METEOROLOGICAL JOURNAL. By Messrs. WILLIAM HARRIS and Co. 50, Holborn, London. The quantity of rain fallen in September, is 2 inches and 11-100ths. We request our readers to correct an error in a calculation of the relative mortality from parturition and its express consequences, which appeared in the 256th page of this volume. That calculation was made from partial statistical accounts, and chiefly from Hospital records in different parts of Europe. On a more full and correct enquiry, we find it to be in the proportion of about one in one hundred. According to the Bills of Mortality, the proportion in London for the last year was one in 109; and this has been nearly the average proportion during the last twenty or thirty years. Read, also, page 237, 6 lines from the bottom, perceptible for forcible. Medical and Physical Journal. 6 OF VOL. XLII.] DECEMBER, 1819. [NO. 250. 66 "For many fortunate discoveries in medicine, and for the detection of numerous errors, the world is indebted to the rapid circulation of Monthly Journals; "and there never existed any work to which the Faculty in EUROPE and "AMERICA were under deeper obligations than to the Medical and Physical "Journal of London, now forming a long, but an invaluable, series." RUSH. Original Communications. FOR THE LONDON MEDICAL AND PHYSICAL JOURNAL. On the Use and Abuse of Purgatives. By Dr. KINGLAKE, THE HE use of purgative remedies is most extensive in alleviat ing and curing diseases of various descriptions. There is, perhaps, no function in the animal economy of so much importance to life and health as the regular and uninterrupted office of the intestinal canal: any considerable deviation from the healthy action of the bowels must necessarily be productive of injurious effects. The first passages, as they are phrased, comprising the stomach and the whole alimentary tube, may be said to constitute the grand outwork of the animal frame: on the integrity, therefore, of this radical part of the system, will mainly depend the more or less perfect state of the general health. The diseases to which the stomach and bowels are liable, are various in nature, in form, and in degree; and all of them are of sufficient importance to demand early and efficient attention. Diseases of the inflammatory kind occurring in the first passages require immediate and adequate relief, to obviate the direct danger of life with which they are inseparably attended. Inflammatory affections of these parts must be speedily overcome, or there will be imminent risk of their running into the gangrenous state, with an insidious rapidity that would preclude the possibility of relief. Diseases of this species may be regarded of the acute kind, and are liable to occur in any temperament, but more particularly in the sanguineous, the robust, and intemperate. The urgent distress attending these cases allows of no delay in resorting to some mode of remedy; it will therefore, in general, be as promptly rendered as required, and the desired relief will most likely be obtained. On these occasions bleeding is the principal remedy: it should be freely employed, both generally and toNO. 250. 3 L pically. After the hardness and compass of arterial action have been sufficiently reduced by general bleeding, if inflammatory pain and tension should remain in any part of the first passages, more blood should be freely and perseveringly taken, either by cupping or leeching, from the abdominal surface, as near to the part affected as may be convenient. Topical bleeding at the advanced and unyielding periods of visceral inflammation, promises to be more effectual in overcoming the disease, than topical stimulus in the way of counter-irritation. Indeed, it would appear, from considerable experience, though perhaps not sufficient fully to warrant its invariable adoption, that cold, topically applied over the region of the visceral cavities, in inflammatory affections of their contents, would prove more directly and lastingly remedial than either vesication, pustulation, rubefacience, or any other mode of inducing increased vascular action on the cutaneous surface. In these cases, a saturated solution of either tartrite of potass or sulphate of magnesia, in oat-gruel or barley-water, and taken to the extent of freely evacuating the bowels, will be found the best purgative remedy, as it will procure all the discharge that may be wanting, with the least possible stimulus; which, in stomachic and intestinal inflammation, is the desideratum. If it should not be speedily operative, a similar solution may be injected clysterwise; and the patient's support during the active and perilous stage of the malady, should be exclusively confined to toasted bread and water, barley-water, and oat-gruel. An objection, it may be presumed, may be here fairly taken against the usual preposterous mode of endeavouring to move the bowels by a large variety of purgative medicines; the united stimulus of which is surely contra-indicated by the existing inflammation, and cannot be employed without occasioning a serious aggravation of disease. Aloes, jalap, scammony, calo. mel, &c. may be justly regarded as too stimulating on these occasions; and should in every instance be superseded by a so lution of neutral salts, rendered bland by a suitable addition of castor oil or manna. Drastic purgatives are noxious stimulants in inflammatory affections of the alimentary canal; and are, generally speaking, perhaps more likely to induce spasmodic and insuperable constriction, than a soluble state of the first passages. A disordered action of the stomach and bowels may be truly said to lie at the root of the greatest portion of chronic diseases incident to human nature. The digestive, chylifacient, nutrient, and transmitting, functions of the alimentary canal, are of the most vital importance, and cannot be impaired without incurring much