or tendency to inflammation. Bleeding from the arm or hemorrhoidal vessels is, our author observes, "useful in these cases, not only by obviating inflammation, but also by favouring the expulsion of the biliary concretions, as it takes off the erethism of the biliary tubes, and the compression which the turgid blood-vessels necessarily exercise upon them." Emetics and purgatives are contraindicated, when an inflammatory diathesis is present. Two ounces of castor oil improperly administered in hepatic colic, our author asserts, dispatched one of his patients to the shades, with all the symptoms of high abdominal inflammation.

The symptoms and progress of bilious fever are pourtrayed in the commencement of the fifth chapter with great clearness and fidelity. The contents of the second section upon prognosis, we shall, as usual, analyze and exhibit in their most condensed form.

Favourable symptoms: Even pulse; softness of the abdomen; the urine not high-coloured on the onset of the disease, becoming so towards the close; nasal hemorrhage in the early stage; undisturbed respiration.

Unfavourable or fatal symptoms: Excessive or painful vomiting; frequent convulsive agitations, especially if succeeded by drowsiness; vomiting of black matter; dark-coloured urine; respiration laborious, short, interrupted, sighing, stertorous; tension of the abdomen, and sudden softening of it, especially if, at the same time, the patient have not had an evacuation of yellow stools. Deafness, coming on in the commencement, is more inauspicious than in the decline of the disease.

The result of dissections of those who have died from bilious fever is thus delivered by the French pathologist: "The serous membranes are dry, of a reddish hue, as though disposed to inflammation; sometimes thickened or adherent to each other. Thus albuminous adhesions frequently take place between the dura and pia mater, the tunica arachnoidea, and the brain. The pleura unites to the surface of the lungs; the pericardium to the peritoneum;* the omentum to the stomach and in

How could the pericardium and peritoneal membranes adhere in the ordinary structure of the internal organs? We apprehend that it is a typographical error. The passage in the original runs thus: La plèvre (est souvent réunie) avec le poumon, le pericarde avec le peritoine, l'epiploon avec l'estomac et avec les intestins. But we imagine, it should rather be read: La plèvre avec le poumon le pericarde; le peritoine avec l'epiploon, l'estomac, etc.

testines. Between these membranes also, albuminous concretions, or false membranes, are frequently formed."

"The brain, the lungs, the liver, and other parenchymatous viscera, are of a structure more or less compact, sometimes indurated or scirrhus-like; often in a state of suppuration, particularly the liver. Serous effusions take place in the different cavities, which sometimes contain a concrete, whitish; at others, a purulent matter."

"The gall-bladder is frequently filled with black and highlyacrimonious bile, which destroys the colour of certain stuffs, and excoriates the fingers of those who touch it. Morgagni asserts, that animals, and particularly pigeons, have been poisoned by swallowing it. This bile, by its irritating qualities, may produce cholera-morbus, with inflammation, erosion, and even gangrene of the intestinal canal."

"The heart is often compact, and diminished in size. The left ventricle, the aorta, and its branches are empty. On the other hand, much black congealed blood, mixed with albuminous concretions, is accumulated in the right cavities of the heart, in the vena cava, vena portarum, and other large veins."

Many inert and anile remedies are mentioned by M. Portal, in the treatment of bilious fever. Veal and chicken broth, with beet-leaves, lettuce, and sorrel; clarified whey, infusion and syrup of violets; almond emulsion; syrup of water lily and poppy. On the decline of the disease, he purges the bowels with a mixture of tamarinds and cassia-pulp in whey, or with a few drachms of soluble tartar (tartrite of potass) in weak veal broth; observing, with superstitious reverence, the maxim of Hippocrates, Purgantia non opportet donec febris remiserit.

Among the energetic and really valuable remedies, we remark emetics; abstraction of blood from the foot or hemorrhoidal vessels; blisters to the legs; pediluvia, and the tepid bath. Speaking of the latter, our author ob

serves,

"Some of these patients I have left for hours, in an almost cold bath; this practice has been repeated during many successive days with excellent effect, and especially towards night, when there was great restlessness. Patients, whom I have attended in ardent fever with furious delirium, and would drink little, have been kept in the water four, five, or six hours at a time; they were ouly calm then, and recovered without other remedy. In some cases, where there was intense fever, and universal burning heat, I have advised the patient to be plunged, for eight or fifteen minutes, into the cold bath, with signal advantage. But, in general, the luke-warm bath,* long continued, has seemed to suc

* Les bains dégourdis. Baths with the chill just taken off,

ceed better than any other, especially when the functions of the brain were more or less disturbed. This morbid state frequently depends upon congestion of the cerebral blood-vessels, which the 'cold bath would only serve to aggravate."

It

We now come to the sixth chapter on hilious colic. opens with three histories of the disease, borrowed from Valsalva and Bianchi. Dissection shewed in the first, extensive inflammation of the small intestines and serous effusion into the ventricles of the brain; in the second, inflammation and lividity of the intestinal canal with many "black spots" on the peritoneum; in the third, effusion of pus into the peritoneal cavity; sphacelus of the small intestines, especially the ileum, and of the neighbouring parts of the mesentery and mesocolon.

The results of a fourth case from our author's practice, we present with our wonted conciseness to the reader.

Morbid appearances: Duodenum highly inflamed and internally excoriated; the other small intestines of a very red color; the colon affected with inflammation; the stomach marked with blackish gangrenous specks; considerable effusion of reddish fluid into the peritoneal sac; the liver enlarged, red, and indurated; the gall-bladder filled with blackish bile.

