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to excite mercurial action, should be carefully kept in view.-If the patient is particularly robust, and of a sanguineous constitution, mercurial action cannot be brought on, until the system is reduced to that level, which permits that action to take place-on the other hand, if the system is low, and the natural constitution of the patient feeble, whilst the hepatic inflammation is going on, a coincidence by no means unfrequent, means of raising it to the level, permitting mercurial action, must be employed whilst the administration of mercury is proceeding. In the first case copious and reiterated bleeding in the second, the cold infusion of cinchona, and simple though nourishing food, are the means I have found most productive of the desired effect. --Sometimes ptyalism comes on rapidly and unexpectedly, and becomes troublesome-scarcely ever dangerous. The means of checking it, are the warm bath, opium, occasionally purging, and the use of a gargle, composed of a decoction of dry fig3, with nitre, in the proportion of two drachms to a pint-sulphur and the sulphuret of potash have been seldom useful." 69.
Chronic Hepatitis is generally the result of the acute form neglected or improperly treated. In the East Indies, however, and in Europe, this form of the disease generally creeps on without any acute symptoms having preceded. A common, but by no means pathognomonic symptom, is a sense of oppression, fulness, and bulk in the right hypochondrium, accompanied by an obscure, obtuse pain, only occasionally evident to the feelings of the patient-especially after strong drink, suppressed perspiration, falls or other external injuries, full meals, violent exercise, &c.
“ The following circumstances, however, appear more conclusive, viz. pain felt in the right, on lying on the left side; difficult respiration, or a sudden, quick expiration, following an attempt to inspire deeply; and an exacerbation of all the symptoms at a particular time of the day. The third seems peculiar to chronic hepatitis, and therefore more worthy of our attention, when the other less distinguishing symptoms are also present. The exacerbation takes place, generally, about four o'clock in the afternoon of every day, and continues one, two, or more hours. It is marked by aggravation of the other symptoms, and the presence of considerable heat and quickness of pulse, neither of which are at any other time perceived. But difficult respiration, or the quick and sudden expiration following an attempt to inspire deeply, when a fulness and obtuse pain are felt in the right hypochondrium, I consider as the most pathognomonic of all those symptoms ascribed to acute and chronic hepatitis.” 71.
Icteritious colour of the skin and eyes is certainly more peculiar to chronic than acute hepatitis. With this colour there is generally torpor of the bowels, and clay-coloured motions.
“ In chronic hepatitis, I may further observe, that there is generally a circunscribed solid substance felt, inclining or suspended, as it may be described, from the right to the left side, on attempting to lie on the latter. It is described by the patient as an unconnected mass, which seems to roll from side to side, according to the position he places himself in;—if bending forward, which is, indeed, the easiest posture in this disease, it seems to press against the parietes of the abdomen ;-if towards the left, it inclines that way, and gives considerable pain of that kind, which we may conceive a heavy weight suspended from the right side may give, and is well defined by the expression dragging pain ;-if backwards, it rests on the spine, and occasions instantaneous acute pain, with tendency to syncope.” 72.
The nature of this disease renders it an insidious and dangerous complaint; and thousands perish under its influence, who might probably be saved by timely interference. The following is our author's methodus medendi in chronic hepatitis.
“ In the treatment of chronic hepatitis, the two principal objects must be, 1st, to remove any inflammation that may be present in the liver; and 2nd, to rouse it to the natural and due performance of its functions. The first is obtained by moderate, general, or partial bleeding and purging; and the second, by exciting a gentle mercurial ptyalism, and giving tone to the secreting vessels, by the use, at the same time, of mild tonics, combined with the nitric acid, and interposing every second or third day, a plentiful discharge from the bowels. To excite the degree of ptyalism required, if the bowels are torpid, their usual state in the disease, from two to five grains, or even more of calomel, may be given only thrice in the day; or if diarrhæa is brought on, opium may be added. But in this open state of the bowels, it may be better to introduce the mercury by friction. For this purpose, a drachm of the strongest mercurial ointment should be well rubbed in on the inside of the thigh every night, or oftener, according to the excitability of the patient, until a gentle ptyalism is established.--The following draught should also be taken thrice in the day-R. infus. gentian.—colomb. āă Zvi, tir cinchon. comp. zi, acid. nitrici
, gtt. viij. ad gtt. xij. If there is evident tumour in the right side, a seton should be introduced over it. When the bowels are torpid, during this course, the following powder and draught should be given every second or third day, or seldomer, according to circumstances : B. submur. hydrarg. gr. ij. ad. v. pulv. rhei. gr. x. m ft. pulvis horâ somni sumendus—R. infus. sennæ žiss. magnes. sulph. zi. tinct. sennæ-card. comp. āā Zi. m. ft. haustus primo mane post pulverein sumendus.—This mode of treatment I have uniformly found successful, when the disease admitted of cure, that is, if instituted before the supervention of abscess. But, indeed, in very many instances, if the tumour is the result of abscess, it gradually disappears, through the increased action of the absorbents, brought about by this course; or, as happened in a few
pus passes off by the common biliary duct into the duodenum, and thence is discharged by stool.-- If, however, the tumour increases, and the abscess proceeds to maturity, without the possibility of arresting it by any internal means, and points outwardly, with evident adhesion to the integuments, then an opening must be made, and the matter discharged.” 74.
