148 PATHOLOGY. 
gifli than another, we Should endeavour to excite it by 
purgatives which aft fomewhat exclusively on it ; as, for 
inftance, rather more rhubarb mult be administered when 
the duodenum feems inaftive.&c. The number of mo¬ 
tions mud be fomewhat regulated by the Strength, &c. 
but three in the courfe of the day will feldom be too many. 
We have noticed, that, when the firft Stage of indigef- 
tion has continued for Some time, the funftion of the 
liver becomes disordered. A greater or lei's tendency to 
diforder in this organ, alter it once appears, always con¬ 
tinues throughout the difeafe, l'o that it is a condant 
attendant on the Second Stage; and tiiofe medicines which 
influence the Secretion of this organ, therefore, always 
form part of its treatment. Of thefewe Still find mercury 
by far the moSt efficacious. Several circumstances, how¬ 
ever, render caution, in the ufe of this medicine, even 
more neceSTary in the Second than in the firll Stage. Not 
only has the greater continuance of the difeafe occasioned 
a greater lofs of Strength ; but its increafe, and the change 
which has taken place in its nature, renders it neceSTary 
to employ this medicine for a longer time, and often in 
a way that more direftly influences the State of the con¬ 
stitution. 
In the firft Stage, as we have Seen, we want only the 
transient efFefts of this medicine on the liver. On the 
other hand, we now want to induce a more permanent 
change in the difeafed State of that vifcus,.and rather to 
reltore the altered properties of its Secreting vefl'els than 
Simply to increaSe their aftion for the fake of removing 
plethora. It has been lately recommended, with this 
view, to give mercury in very-minute and fomewhat-fre- 
quentdofes. Dr. Philip Says that he has “generally given 
a grain of the blue pill, Sometimes only half a grain, 
twice or three times.in twenty-four hours, till the l'ecre- 
tion of bile appeared to be healthy, repeating thefe dofes 
when it was again dilordered ; and by fuch dofes, which 
may appear to many little better than trifling, I have Seen 
the bile gradually reftored to a healthy Slate, when larger 
dofes had been employed in vain. They not only often 
Succeed where larger dofes fail, but the change, in pro¬ 
portion as it takes place more Slowly, feems generally to 
be more permanent.” We may add, that, in the Second 
Stage of indigestion, violent aftion of the abdominal vif- 
cera Strongly tends to deftroy their tone; and this forms 
another reafon againSt employing large dofes.of mercury, 
Since, by their aftion on the Secreting Surfaces, they pro¬ 
mote Sudden,anft debilitating evacuations; an effect very 
unfavourable in the weak Hate of the constitution which 
attends this Stage! 
By the above praftice we avoid the occasional ill eft'efts 
of mercury in a great degree, though Some practitioners 
of diftinftion conceive it to be fomewhat inert. Our own 
experience, however, is in favour of it ; and in Dr. Hall’s 
writings cafes are mentioned in which the like diminutive 
dofes of this medicine produced favourable refults. 
Much latitude will be allowed, however, in the ufe of 
mercury, Since the difference of climate or of constitution 
renders a dofe in Some cafes too-powerful, in others per- 
feftly nugatory. There can be no doubt, for inftance, 
that in hot climates a much larger proportion may be 
given of this medicine than in temperate ; and the various 
degrees of fufeeptibiiity to its aftion, which different in¬ 
dividuals exhibit, are equally well known and unaccount¬ 
able. 
When mercury disagrees with the bowels, conium, hy- 
ofieiamus, or extract, papaveris, maybe conjoined with it; 
or we may have recourse to the nitro-muriatic-acid bath 
as a Substitute. The latter remedy is indeed Sometimes 
of uSe during the intervals of ufing mercury; but it too 
often happens that the cathartic tendency of the mer¬ 
cury is increafed by the acid. The bath muSt not be 
ufed during the inflammatory State of the Stomach, but 
may be very advantageoufly preferibed when local blood¬ 
letting has been premifed. The degree of aftion which 
the nitro-muriatic-acid has to exert on the constitution is 
regulated by the Strength of the health, and by the extent 
of the cutaneous Surface immerfed, a hand ora foot being 
firft bathed ; and, if its eifefts are borne well, by degrees 
the reft of the body up to the chin. See vol. xvii. p. 106. 