Symptoms: Violent pain in the umbilical region, after scanty but severe vomitings of bile, felt principally in a transverse direction, between the stomach and navel, a little to the right and deeply seated; hard but useless ef forts to vomit; afterwards, copious evacuation of bile by the mouth and rectum; accession of fever with daily exacerbations; the abdomen universally painful and tense; the tongue red, and vault of the palate covered with aphthæ; disease terminating fatally on the sixth day. The subject of the case, a stout man, aged 40; attacked during the heats of summer. He had used violent exercise, after eating a large quantity of unwholesome fruit, and indulging unduly in wine and spirits.

We subjoin, for the amusement, would that we might add for the edification, of our readers, the practice employed in this case. Remedies: Weak infusion of chamomile; emollient injections; anodyne julep; injections made purgative with mercurial honey; chicken broth; tepid bath; infusion of lime tree and other antispasmodic plants; orange-flower-water, with Hoffman's anodyne (spiritus ætheris sulphurici compositus) and Sydenham's anodyne drops (a vinous preparation of opium.)

No. 54.

2 U

In his remarks upon the nature and causes of bilious colic, M. Portal draws the line of distinction between this affection and the hepatic colic. The latter has its seat in the internal biliary tubes of the liver, in the gall-bladder, the cystic, hepatic, or common ducts, and is not accom panied by pyrexia. The former seems to affect originally The duodenum, but often extends consecutively to the small intestines and colon; and fever, he adds, for the most part attends it. Yet, with an inexplicable want of consistency, M. Portal asserts shortly afterwards, that "bilious colic is frequently without fever."

Our author attributes the production of bilious colic to the superabundance and acrimony of the hepatic secretion, which thus becomes unduly stimulating to the duodenum and whole intestinal canal. Severe pain in the region of the duodenum; cardialgia; obstinate constipation or exhausting diarrhoea, with tenesmus, nausea, flatulence, vomiting of aliment or bile; convulsion of the trunk and extremities, constitute principally the assemblage of symptoms. The pulse is frequent, unequal, but not hard or strong, as in hepatic inflammation, which hence may be distinguished from bilious colic. When fever is present, flushing in the hands and feet; increased weight and tem perature of the head; giddiness; bitter mouth; are experienced. Hiccough, vomiting of black matter, and syncope, are the usual forerunners of dissolution. The disease is frequent in warm climates, especially during the fruit season. Violent exertion of the mental or corporeal powers; excesses in diet; indulgence in spirituous liquors or highly seasoned food, and the use of bad butter or putrid fish, greatly favour its attacks. Infancy and manhood are more prone to it than advanced age. It affects persons of a bilious temperament, melancholics, and hysteri cal women, more frequently than others.

Bilious colic is evidently considered by our author as a spasm of the intestinal canal, and particularly of its duodenal portion. On this point of doctrine, we cannot en tirely accord with our author; for although the affection, induced by the too stimulating or other morbid properties of the bile upon the alvine tube, be at first purely spasmodic, as we are willing to allow it may be, yet we are persuaded, that it never assumes a severe or a menacing aspect, without the occurrence of inflammation, in a degree more or less decided. The mucous membrane of the duodenum is, we believe, the precise seat of this inflammation; and while it remains confined to these limits, no

tension of the abdomen is manifested. But the inflammatory action diffused to the ileum, the features of iliac passion are developed: again, it may, under some circumstances, pervade the whole track of the intestines, involve their peritoneal covering, and thus extend to the layer of that membrane which lines the abdominal muscles. In this event, tension of the belly, and all the dire phenomena of enteritis, display themselves. Hence, the gangrene, sphacelus, serous or purulent effusions, evident consequences of increased action, which have commonly been shewn by dissection to exist in these cases. Let us turn and observe how completely the observations and histories of M. Portal confirm our reasoning upon this question of pathology.

"Frequently," he writes, "these colics (bilious) have been so inflammatory as to terminate in suppuration or gangrene of the bowels, or abscesses of some part of the abdomen.” Again: "There is often no tension of the abdomen; this serves to distinguish it from a state of inflammation: yet inflammation, nevertheless, sometimes takes place in bilious colic. Then cholera morbus, or the iliac passion, is its frequent consequence."

;

In this view, the cases and dissections which we have noticed in the beginning of this chapter, particularly the fourth from our author's observation, are at once clear and conclusive. The internal excoriation of the duodenum the inflamed state of the other small and large intestines; the gangrenous spots of the stomach, and peritoneal effusion, are phenomena, the origin and order of which, no' oue availing himself of the attendant light of clinical observation, can surely mistake.

The only important remedies which we notice in the section, Treatment, are vomits, to be employed only when there exists no fever, or severe pain and tension of the epigastric region; emollient and anodyne injections; abstraction of blood from the arm or hemorrhoidal vessels. British practitioners would, we presume, in a disease like this, prefer calomel to "magnesia," and blisters and the hot bath to "chicken-broth" and "tamarind-water." Infusion of nut-galls, alum, and cream of tartar, are recommended as prophylactics. There are endless repetitions and much obscurity in this chapter. We rejoice in having reached its close.

Inflammation of the liver and its consequences forms the important subject of the seventh chapter. It occupies almost seventy pages. Nineteen histories of this affection are quoted from various pathologic writings. In all of