In the eastern hemisphere and in Europe, a slower introduction of the mercury than is above directed, is generally sufficient; but, it is absolutely necessary to keep the mouth sore till the symptoms are entirely dissipated, else the patient is left in a worse state than before. In chronic organic diseases of the liver in this country-which are often of a tuberculous or scrofulous nature, mercury, and indeed all other medicines are of little avail. Gentle aperients-local abstractions of blood-counter-irritation, and taraxacum with the mineral acids, are the principal remedies.
The remainder of the volume before us is chiefly occupied with a class of diseases as common (or more so) in this country as between the Tropics. We shall therefore reserve it for separate consideration in the succeeding number of this Review. Our European readers, we are persuaded, will have been gratified and improved by what we have extracted from the first half of the volume—they will find in our next article matter of high import, which it will behove them to study well. Our tropical brethren, more especially those in, or proceeding to, the West Indies, may rest assured that this is one of the most valuable publications that ever issued from the press on the diseases and medical topography of the western hemisphere. They will not, therefore, fail to place it in their libraries. To the vencrable, zealous, and able author himself, we offer the tribute of unfeigned gratitude, respect, and esteem. He has wound up a long and active life by bequeathing to posterity a legacy that will render that life as useful to others hereafter, as it has been honorable to himself in times past. He has had his “youth of labour," and it is but right that he should now have his "age of ease.” He spent the hey-day of health amid the burning savannahs of Western India. He has now but
“ To husband out life's taper at its close,
“ And keep the flame from wasting by repose,” amid those peaceful valleys and alpine solitudes that formed the cradle of a Rousseau and the retreat of a Gibbon.
A Treatise on Diseases of the Nervous System. Part the
First: comprising Convulsive and Maniacal Affections.
(First Analytical Article.)
Can we wonder that this, which is the most numerous class, should gladly avail themselves of such analytical portraits as concentrate the pith or marrow of the subject, and thus lead to the direct application of principles at the bed-side of sickness? We have long had the most authentic means of knowing that, were it not for these analytical portraits, nine-tenths of our best productions would never travel beyond the circle of a few book-worms, or their information be diffused to any distance beyond the publisher's groaning shelves.
These reflections have been excited by a conviction that the valuable volume before us will never circulate, in propria persona, to one-tenth the distance it ought to go—while the regret is heightened by a consciousness that all our exertions, in delineating its qualities or concentrating its information, must be very inadequate to the object in view. It will be readily enough imagined that, under these circumstances, we shall adbere, with more than usual rigour, to our fundamental principle of confining our analytical labours to the most useful and practical parts of a volume embracing a
great proportion of ingenious physiological and even metaphysical reasoning and inquiry.
It is proper to state, in limine, that our author has held, during the last ten years, the appointment of physician to an Institution where a great proportion of the complaints belonged to that class of maladies which are the subject of this treatise. Here a variety of phenomena have presented themselves, from time to time, to his notice, which appeared to throw light on some pathological enquiry, or to suggest some practical indication. With the hope of contributing his mite to the general stock of knowledge, respecting an interesting but obscure class of diseases, our author has modestly submitted this volume to the public, and we are convinced that, in so doing, Dr. Prichard has materially added to the edifice of his former reputation.
Our author observes in his preface, what indeed several others have lately observed, that facts which have fallen under his notice induce bim to suspect that disorders of the nervous system are, in the majority of cases, secondary and sympathetic affections-often at least symptoms of some latent disease in another part of the constitution-particularly in those organs which are subservient to the natural functions. This observation led our author into the attempt to discriminate these affections into certain classes, according to the nature of the primary diseases, of which they are symptoms or indications. The arrangement which our author has adopted certainly appears very complicated, and will doubtless be objected to by fastidious critics and indolent readers; but we think he has offered substantial reasons for his plan, which appears to place the facts and analogies on which his conclusions are founded, in the clearest point of vicw.
The first chapter of the work, containing a "physiological survey of the functions of the nervous system,” intermixed with a considerable proportion of metaphysical observations and speculations, we must pass over in a very rapid manner. We may first remark, en passant, that Dr. Prichard, while he views the brain and nervous system as the instrument of sensation, perception, memory, and many other intellectual operations, yet considers some of the higher faculties-judging or reasoning for example, as appertain. ing to mind, soul, immaterial principle, or whatever other designation we may apply to that mysterious essence. He justly observes that there is no analogy between remembering and judging-between the operations of a faculty which only recalls the impressions produced by external objects, and of one which is conversant with abstract relations, the