ailment, and not suspended without an inevitable destruction of life. As transmitting organs, the office of the intestines is indispensably necessary to both health and life. Their digestive and nutrient functions are equally requisite for the support and continuance of existence. The investigation that should clearly ascertain the share which a disordered state of the digestive organs had in producing most of the chronic, and many of the acute, affections arising in the animal economy, would be of inestimable practical worth; as it would directly point to the chief cause of occurring diseases, instead of allowing of conjectures concerning them, that often prove to be seriously erroneous. Misapprehensions of the nature of disease are deplorable practical evils, as they at once preclude the possi bility of affording relief, and may greatly exasperate the exist ing difficulty. Diseases of the first passages, whether founded in inflammatory action, in deficient tone, in disturbed habit, in vitiated irritability, in distempered sensibility, faulty secretions, or in either excessive or insufficient evacuations, are objects requiring the nicest discrimination, and the most precise adaptation of appropriate treatment. To say that a morbid state of these organs, however circumstanced, requires a free use of purgative medicines, would be to authorize the abuse into which this mode of remedy not infrequently falls. Due attention to the history of diseases in which the stomach and bowels sooner or later become prominently affected, will show that, in by far the greater number of instances, the origin, the progress, and eventual establishment, of the disease, were principally, if not solely, referable to a disordered state of these organs. Febrile affections, whether from general or particular causes, very commonly either derive their origin, or owe their long continuance and obstinacy, to an unnatural condition of the first passages. It is enough that these important parts should imperfectly execute the several offices with which they are respectively connected, not only to induce positive disease. in their own immediate sphere of action, but to awaken morbid sympathies in any or all the other vital organs. Palpitation at the heart, oppressed respiration, head-ach, pains in the ligamentous and tendinous structure, and also in the muscular fibre, disposing to spasmodic irregularity of action, are among the direct sympathetic effects of a morbid state of the stomach and bowels. Indeed, every action of both life and health is so intimately allied to an undisturbed condition of the first passages, that most of the internal, as well as external, ailments that present, may be justly said to be more or less influenced by their existing state. The most untractable diseases in surgery, whether tumors, ulcers, or even osseous enlargements and incurvations, have often the cause of their unyielding inveteracy lurking in a morbid derangement of the digestive organs; and can only be remedied by correcting the faulty state of these parts. The salivary, the gastric, the biliary, the enteric, and pan creatic, secretions, are indispensable agents in the healthy process of digestion. These are very apt to be vitiated when the secerning actions by which they are generated, are, by any course, rendered unnatural. Any considerable deviation from the natural state of either of these fluids, would unfit it for the decomposing and re-arranging uses to which they are severally destined in the animal chemistry of nature. If the gastric juice is not the precise product intended, it is an offensive fluid: the same may be said of the bile, and other ingredients in the process of digestion. The disordered action producing these degenerated fluids, likewise awakens visceral and other sympathies over the frame, so as greatly to disorder the general health, and to preclude the possibility of its being restored until the natural actions and secretions of the disordered parts be reinstated. This very generally is to be effected by purgative medicine, conducted so as to reach the salutary object, and not to go beyond it. The chief indication to be regarded in the use of purgative medicines, is to excite the peristaltic power of the intestines sufficiently at once to secure a due transmitting action on the contents of the intestinal canal, and a healthful course of alvine secretions. When these salutary objects have been obtained,when the digestive, the assimilative, nutrient, and evacuant, functions of the first passages have been established, there can be no further occasion for subjecting these parts to the influence of cathartic medicine. The morbid condition and effects of constipation, torpor, and noxious sympathies, must be overcome, before a restoration of the healthy state either of the digestive organs or of the system at large, can be produced. Continued excitement, for the several purposes of inducing additional determination of the circulating fluids, increased action, and improved energy, on the alvine viscera, is often required in affections of the first passages. These various effects do not admit of being at once accomplished. The endeavour for realizing them must be therefore pursued with a perseverance commensurate with the difficulty and importance of the object to be obtained. The necessary distinction to be kept in view, in the use of purgative medicine in diseases more particularly of the digestive organs, is, that the prevailing debility, either of the system at large or of the first passages, is more effectually overcome by cathartic excitement than by tonic influence. The stimulus of purgative action at once energizes the languid and torpid state of vital power on these occasions, and induces actions and discharges that directly conduce to invigorate and amend the weakened and discased state of the parts subjected to such ex |