piness, and for days together they have been sensible of a degree of an agreeable intoxication. There are other symptoms, though less obscure, perhaps, in their origin, that are often connected with the chronic affection of the liver. The blood cannot pass through it with the facility necessary to health, nor is it possible to relieve it effectually from such a state, but by giving solubility to the bilious matter. It then passes off abundantly through the proper channels into the duodenum. If, from obstruction or enlargement, the blood be prevented from circulating with ease in the liver, a general disorder of the whole frame becomes apparent. The feet and ankles swell, and a fulness in the head comes on, with head-ache and giddiness, and a train of unhappy feelings. In this country it is a common practice to have recourse to the abstraction of blood by cupping, or by the laucet, in order to alleviate such symptoms. The first effect of this practice is, no doubt, occasionally to give relief to the head; but this is only temporary. An equal quantity of blood is again accumulated; a repetition of blood-letting is required; the state of weakness continues to increase; and the patient falls a victim at last to an injurious practice, derived from a theory altogether erroneous. not by letting off a part of the blood that we can do any good; for it is neither too abundant in quantity, nor bad in quality. The fulness of the head, as well as of the feet, does really arise from the remora to the blood in another portion of its circuit; and in both extremities of the body it is produced by one and the same cause. It is I need hardly say that melancholy and despondency of mind are often connected with a peculiar state of the bile, for this has been observed in all ages. This state of mind I have often seen removed by a proper use of nitro-muriatic bath; and people of both sexes have assured me, that they think it had preserved them from the crime of suicide, to which, during the horrors of their feelings, they had an alarming tendency. That state of the bile already mentioned, in which it seems to be deficient in quantity, and probably at the same time unhealthy in its nature, is very common. Of all hepatic affections, I think this attended with the most pain and distress of the bowels. This disorder of the biliary system frequently gives rise to a flux, which I have known to go on for many months, and even for years. I have generally seen a deficiency of bile without a tendency to flux, and often even accompanied by a constipated state of the prima viæ. Such a condition of the liver and bile does frequently give rise to most uneasy derangements of the stomach; a tendency to acidity or heartburn; little ucerations over the surface of the mouth and oesophagus, and perhaps extending downwards through the whole track of the intestinal canal. This aphthous disease is very distressing and dangerous, though I have been very successful in curing it by the nitro-muriatic acid. I know of no other remedy for this affection of the stomach and intestines, as the common means of cure seem to me to be very far from sufficient. I may say with truth, that in such a condition of the liver and bile, all remedies that stimulate or excite the circulation are inju rious. Among such I may reckon wine, spirits, bark, bitters, and steel. With such agents opium has been classed; but many of its effects are peculiar to itself, and a proper application of it in such complaints is often of the utmost importance and utility. In almost every state and stage of diseased liver, opium may be given to many with benefit. Even in acute hepatitis it answers a salutary purpose when combined with calomel, or with the quicksilver pill: for, unlike what occurs in other inflammatory affections, it seems in those of the liver to be unattended by almost any ill effect. In chronic hepatitis, it alone is able to calm the irritability and unhappy feelings, and to allow time for the application of the means of cure, It seems, indeed, by its sedative power, to have a beneficial influence on the liver, and perhaps to do something more than produce a temporary calm. Opium, however, should never be given in chronic hepatitis, without great attention to its effect in diminishing the propulsive motions of the primæ viæ. I have been accustomed to give an opiate at bed-time, together with some laxative substance, such as the sulphate of magnesia, to correct its constipating effect. It is proper to observe, that bilious people, and especially those who have been subject to intermittents, after finding the utmost relief from mercury, or the nitro-muriatic acid, and at the moment when we think they are advancing fast towards a perfect recovery, are apt, all at once, to say they are unwell, to lose their appetite, to become a little feverish, and to complain of their head. If these symptoms be neglected, the patient soon gets regular attacks of a quotidian fever, beginning with a cold fit, and followed by the ordinary stages of that disease. Such is the connection which a great flow of bile, however excited, appears to have with fever of the intermittent kind.* Besides this fever, which is of the true intermittent kind, there is very generally a troublesome symptomatic fever, that plagues bilious people. It steals on imperceptibly, and, when once begun, gives rise, with little other inconvenience, to a state of most obstinate sleeplessness. This too may be obviated by an opiate, given before the hour of its accession; but it can be cured only by correcting the cause of it. Opiates, with bilious people, are very apt to occasion * Although I have not seen this fever under a violent form, yet it is depressive and inconvenient. It is easily stopped by the Peruvian bark, taken daily in decoction, before the hour of the fit, and repeated at the same time for a few succeeding days. A common wine glass full of it, every two hours, and repeated for three or four times before the fever is expected, I have always found to be sufficient for curing it. With some people, I judge it prudent to give the bark decoction during the whole of the time they use the acid. It is often very useful to add a few drops of laudanum to each glassful of the bark decoction. No. 226. 