fore to state, that in general these are the most curable cases, and arise from causes more manageable and accidental.

As

"Without any discolouration of the skin, the liver may be very much impaired both in function and structure, and dropsy take place in consequence: in proof of this I could adduce some very interesting cases, which have come under my observation, were it not digressing too much from the object before me. far as one fact can tend to corroborate an opinion, this which I have now mentioned is conclusive, there being no apparent fault in the stomach, but entire loss of appetite, from the total absence of bile.

"That it proceeds from this, and not from any sympathy between the stomach and the liver, is certain, because the obstruction to the passage of the bile by a gall-stone, without any disease in the liver itself, produces a similar effect.

"It is fortunate for the support of my opinion, that what I now advance is not confined to my own personal experience; and I appeal to every one who reads and practices for the confirmation of what I say if, therefore, it be true that the absence of bile does impair the digestion, the converse of the proposition is most likely to be true also.

"When a person in maintaining an opinion, draws an inference from something which once happened, but which can no longer be repeated, the ground of his arguments may very fairly be called in question.

"Instead of attempting to inveigle the approbation of the reader in this manner, I recommend him to examine the truth and accuracy of my assertions by a comparison with his own experience; and having asserted the absence of bile to be the great cause of indigestion, I submit the following proposition to the same test of examination, that bile in the stomach is a very powerful stimulus to hunger.

"I suspect this paragragh will strike the reader as very heterodoxical, and he may perhaps exclaim, How can this be true? do we not often meet with cases, where people have every appearance of being bilious, in which loss of appetite, nausea, and vomiting, are the predominant symptoms? and is not the tongue white, and covered with a kind of whitish crust? In addition to these, does it not often happen, that large quantities of bile are thrown off from the stomach, to the immediate and effectual relief of the patient ?

"These are very reasonable interrogatories, and such as I feel it incumbent on me to explain, if I expect to gain proselytes to my opinions. I begin with the first question, by considering what are the symptoms, from which we are led to say a patient is bilious. "They are these: a sallow complexion, yellowness in the white of the eye, and a little tinge of the same colour around the temples; great languor and lassitude, a disrelish of animal food, and

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a partiality for vegetables of the acescent kind, drowsiness, giddiness, and a white tongue.

"Some or more of these are generally found to accompany the loss of appetite, nausea, &c. already alluded to. Now all these symptoms I most decidedly affirm, originate, not from the presence of bile in the stomach, but from its absence, and from its retention in the circulation. This I think cannot reasonably be doubted by any person who will take the trouble to reflect upon the subject; and of those who do doubt, it will be found that their practice is in opposition to their opinions, for it is agreed, that the most effectual means of relieving these are vomiting and purging. We give calomel to emulge, as it is often expressed, the biliary ducts; what is the effect of this, but to encourage the discharge of bile from the liver into the duodenum? But the symptom which most frequently gives rise to erroneous conclusions relative to this point, is the appearance of the tongue.

"A white tongue. When a person is attacked with fever, the surface of the tongue very frequently exhibits a morbid appearance, in some being white, in those of the more malignant kind, or towards the decline of the disease, brown, and sometimes black; hence many are disposed to consider this change as an indication of fever; and so prevalent is the notion among the public in general, that when you ask to see the tongue, the answer frequently is, I have no fever.

"But this state of the tongue is merely accidental; it is by no means essential to fever, since it is very often found where fever does not attend; and frequently in the most severe attacks of that disease, the tongue exhibits no discolouration at all.

"I know a person who has for several years been engaged in a large white lead manufactory; his appetite has long been imperfect, attended with constipation of the bowels, and his tongue continually covered with a complete whitish incrustation, but without either fever or thirst. This varia.ion in the appearance of the tongue may be easily explained, for as fever may attack a person under different states of the system, it is that state of the system, and not the fever itself, on which the appearance of the tongue will depend.

"But the error to which I now make an allusion is this, that when the tongue is white, the patient is supposed to have bile in the stomach; this I have repeatedly witnessed, and have seen calomel, rhubarb, jalap, &c. often recommended with the professed intention of carrying the bile out of the stomach; andI avail myself of this point to convey the distinction between my own sentiments, and that which I believe to be the general one. I say, that in this case, the whiteness of the tongue proceeds from the deficiency of bile in the primæ viæ,

"The facts which I shall presently adduce will bear me out in

this

this declaration, and therefore I proceed to explain what certainly seems to be the most plausible objection to the doctrine, that large quantities of bile are thrown off from the stomach, to the immediate and effectual relief of the patient."

As these opinions of our author are in a great degree peculiar to him, and, if well founded, of great practical importance, we have given his own statement of them, that there may be no misrepresentation. The last objection, the plausibility of which he admits, receives a very full and ingenious answer, supported by facts and cases, for which we must refer our readers to the work itself.

When Dr. R. has established his new opinions on what we think a very fair basis, he proceeds to draw practical inferences from them. When the bile becomes deficient, he reminds practitioners of what has long been known and employed; the substitution of artificial bile or else that of other animals. As bile is an animal soap which has been analysed, all the constituent parts except the bitter principle are understood. The origin and formation of this principle in an animal secretion, when the animal never tastes any thing bitter, will probably always remain among those mysterious processes, by which animals and vegetables are found to create substances which their own bodies or nourishment never were found to contain, The following extract from Van Swieten's Commentaries, appears very apposite to this subject.

