PATHOLOGY. 
m 
the jaundice to take place. The number and fize of the 
concretions alfo vary much : fometimes the gall-bladder 
is filled with them ; at other times there are not more 
than one or two: fometimes they are fmall and angular; 
at others large, and have a more regular furface. They 
have been fometimes feen nearly of the fize and figure of 
the gall-bladder itfelf, fo as almoft to fill the whole ca¬ 
vity. Thefe large concretions are lefs frequently the 
caufe of jaundice than fmaller ones; for, from their bulk, 
there is but little probability of their entering the dudus 
cy/licus, and afterwards of obftrudling the dudus communis: 
it is from calculi of fmaller dimenfions that fuch obftruc- 
tions generally arife. Cafes are recorded, however, in 
which calculi of immenfe bulk have paffed ; but thofe 
have no doubt obtained their paffage by contracting ad- 
liefion, and producing ulceration into the bowels. It is 
remarkable, that while ftones remain in the gall-bladder 
they are perfedlly harmlefs; and when they are very fmall 
they readily pals with the cyftic bile. The principal in¬ 
convenience, then, arifes upon the accident of their being 
carried from the cyft into the narrow dudls. Biliary 
concretions are very frequently found in the gall-bladder, 
in the d'iffedlions of dead bodies, when no fymptom has 
appeared during the life of the perfon to excite a fufpi- 
cion of their exiftence. 
It is commonly fuppofed that the biliary concretions 
♦ are protruded from the dudts by the contractile power of 
the duffs alone. The truth of this opinion, however. 
Dr. Pemberton has queftioned ; and he maintains, that 
the gall-ftone is propelled by the accumulating bile be¬ 
hind it, which at the lame time pulhes it forward and 
diftends the duct. For, in the firft place, the duff, he af¬ 
firms, is always found contrafled before the gall-ftone; 
whereas, if the concretion were protruded by the con- 
traffile power of the duff, it ought to be contraffed be¬ 
hind it. In the fecond place, opium and blood-letting 
are employed as relaxants and antifpafmodics, and fuc- 
cefsfully : but this relaxation would rather retard than 
expedite the palfage of the calculus, if its protrufion were 
the refult of the contraflile power. This opinion has 
unqueftionably much probability in its favour. 
The ftate of the pulie and the remiffion of pain, the oc¬ 
currence of fhivering after and not anterior to the pain, 
diftinguilh Ifferus from the Phlogotica and their confe- 
quences. 
The ifferodic hue which occurs in Chlorofis is diftin- 
guitiled from the colour of jaundice by the unaltered 
whitenefsof the eye, and the abfence of bile in the fecre- 
tions in the former complaint. 
The treatment of this complaint mull be varied accord¬ 
ing to the exciting caufe of the obftruffion. In Ifferus 
cholceus ourobjeft will ofcourfe be to promote the adtion 
of the liver; for which purpofe, brilk dofes of calomel 
given at night, and worked oft’ in the morning with 
falts, will be necelfary; and, in addition to this, the re¬ 
gulation of diet’and exercile, as noticed under Dyfpepfia, 
mull be attended to; and the mufcular fylfein put into 
moderate and regular adtion. 
In the fecond fpecies, of courfe, no permanent cure 
can take place till the biliary concretions are removed 
from the bile-dudts ; and we know of no agent capable of 
accelerating their palfage. If the notion of Dr. Pember¬ 
ton be true, fuch medicines as relax the dudts may in¬ 
deed be ufeful; and there can be little doubt but that, 
feeing how materially the mufcular adtion aft'edts thefe 
tubes, its prelence may indiredtly aflift the palfage of the 
ftones; but., as to dilfolving them by chemical agents, it 
appears to be a vagary long fince given up by all enlight¬ 
ened pathologilfs; and we believe that we allow to our 
knowledge of the treatment of thefe complaints all the 
praife it deferves, when we ftate, that it embraces nothing 
more than the removal of impediment to the fpontaneous 
operations of the afredted lfrudfure, and the corredfing 
of fympathetic derangements. With this firft view, 
large doft* of opium may be given, and fuch meafure 3 
may be ufed as produce general relaxation, as the warm- 
batlv. The fecond will vary of courfe according to the 
nature of the fympathetic difeafe. If the palfage of the 
(tone excite motions in the vafcular fyftem even in a 
flight degree, we Ihould fubtradl blood freely and fud- 
denly, and endeavour to calm nervous excitement by 
digitalis,&c. If, on the contrary, thefe motions are not 
induced, opium, is unqueftionably the moft powerful re¬ 
medy for abating pain with which we are acquainted : it 
Ihould be given firft in a large dofe, (for inftance two grs.) 