3 P great great itching of the skin, by delaying the passage of the bile through the bowels. From a diseased state of the bile, the memory is often affected, and a degree of stupidity, and even of idiotcy, comes on. From this cause, too, the hair at times grows harsh and hard to the feeling; and I have seen it, like the skin, become soft and flexible from the use of the nitro-muriatic acid. In both cases I imagine that the effect arises from the long-suppressed matter of perspiration being abundantly restored. To all these I may add another inconvenient complaint from a bilious state-a frequent desire to pass the urine. Whether this irritation arise from a diseased sensibility of the whole nervous system, or from a morbid alteration in the urinary fluid, I do not know. In all biliary derangements the rule is never to be forgotten, and I repeat it again, that there is no security against a relapse till the health and strength are fully restored; and that, till then, some repetitions of the remedy are necessary. The good effects of the nitro-muriatic practice can never be appreciated until it has been discontinued for several weeks, or rather months. During the use of the bathing or sponging, the pulse is often very quick, and patients grow thinner, even when they feel better. At times, too, they often complain of more than usual uneasiness in the liver, or in the region of it; they often lose their flesh, and look very yellow. The remedy seems to alter and agitate that organ. The flow of bile, when once excited, goes on for a number of days; and not, with some people, without inconvenience. If it do not affect the bowels as a laxative, it is highly necessary at this time to employ some substance that has this power, such as the sulphate of magnesia, senna, or aloes. In time, however, it is commonly found that the health, the strength, and the colour of the skin are much improved. It is no small advantage of this practice, that we can apply the power in as high a degree as the strongest can bear, or in quantities so minute, that the most sensitive and nervous being can hardly be injured by it. I have immersed many to the chin in this bath, and I have been afraid, in other cases, to wet more than a single hand with the acid. The length of time, too, that the acid remains in contact with the skin may be infinitely varied. We have thus a power extremely divisible, and applicable to almost every degree of resistance or sensibility. When the acid produces very considerable effects, it is right, after a few days, to stop its use for a week or two; as, if used long, it gives rise to unnecessary uneasiness from bilious discharges or bilious feelings. I have said that drinking the pitro-muriatic acid has the very same effects with its external use, When taken in this way, it should be very much diluted with water. Indeed it should taste but very slightly acid, and be drank in small portions at a time. I need hardly say, that it is very necessary to take care that, even in this weak state, it be not allowed to touch the teeth. The mouth should be immediately washed after swallowing it, and every precaution precaution employed that is used with the mineral acids, to prevent injury from its external action. This way of using the nitromuriatic acid is often very convenient and salutary, and in many cases may deserve a preference to any other. I think it is particu larly applicable to some states of indigestion, and when we wish to produce effects gradually and insensibly. [Some inquiries follow concerning the modus operandi, of which, however, Dr. Scott candidly confesses his total ignorance; but, that the power depends on the chlorine, as Sir H. Davy terms it, he has no doubt. This is further explained in a supplementary note.] P. S. Since I wrote the preceding paper, several of my friends have become convinced with me, that the very same effects arise from a diluted solution of chlorine in water, as are produced by the nitro-muriatic acid. Our late experience puts an end to all doubt, if any could have existed, that chlorine alone is the source of the material effects. We have sponged the skin with a solution of chlorine in water, and in many cases, have obtained the same results as arise from a similar application of the nitro-muriatic acid. The solution of chlorine to which I allude, is water through which the oximuriatic acid gas has been made to pass, until it could retain no more of it. This mode of applying chlorine has the advantage of not irritating the most sensible skins so much as the diluted nitro-muriatic acid might do; but even this solution I have diluted with about four times its bulk of water, before I applied it. It is remarkable that the aqueous solution of chlorine, procured by mixing the acids together, is far less offensive than its solution got by the common means of passing the gas through water. Some degree of affinity seems in the first case still to subsist between it and the other elements of the acids, by which its sensible qualities are diminished to a certain extent. We are under great obligation to Sir Humphry Davy, for the light he has lately thrown on this subject, by which the effects of the aqua regia of the chemists are clearly accounted for. I have of late received from different quarters, and from competent judges, a confirmation of the opinions I had expressed of the effects of chlorine in derangements of the liver, and in syphilitic af fections. As those opinions were derived from experience alone, I cannot but think that a future day will confirm them. I am told that some others have been less successful than myself or my friends with this remedy, and that by the application of chlo rine to the skin, they have been unable to produce a sensible effect of any kind. I can make no reply to such opinions, as I do not know how the trials on which they rest have been conducted; but I must affirm, that I have sooner or later been able to produce very distinct effects in almost every case in which I have employed it. *For Sir H. Davy's Theory of Chlorine, see our Journal, vol. xxxv. p. 111. Time will decide between us, but on one side of the question I need not say, there is a want of right observation. If it be considered that the most active of all the mercurial preparations in use are calomel, (submuriate of mercury,) and corrosive sublimate, (oxymuriate of mercury,) we may ascribe this great activity to the chlorine of the composition. Why the sanative powers of the mercurial preparations were supposed to arise from the metal alone, I cannot conceive. In like manner the chemists for a long time neglected the water that might be mixed with the materials of their experiments, the elements of which water gave rise to effects that misled them in all their reasonings. I am now nearly, I think, in a condition to shew what effects in the system arise from mercury as a metal, and what effects are derived from the other element of the mercurial preparations, whether this metal in them be combined with oxygen or with chlorine. CRITICAL ANALYSIS IN THE DIFFERENT BRANCHES OF PHYSIC, SURGERY, AND MEDICAL PHILOSOPHY. " Surgical Observations; with a Quarterly Report of Cases in Surgery; treated in the Middlesex Hospital, in the Cancer Establishment, and in Private Practice: embracing an Account of the Anatomical and Pathological Researches in the School of Windmill-street. By CHARLES BELL. 8vo. Longman and Co. AFTER such a title, many readers will exclaim, «Quid dignum tanto feret hic promissor hiatu?" The following extract from the Preface will develope the author's design. "The object of this work is to illustrate the principles of surgery by observations made in a public hospital and in a school of anatomy, where every thing is open to inspection, and where, consequently, the statements are made in the presence of many observers. The author does not intend to publish more than three volumes of cases. These he hopes will embrace the whole practice of surgery, and supply a book of reference for the history of surgical diseases, and the minute account of symptoms. "This work was suggested by observing, that published cases contain only what is new and monstrous, and but few examples which may serve to initiate the young surgeon into the business of his profession. But, although the author began to take his cases |