Dr. Philip has recommended dandelion to be tiled as a 
Substitute for mercury in dyfpepfia. He fays that “ it ap¬ 
pears to poSfefs greater powers in this difeafe than are 
ufually aferibed to it, but it requires to be taken in very 
large dofes. It is belt adapted to thofe cafes, in which 
the bile is deficient or much disordered, while the power 
of the Stomach is Still considerable. In Such cafes, I have 
Seen the patient reftored by a Strong decoftion of dande¬ 
lion ufed for common drink, without the aid of any 
other medicine. In addition to its effeft on the liver, it 
tends to cool, and consequently allay the inflammatory 
diathefis, and often excites both the bowels and kidneys. 
The latter effeft, which is belt counteracted by alum, 
when the Stomach bears it well, is frequently fuch as to 
make it neceSTary to discontinue the dandelion. The 
former is feldom considerable, and can always be restrained. 
It is often given with great advantage in aid of the fmall 
dofes of mercury when the Stomach bears it well, and 
enables us further to diminish the quantity of this medi¬ 
cine.” 
The functional derangements which occur as remote 
confequences of dyfpeplia, are to be cured only by remo¬ 
ving the original difeafe. The topical inflammations re¬ 
quire additional remedies; for we have before noticed 
that, when of long Standing, they often aft as counter-ir¬ 
ritants to the gaftric disturbance. The liver, lungs, Spleen, 
and heart, are molt liable to this affeftion ; and are all to 
be treated on thefe principles ; viz. to withdraw nervous 
irritation by counter-Stimulation, to bleed locally or ge¬ 
nerally according to the frequency and hardnefs of the 
pulfe, and procure Secretions from the abdominal vifeera, 
and from the Skin, by the warm bath. 
The Same rules apply to the treatment of the head- 
affeftions. Here the Sympathy between the external and 
internal parts allows the additional ufe of cold lotions to 
diminish the aftion of the velTels of the head : a Simple 
meafure, but one of great efficacy. The ereft polture, or at 
lead a near approach to it, Should likewise be infilled on ; 
and a more aftive kind of purging than in the derange¬ 
ments of the abdominal vifeera. The erethifmal State of 
the brain Should be treated with continued counter-irrita¬ 
tion, and with much alfiduity; Since, when once it has 
apoplexy, this latter calamity is generally fatal, and ap¬ 
pears uninfluenced by bleeding or any other known means 
of relief. 
In the gouty and rheumatic affeftions of this Stage of 
indigeftion, in addition to the ufual means, the Colchi- 
cura is by no means a defpicable remedy. Indeed, where 
this drug agrees, it Seems to reduce both the arthritic 
and the gaftric inflammation at the Same time. The ufe 
oS an anodyne liniment likewife affords temporary relief 
to the rheumatic pains. 
When the inflamed Slate of the mucous membrane has 
been communicated to the bowels, and piles, Strifture, 
or tendernefs along the courfe of the ccecum, are prefent, 
the molt efficient method of relief is anal leeching. This 
praftice has not obtained in our country the attention it 
deferves, though the great benefit our continental neigh¬ 
bours derive from it, Should have taught us its common 
ufe long ere this time. We find Some prejudice oppofed 
to it; but, if properly condufted, it is by no means un- 
pleafant or indelicate. The leeches may be applied to the 
fundament by means of a glafs formed like an eye-glafs, 
but of larger dimenfions ; and, after they have laid hold, 
the patient Should fit over a bidet, and by the warm va¬ 
pour or by ablution promote the difeharge of blood. We 
have found this method more fuccefsful than even leech¬ 
ing over the epigaftrium, where tendernefs of the part is 
prefent; and it has this further advantage, that, from the 
nature of the Sanguineous distribution, it direftly depletes 
the whole abdominal vifeera. 
Pain 