and then fmaller proportions at fuch intervals that a 
regular effedl be procured ; always premifing thdt the 
bowels are kept open and the vafcular lyftem undifturbed. 
The fame general rules are applicable to the third fpe¬ 
cies. We may remark, however, that in this a free courfe 
of purgatives will in moft inftances be required: thefe 
Ihould be of a warm and ftimulating nature. The ex¬ 
treme pain often felt in this fpecies requires, as in the 
former, the exhibition of opium. 
In all cafes, we think fome good will be derived from 
the ufe of medicines which promote free difcharges of 
the hepatic fecretion. Mercury is of courfe ufually pre- 
fcribed; but, when this fails or is inadmiflible, the acids 
internally and externally may be ufed with advantage. 
Indeed the nitric acid had obtained much reputation in 
jaundice, even fo long ago as the time of Baglivi. The 
ufe of alkaline medicines has alfo obtained fome counte¬ 
nance, which can only depend on their corredfing in fome 
degree the morbid ftate of the bile; a ftate which proba¬ 
bly often occafions biliary concretions. 
In that ftate of the liver which produces jaundice to¬ 
wards the end of intermittent fevers, mercury is the bell 
and only remedy; and calomel, in fmall dofes, is the 
form under which, in this and fome other hepatic difeafes, 
it feems to adl moft powerfully. Where fcirrhus of the 
fubftance of the liver, or of the neighbouring organs, ope¬ 
rates mechanically by its prefl’ure upon the duffs, and 
occafions jaundice, it is more likely to prove the fource 
of permanent mifchief than any other caufe, and our 
means of relieving it are lefs eft'eftual. In the true tu¬ 
bercle of the liver, which begins with induration, and 
afterwards pafles on to ulceration, the efficacy of any me¬ 
dicine is very doubtful; even mercurials, when given in 
large quantities, and under any form, have not feemed to 
produce any decided advantage. 
When jaundice arifes from a general congeftion of the 
velfels of the liver, general blood-letting, or, if the cir- 
cumftances of the conftitution and ftrength of the patient 
forbid that, local bleeding by leeches, or cupping-glafles 
after fcarification, or the application of blifters to the 
hypochondrium, will be ufeful, together with the exhi¬ 
bition of purgatives; and if it be admitted, that torpor, 
of the inteftinal canal, and a retention of bile or an accu¬ 
mulation of mucus in the duodenum, can fufficiently 
obftrudt the departure of the bile, and thus occafion 
jaundice, as it feems to do in young children, the em¬ 
ployment of any adtive purgative will be adequate to its 
removal. Calomel and jalap are particularly well fuited 
to this indication. 
Dr. Caleb Miller, of Briftol, (U. S.) has employed with 
confiderable fuccefs the phofphoric acid, internally, for 
the cure of jaundice. He directs a large table-fpoonf ul 
of the acid, prepared according to the diredtions con¬ 
tained in Murray’s Materia Medica, to be added to a 
pint of balm-tea, and the mixture to be taken as fall as 
the ftomach will bear it, till it operates as a diuretic. 
In a very obftinate cafe of jaundice, which was ultimate¬ 
ly cured by this remedy, Dr. Miller ftates, that the pa¬ 
tient took eight pints of the mixture in four-and-twen- 
ty hours. 
Genus II. Melana, [from black.] Black Jaun¬ 
dice. Generic charadters—The colour of the eyes and 
fkin fuliginous, leaden, or livid ; black vifcid dejedtions, 
with occafional vomitings of the fame ; anxiety ; deprel- 
fion of fpirits. 
The 
