued charafter 
which we have called, after Dr. Hall, the Mimofis urgens, 
antifpafmodics, as mulk, valerian, ether, emetics, &c. are 
the remedies indicated in addition to the ufual dyfpeptic 
treatment. The fame remark applies to the fpafrnodic 
dyfpncea,palpitatio cordis,&c. When more permanent ef¬ 
fedts feem induced,counter-irritantsareofelfentialfervice. 
The affections of the head which occur in indigeftion 
require more particular notice. We fliould be par¬ 
ticularly careful to keep the circulation rather below 
than above the ufual llandard in cerebral affedlions, be- 
caufe of the formidable difpofition to inflammation which 
they frequently and fuddenly affurne. On this account, 
when the pulfe does not forbid it, and the cerebral is not 
relieved by the excitement of fecretion in the gaftric 
ftrudture, topical bleeding is the moft advifable ftep. 
This fliould be followed by the fliower-bath, an agent at 
once exciting the Ikin and depleting the cranial circula¬ 
tion. This pradtice is ufeful in the ftate of erethifm which 
we before noticed as defcribed by Dr. Nicholl. That 
author recommends the ufe of the pulv. ipecac, comp, 
but a fpecimen of the difeafe we lately faw feemed in- 
creafed in violence after each exhibition of the above me¬ 
dicine. On the whole, topical bleeding, a cooled ftate of 
the external part of the head, the abllradlion of ftrong 
light and of all irritating irnprellions from without, tole¬ 
rably free purging, and the ufe of diuretics, are the beft 
modes of treatment. In all head-affedtions, free dif- 
charges from the inteftines and bladder are ftrongly re¬ 
quired. In the head-ache of the firft ftage, emetics give 
temporary relief; but particular care is required to note 
the diagnoftics, as ftupor, or throbbing of the temples, 
w’hich tend to fliow eftablilhed difeafe in the head. When 
tills occurs, or indeed when inflammation is-sfet up in any 
ftrudture, the ufual treatment of the phlogoticiK null be 
combined with that in queltion. 
The connexion between the functions of the Ikin and 
alimentary canal has been often adverted to. The former 
ftrudture affords an excellent mean for relieving the dif- 
orders of the latter. Thus the medicated bath recom¬ 
mended by Scott is a more powerful agent in improving 
the fecretion of the ftomach, liver, and bowels, than the 
internal ufe of the acid. But the chief meafure adting on 
the fkin is the bath. Cold bathing is an old remedy in 
indigeftion. It is feldom fafe, however, in nervous or 
debilitated lubjedls. Where its ufe can be borne, a fliort 
plunge 