"The bile and phlegm are of so opposite a nature, that they can never predominate together, bile being the greatest detergent, dissolvent, and attenuant of all pituitous matter. If the bile be hindered from flowing into the duodenum, and by this means be thrown back into the blood, it dissolves it to such a degree, that after a long jaundice there usually follows a dropsy. Whenever this viscid, pituitous matter is accumulated, the bile is either deficient in quantity, or it is too inactive. Nothing, therefore, seems more proper in this case, than to supply the defect of the bile, either by giving the bile of some other animal, or by the use of bitter plants, such as wormwood, centaury, &c. The former seems the most natural method, and for this reason the bile of the most voracious animals that use no manducation, nor have several of the other aids of digestion, has been chosen principally for this purpose, as in these a sharper bile than ordinary seems to have supplied the want of the other. Thus the gall of a jack, that devours fishes whole, and of eels, has been much commended for this purpose.

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Zoographer's observe, that the fiercest animals have the most acrid bile, and for this reason, the apothecaries keep in their shops the gall of bulls inspissated; and perhaps that most costly porcupine stone, called perdro del porco, may owe its virtue, as well as its original, to bile."

Here then theory and practice correspond, and a wide field is open for the physiologist and experimentalist, which, if properJy cultivated, promises to be productive of the best effects.

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Dr. R. having finished his discussion of the uses and importance of the bile, in regulating the appetite and promoting digestion, he adopts the common opinion respecting the pancreas, and proceeds to the signs of a weak stomach. These he treats of in considerable detail; the first of them is a florid countenance; and he takes care to distinguish, by their proper signs, the florid hues of rural health from the morbid efflorescence which indicates the feeble state of the stomach; and very properly distinguishes between that appearance which is the effect of hard drinking, and that which accompanies the most perfect temperance. In the treatment of this state of the stomach, Dr. R. suggests some cautions which we think important.

"Great circumspection is necessary in the management of those who have the complexion now described; their peculiarities with respect to diet ought to be carefully enquired into; for even a draught of cold water to such persons would at times prove a poison.

"Wine, especially port, generally turns acid: all eruptions in such persons, however trifling, are critical and constitutional, and should never be repelled.

"Bleeding, under any circumstances, in these habits cannot be resorted to without danger: even medicines of moderate activity, must be given in very small doses. The neutral salts, unless combined with warm carminatives, disagree, producing spasms, and severe griping. I know some persons, for whom ten grains of magnesia is a sufficient dose to procure three or four stools, and this is found frequently to answer the purpose of an aperient better than any other.

"This may be owing to the acidity of the stomach, with which such patients are frequently troubled; and' indeed it appears to me that the foundation of the complaint is the want of a proper se: cretion of bile into that organ.

"I know a lady who was recommended to take half a drachm of rhubarb, which was made into eight pills; by mistaking the directions, she fortunately only took one, and this operated briskly; so that in this, as in other similar cases, an ordinary dose of medicine would be a dangerous remedy; the warm tinctures, those of hubarb, senna, and aloes agree best; oily medicines are in general very obnoxious, and the common neutral salts too cold; they produce great oppression at the stomach, violent sickness, fainting, and spasms. Nothing is more common than to hear these patients declare, they thought they should have died from taking them.

The next indication of a weak stomach, is the " inability to continue long without food." Those who labour under this infirmity are advised to dine early, and not to suffer that inward sinking, or sick head-ache, to continue or supervene by long fasting. He considers nervous head-achs and hypochondriasis as indications of a weak state of the stomach; oppression, and heaviness after dinner, and flatulence, which being very often constitutional, admit of

only

only temporary relief. He enumerates some other signs of this infirmity, which seems more equivocal, such as the following three. "1. A sense of langour and lassitude suddenly coming on the

lower limbs.

"2. A frequent desire to make water, especially on any slight agitation of mind, and the evacuation of pellucid urine without smell.

"3. In women, large full breasts, or rather breasts surrounded with a very large proportion of fat, denote the same thing.

"4. The use of spirituous liquors, even in small quantities, proving highly prejudicial."

He thinks that mothers who suckle too long, frequently induce these disorders of the stomach.

"This is an error that ought to be corrected, for when the practice of suckling is continued much beyond the powers of the system, it brings on a train of incurable evils.

"What that change is which is thus produced it is exceedingly difficult to define; suffice it to say, it is such as no future amendment of the health will remove. Spasms of the stomach, flatulencies, epilepsies, and particularly the sick nervous head-ach, are thus engendered in the habit.

"If she feel a great and unusual sinking inwardly, sighs very often, looks pale and hollow-eyed, with a dark circle under the eye-lids; if she have giddiness and vertigo, with occasionally temporary loss of sight, a little short dry cough, a slight oppressive pain about the chest, then there can be no question, either that she has suckled too long, or is disqualified for discharging the dụties of a nurse.

"Nervous head-achs in men, comparatively, but rarely occur; they are alike indications of a weak stomach, and return periodically; go off spontaneously after continuing six or eight hours, and leave some weeks interval of perfect ease. These intervals of ease are the strongest marks of distinction between this and headachs arising from other causes

"There is scarcely a point in practice that requires nicer discrimination, than the different species of head-ach; they often assume appearances very similar to nervous affections, when they originate, not from debility, but plethora.

In the former instance, they very generally arise from the stomach, and are to be relieved through the medium of that organ; in the latter, the deranged functions of the stomach are attributable to the alteration in the head."

Dr. R. then subjoins a number of ju licious and valuable observations respecting the various causes and treatment of the offerent kinds of head achs, which we particularly recommend to the attention of junior practitioners.

On the very frequent and distressing symptom denominated fla tulence, Dr. R. gives the following directions, and reference to a case where bleeding was found an effectual remedy.

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